Assessment 2: Substance Use During Pregnancy – Nursing Essay (2026)
Unit / Course Context
Course level: Undergraduate Bachelor of Nursing / Midwifery (Year 2–3)
Assessment type: Individual written essay
Indicative course code: NUR2MHW / NUR3MAT / Maternal–Newborn Nursing / Women’s Health and Perinatal Care
Weighting: 30–40% of final grade (typical for major essay)
Due: Week 6–8 of semester (as per local unit outline)
Length: 1,200–1,500-word academic essay (approximately 3–4 pages, excluding title page and references)
Assessment Title
Assessment 2: Substance Use During Pregnancy – Maternal, Fetal and Nursing Practice Considerations
Assessment Description
You will write a 1,200–1,500-word academic essay that critically examines substance use during pregnancy as a complex clinical and public health issue in maternity care. Drawing on current evidence, you will discuss commonly used substances, associated maternal and neonatal outcomes (including Neonatal Abstinence Syndrome / Neonatal Opioid Withdrawal Syndrome), and evidence‑based nursing and midwifery interventions. You will also analyse the ethical, legal and psychosocial dimensions of caring for pregnant people who use substances, with particular attention to non‑judgemental, trauma‑informed, and culturally safe practice.
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
Learning Outcomes Assessed
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- Apply current evidence to explain the impact of licit and illicit substance use on pregnancy, birth, and neonatal outcomes.
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
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- Identify and appraise evidence‑based strategies for screening, brief intervention, referral, and ongoing care for pregnant women/people with substance use disorders.
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
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- Demonstrate understanding of the nurse’s/midwife’s role in interprofessional care, advocacy, and harm reduction in the perinatal period.
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
- Communicate clearly in academic written form, using an appropriate referencing style.
Task Instructions
Write a structured academic essay of 1,200–1,500 words responding to the following task:
Essay Question
“Critically discuss the impact of substance use during pregnancy on maternal and neonatal outcomes, and evaluate the nurse’s/midwife’s role in assessment, intervention, and ongoing support, including the management of Neonatal Abstinence Syndrome (NAS) / Neonatal Opioid Withdrawal Syndrome (NOWS).”
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
Required Content Structure
- Introduction (approximately 150–200 words)
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- Briefly introduce substance use during pregnancy as a clinical and public health concern.
- Identify the main types or categories of substances relevant to perinatal care (e.g. alcohol, tobacco, prescribed opioids, illicit drugs such as heroin, methamphetamine, cocaine).
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
- State a clear thesis and outline the key points you will address.
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- Overview of Substance Use in Pregnancy (approximately 250–350 words)
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- Summarise prevalence patterns and key risk factors for substance use in pregnancy (biological, psychological, social and structural).
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
- Discuss under‑reporting, stigma, and barriers to disclosure and care.
- Briefly note differences between substances (e.g. opioids versus stimulants versus alcohol) in relation to pregnancy.
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- Maternal and Fetal/Neonatal Outcomes (approximately 350–450 words)
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- Describe short‑ and longer‑term maternal outcomes associated with substance use in pregnancy (e.g. preterm labour, placental abruption, poor antenatal attendance, overdose risks).
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
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- Explain fetal and neonatal impacts such as growth restriction, low birth weight, stillbirth, congenital anomalies, and neurodevelopmental consequences where evidence supports these associations.
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
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- Provide a focused explanation of Neonatal Abstinence Syndrome / Neonatal Opioid Withdrawal Syndrome, including pathophysiology, typical signs and symptoms, and implications for length of stay and health service use.
[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)
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- Nursing/Midwifery Assessment and Management (approximately 350–450 words)
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- Discuss approaches to screening and assessment (e.g. history taking, validated screening tools, urine/blood testing, interprofessional collaboration), including ethical and legal considerations.
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
- Outline evidence‑based pregnancy care for people who use substances, for example:
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- Opioid agonist therapy (e.g. methadone, buprenorphine) and its benefits and limitations.
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
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- Non‑pharmacological and pharmacological management of NAS/NOWS.
[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)
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- Harm‑reduction strategies, psychosocial support, and referral pathways.
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
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- Emphasise communication, therapeutic relationship, cultural safety, and trauma‑informed, non‑judgemental care.
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- Ethical, Legal, and Professional Issues (approximately 150–250 words)
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- Critically consider tensions between maternal autonomy, fetal welfare, child protection concerns, and mandatory reporting requirements (jurisdiction‑specific).
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
- Discuss professional responsibilities in advocacy, confidentiality, and collaborative decision‑making.
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- Conclusion (approximately 100–150 words)
- Summarise the key points argued in the essay.
- Restate how effective, evidence‑informed nursing/midwifery care can improve outcomes for mothers, infants, and families.
- Optionally identify a brief implication for practice, policy, or further research.
Formatting and Referencing Requirements
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- Length 1,200–1,500 words (excluding title page, headings, and reference list). Essays significantly under or over the word limit may be penalised according to School/Faculty policy.
- Use 12‑point font, 1.5 or double spacing, and standard margins.
- Use formal academic style in the third person, with clear paragraphing and logical flow.
- Use APA 7th edition referencing (or the style specified in your unit outline) consistently.
- Include at least 8–10 recent, peer‑reviewed sources (2018–2026), alongside credible clinical guidelines where appropriate.
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
- Avoid use of AI‑generated references. Only include sources you have actually accessed.
- Ensure academic integrity: paraphrase appropriately, use quotation marks for direct quotes, and submit through the required similarity checking system.
Marking Rubric (Indicative)
Table 1: Marking Criteria for Substance Use in Pregnancy Essay
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
| Criterion | High Distinction (HD) | Distinction (D) | Credit (C) | Pass (P) | Fail (N) |
|---|---|---|---|---|---|
| 1. Knowledge and understanding of substance use in pregnancy (20%) | Demonstrates comprehensive, accurate, and nuanced understanding of patterns of substance use in pregnancy, including multiple substance types, risk factors, and contextual issues; integrates current epidemiological and guideline evidence throughout. | Demonstrates strong and accurate understanding with minor omissions; draws on current evidence with some integration of guideline sources. | Demonstrates sound understanding, though some aspects are described rather than analysed; evidence used but may not be fully integrated. | Demonstrates basic understanding with limited detail; some inaccuracies or generalisations; limited use of recent evidence. | Shows minimal or inaccurate understanding; key concepts missing or seriously misunderstood; little or no credible evidence. |
| 2. Analysis of maternal and neonatal outcomes, including NAS/NOWS (25%) | Provides clear, critical analysis of maternal and fetal/neonatal outcomes with accurate linking of specific substances to specific outcomes; offers detailed and current discussion of NAS/NOWS pathophysiology, manifestations, and health‑system implications. | Provides well‑developed discussion of outcomes with mostly explicit links between substances and effects; strong explanation of NAS/NOWS with minor gaps. | Describes key outcomes accurately but with limited depth or critical engagement; NAS/NOWS discussed but not fully developed. | Lists some outcomes with limited explanation or unclear linkage; NAS/NOWS mentioned briefly or superficially. | Outcomes largely absent, incorrect, or not linked to substance use; NAS/NOWS omitted or seriously misrepresented. |
| 3. Nursing/midwifery assessment, management and interprofessional care (25%) | Presents a sophisticated, evidence‑based evaluation of screening, assessment, and management strategies, including pharmacological and non‑pharmacological approaches and interprofessional collaboration; clearly articulates the nurse’s/midwife’s role in harm reduction, advocacy, and culturally safe practice. | Provides detailed and well‑supported discussion of assessment and management, with clear articulation of professional roles and mostly explicit links to evidence. | Identifies key strategies and roles with some evidence base; discussion may be more descriptive than critical. | Mentions some assessment and management approaches but in limited detail; few links to evidence or guidelines. | Little or no discussion of assessment or management; nurse’s/midwife’s role unclear or absent; lacks evidence. |
| 4. Ethical, legal and professional considerations (15%) | Critically analyses ethical and legal issues, including autonomy, child protection, stigma, mandatory reporting, and professional codes; demonstrates sophisticated reflection on tensions and implications for practice. | Discusses key ethical and legal issues with clear relevance to practice; some critical reflection evident. | Identifies main ethical and legal issues but analysis is limited or somewhat generalised. | Mentions one or two ethical or legal points with minimal explanation. | Ethical and legal considerations largely absent, superficial, or inaccurate. |
| 5. Academic writing and referencing (15%) | Writing is clear, fluent, and well‑structured with excellent coherence and flow; minimal errors; adheres strictly to word limit; APA 7th (or required style) applied accurately and consistently in‑text and in reference list; uses more than the minimum number of high‑quality recent sources. | Writing is well‑structured and mostly fluent; minor errors that do not impede meaning; referencing is generally accurate with minor inconsistencies. | Writing is understandable with some structural or grammatical issues; referencing shows some errors but sources are traceable. | Writing is frequently unclear or poorly structured; significant referencing errors or insufficient sources. | Writing is very difficult to follow; numerous errors; referencing absent, inaccurate, or suggests academic integrity concerns. |
Sample Answer Excerpt (SEO and AI‑Search Friendly)
Substance use during pregnancy presents a layered challenge for nurses because clinical risks intersect with stigma, trauma, and uneven access to antenatal care. A pregnant person who uses opioids, alcohol, or stimulants may face higher rates of preterm birth, fetal growth restriction, and perinatal mortality, yet many delay or avoid care because they fear judgement or child protection involvement. Clinical guidelines now emphasise harm‑reduction and continuity of care, so opioid agonist therapy with methadone or buprenorphine is often preferred over abrupt detoxification, which can destabilise both maternal health and fetal well‑being. From my perspective at the bedside, consistent, non‑punitive screening, clear information about Neonatal Abstinence Syndrome, and early involvement of social work and addiction services can change the trajectory for both mother and baby. When nurses understand how withdrawal symptoms are assessed and managed, and when they use language that avoids blame, they help families stay engaged with services long enough to benefit from treatment plans that might otherwise remain theoretical.
[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)
Evidence also indicates that simple, relationship‑based measures such as rooming‑in, skin‑to‑skin contact, and breastfeeding where clinically safe may reduce NAS severity and shorten hospital stay, although effects vary between settings and protocols. Policy documents caution that punitive responses can worsen outcomes because they push substance‑using pregnant women away from formal care systems, particularly those who already live with poverty, racism, or previous child removal. A careful reading of recent practice guidelines suggests that nurses and midwives are central to bridging this gap, since they carry out daily assessments, coordinate interprofessional input, and advocate when legal requirements appear to conflict with trust and therapeutic rapport. Students who engage with contemporary case studies and jurisdiction‑specific law can therefore move beyond simplistic narratives about “non‑compliance” and instead describe practical strategies that balance maternal autonomy with fetal and neonatal safety in realistic clinical contexts.
[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)
Proposed Next Assessment / Discussion Post
Assessment 3: Discussion Board – Trauma‑Informed and Non‑Judgemental Care in Perinatal Substance Use
Type: Online discussion post and peer responses
Timing: Week 8–9 (following submission of the essay)
Length: Initial post 300–400 words; two peer responses of 100–150 words each
Prompt: Drawing on your essay and at least two additional recent sources, post a 300–400 word discussion that explains how nurses and midwives can provide trauma‑informed, culturally safe, and non‑judgemental care to pregnant or parenting people who use substances. Include one brief case vignette (real or composite, de‑identified) and describe specific communication strategies, environmental adjustments, and referral options that could support this person and their family. In your two responses to peers, extend the conversation by suggesting at least one additional strategy, policy consideration, or interprofessional collaboration that might strengthen the approach described.
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
Suggested Recent References (APA 7th)
(You can substitute or add local/jurisdictional guidelines as required.)
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- Anbalagan, S., & Mendez, M. D. (2024). Neonatal abstinence syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551498/
[ncbi.nlm.nih](https://www.ncbi.nlm.nih.gov/books/NBK551498/)
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- Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), e547–e561. https://doi.org/10.1542/peds.2013-3524
[digitalcommons.pittstate](https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1060&context=dnp)
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- New York State Department of Health AIDS Institute. (2021). Substance use disorder treatment in pregnant adults. Clinical Guidelines Program. https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/
[hivguidelines](https://www.hivguidelines.org/guideline/substance-use-treatment-pregnancy/)
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- South Australia Health. (2014). Substance use in pregnancy. Government of South Australia. https://www.sahealth.sa.gov.au/…/Substance+use+in+pregnancy_May2014.pdf
[sahealth.sa.gov](https://www.sahealth.sa.gov.au/wps/wcm/connect/fad90e004eede261b572b76a7ac0d6e4/Substance+use+in+pregnancy_May2014.pdf?MOD=AJPERES)
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- Velez, M. L., & Jansson, L. M. (2018). The opioid dependent mother and newborn dyad: Non‑pharmacologic care. Journal of Addiction Medicine, 12(2), 86–92. https://doi.org/10.1097/ADM.0000000000000385