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.

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