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The name "Sheway" is the Coastal Salish native word for growth. Sheway is a multi-agency, multidisciplinary project for pregnant, substance-using women in Vancouver's downtown eastside. Here, nurses play a unique role in providing services to chemically dependent, socially high-risk pregnant women.
The excessive use of harmful substances such as alcohol and illicit drugs during pregnancy puts mothers and their infants at risk for poor health and social outcomes. Certain environments and conditions such as poverty and social isolation predispose women to alcohol and drug use during their pregnancies.(f.1) One such environment where the risk for alcohol and drug use is extremely high is Vancouver's downtown eastside, a neighbourhood renowned for its poverty, sex and drug trade, crime, violence, substandard housing and, more recently, an AIDS epidemic.
The substance-abusing lifestyle is chaotic, disorganized and dangerous. Pregnant women involved with it tend not to access prenatal care, and have limited resources because of the primacy of their addiction.(f.2) Generally, infants born to this population of women have low birth weights with signs of teratogenic effects, fetal dependence and withdrawal. They also tend to be delivered pre-term.(f.3)
Historically, many women living this lifestyle avoid traditional health care and social services.(f.4) Socially, high-risk, pregnant, substance-using women often fear if they admit that they have substance-use issues, work in the sex trade or have a violent partner, they will be stigmatized or lose their children instead of getting the support they need to overcome these challenges.(f.5) This fear tends to force women substance users into seclusion and away from the much-needed support they require to succeed in their pregnancies.
More health and social service providers are being challenged to provide services and care to this high-risk population of women. Providing care and services to chemically dependent women with complex social histories presents multiple dilemmas and challenges.(f.6) A co-ordinated response among health and social service providers can improve health and social outcomes for chemically dependent women and their children living in high-risk social situations.(f.7) How services are structured and delivered can also affect women's willingness to access services and improve their chances of success.
The beginning
In the early 1990s, data from a report entitled Targeting High Risk Families revealed that approximately one baby out of every two in the downtown...