Tuesday, August 28, 2012

Getting information

I have been pondering the question of how do women get the information they want in relation to their maternity decisions.

We have always talked, shared, and explored 'women's business' - in the past over the back fence, or over a cup of tea.  These days it's via social networking, via the iPhone or tablet.  The details of the horrible nausea, or the results of the most recent ultrasound scan, complete with picture, are updated for all one's 'friends' to see, and many check the 'like' button.  Questions are asked at internet forums, and there seems to be no shortage of guides who are willing to assist the inquirer with their tried and true remedies.  Women wanting to get pregnant can download their 'fertility tracker' free!  (How did we get pregnant before we had fertility trackers?)

Today I entered 'nausea and vomiting in pregnancy' in a search engine, and got more than 1.3 million hits.  Take your pick from ginger, vitamin B6, acupuncture, ...
The first site I went to told me that morning sickness is "generally considered to be the result of a combination of elevated oestrogen levels and low blood sugar" [that's news to me!]

So, how does someone get reliable information about a pregnancy issue?  How does one make informed choices?  How should a midwife advise a woman who is experiencing nausea, retching, and vomiting in early pregnancy?

Midwife academics Lisa McKenna and Meredith McIntyre published a literature review on the use of over-the-counter medicines by pregnant women.   The authors reported that ‘preparations used included cold cures, antihistamines, pain killers, herbal teas, antacids and laxatives – all of which are easy to obtain …  and are considered as low risk [of causing any harm to the developing fetus].’ (McKenna and McIntyre 2006, p637)  A Cochrane review by Matthews and colleagues (2010) reported a lack of high-quality evidence to support professional advice on complementary and alternative treatments for nausea and vomiting in early pregnancy.

I have found in practice that many women who seek primary care from a midwife, especially a midwife who attends homebirths, will have established patterns of alternative health care, including self-care, which the woman may not mention unless specific questions are asked.   The scientific paradigm that midwives and many other regulated health professionals follow in understanding evidence may not be accepted or understood by people who follow alternative health care systems.  To complicate matters even more, there are many midwives and doctors who have integrated alternative therapies into allopathic models of care.

In reviewing over the counter medicines for pregnant women, I came across the RANZCOG College Statement  (C-Obs25) on evidence supporting vitamin and mineral supplementation in pregnancy and lactation.  I recommend this statement for those who are seeking reliable information on folate, vitamin B12, B-group vitamins, vitamin D, vitamin K, and minerals such as Iron, Calcium, and Iodine.

Wednesday, August 08, 2012

the death of a baby

I am writing with deep sympathy for the family who lost their baby in late 2010, and for the midwives and doctors who attended the mother.

I am writing about this because the Melbourne Coroner is currently hearing evidence from the various parties.  In time the Coroner's report will be published.  The Coroner's job is to find out what happened, in a respectful and unbiased way.  At present fragments of information have been published in newspapers and online news sites.  Some pieces of the information circulating in the media are factual, while others are contested.

I am writing because this case raises issues that are similar to a case that I wrote about a couple of months ago.

It is difficult for me to write.  I know the midwives; they are my colleagues, and we have shared in professional and personal journeys over the years.  I know the hospital; I have been there with women many times over the years.  I know the mother, who was a member of a peer support group I facilitated a few years ago.

The big issues as I understand this and similar cases are around a midwife's duty of care, a woman's decision-making, and the need for women to be able to feel respected in maternity hospitals.

The questions that I asked in my previous post are still pertinent:
"If a mother does not want to go to hospital, when overwhelming professional advice would want her to give birth in hospital, WHY?", and
"What can be done to make going to hospital a more acceptable choice for women for whom complex obstetric care may become necessary?"

I have many thoughts that I will not make public at present.