Drinking alcohol when pregnant- what are the risks?

Women who drink alcohol and are pregnant at the time are seeking abortions under the misapprehension their babies will suffer foetal alcohol syndrome (FAS).
Drinking alcohol when pregnant- what are the risks?The British Pregnancy Advice Service (BPAS) says there is “no need” for an abortion in such cases, as there is “minimal” damage to babies from isolated episodes of binge drinking by their mothers.

FAS is a rare but serious condition that can cause:

  •     facial deformities
  •     restricted growth
  •     learning and behavioural disorders
  •     a poor memory or short attention span

Statistics for the incidence of the disorder in the UK are not available, but in America, experts say 0.2 to 1.5 cases occur for every 1,000 live births in certain areas of the country.

BPAS says this risk is incredibly small and women should not needlessly fear their behaviour has damaged their baby.

A Danish study in 2012 of more than 1,600 women suggested low-to-moderate drinking was not linked to adverse neurological effects in five-year-olds, but heavy, weekly drinking was associated with a lower attention span in the children.

What are the guidelines for drinking alcohol during pregnancy?

Up until the 1980s, pregnant women were advised to drink stout to boost their iron levels. Official advice today is somewhat different.

Pregnant women should avoid alcohol altogether, says the British government. And if alcohol really must be consumed, it should be limited to the equivalent of one small glass of wine, once or twice a week, it adds.

This advice is mirrored by the Royal College of Obstetricians & Gynaecologists, (RCOG), which says the safest option for women is not to drink at all for the first 12 weeks and then minimal amounts per week after that.

Meanwhile, national guidelines from the National Institute for Health and Care Excellence say women should not drink for the first three months of their pregnancy, to minimise the risk of miscarrying.

And after that, it says pregnant mothers should drink only one to two units a week.

Alcohol can disrupt the baby’s normal development in the womb, its health at birth, susceptibility to illness in infancy, childhood, teenage years and later life, warns the RCOG.
Woman and man drinking Binge drinking during pregnancy tends to have an “all or nothing” effect, says the RCOG

It says the effects of drinking are “most harmful” just before pregnancy, due to the way alcohol hampers fertility, in both men and women – the mechanism of which is largely unknown.

Later in pregnancy, the shared blood supply between the mother and her baby via the placenta means that any alcohol that is consumed could easily reach the baby.

Before this – soon after conception and often prior to the woman finding out she is pregnant – could be a different matter.

There is limited evidence about how alcohol affects the baby before there is a direct line between the mother and baby’s blood supply, which happens about week four of pregnancy, the point at which a woman might be aware of missing her period and suspecting she is pregnant.

Understandably, it is ethically difficult to study. This uncertainty means experts often err on the side of caution when providing advice

The jury is largely out about exactly how much alcohol can be drunk during pregnancy, and when.

New draft guidelines from the government are expected to be released in the middle of next year – until then, the Department of Health suggests anybody concerned they have drunk too much alcohol during pregnancy should contact their doctor.

Warning over shortage of midwives

The Government must address the “serious shortage” of midwives, the Royal College of Midwives said, as an independent report found that numbers of staff are one of the main challenges facing maternity services.Warning over shortage of midwivesLong term vacancy rates for midwives have steadily increased in recent years, the Care Quality Commission (CQC) report found.

Although births in England increased by over 21% between 2001 and 2010, the number of midwives only increased by around 15%, from 18,048 to 20,790.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: “This supports and highlights all we have been saying for many years about the shortage of midwives and the need for serious investment in maternity services.

“A failure to have adequate numbers of midwives leads to mistakes and lower quality care.

“We recognise investment in midwifery training but this will be wasted if the newly qualified midwives cannot find jobs. Once qualified, they need support from experienced midwives whist they consolidate the skills learned during their training. Many of these midwives are those whose jobs are currently under threat.

“This Government must take this issue much more seriously and give it more attention than they are doing. If they do not mothers, babies and their families are the ones who will suffer the consequences of this Government’s failure to ensure that maternity services have the resources to meet the demands facing them.”

The union has launched an online petition Recruit 5000 more NHS midwives in England calling for more midwives in the NHS in England.

The CQC report, which is based on findings from unannounced inspections of 14,000 health and social care providers in England, found that across the board one in 10 institutions were failing to meet staffing standards.

“The non-availability of temporary staff and organisations leaving vacancies open for a number of months – particularly for qualified staff – can lead to compromises in the quality of care given to people, and staff training and supervision,” the CQC said.

From: http://www.independent.co.uk/warning-over-shortage-of-midwives

Morning after pill not effective on most fertile days

The ‘morning after pill’ which was being offered over the phone in a controversial new scheme over the Christmas period is “not effective” when a woman is most fertile, a consultant gynaecologist has warned.Morning after pill not effective on most fertile daysDr Kate Guthrie said Levonelle One Step, the form of emergency contraception being offered by the British Pregnancy Advice Service (bpas), was “not effective” for up to five days around ovulation.

Dr Guthrie, a member of the Faculty of Sexual and Reproductive Health, was concerned that women could take the pill during these days and wrongly think they would avoid pregnancy.

She said: “There’s very clear evidence showing that it’s not effective in the couple of days running up to ovulation, and probably not very effective in the 36 hours afterwards.”

The aim of the bpas scheme is to cut the number of women seeking abortions over the festive season.

The idea is that women will be able to pop the pill on the morning after accidentally having unprotected sex, rather than having to get an appointment, which can be difficult over the Christmas break.

Part of the rationale is, as bpas puts it, “the sooner the morning after pill is taken after unprotected sex, the more effective it is.”

Dr Guthrie, who works in East Yorkshire, agreed with that, saying that Levonelle should always be taken within 72 hours of sex.

However, she was concerned that women would not be sufficiently informed of Levonelle’s limitations.

While she welcomed immediate access to emergency contraception, she said: “You have to know how effective or ineffective it is.”

Guidance from the faculty, published this August, states that Levonelle “has been shown to be no better than placebo at suppressing ovulation when given immediately prior to ovulation, and is not thought to be effective once the process of fertilisation has occurred”.

Dr Guthrie said that, if a woman has had unprotected sex at this time of the menstrual cycle, she should see a doctor about obtaining another form of emergency contraception.

Caesareans operations to be offered due to midwife shortages

Caesareans are to be offered to all pregnant women who ask for them, new guidelines state, amid concerns that some are too scared to give birth naturally on Britain’s overstretched labour wards.Caesareans operations to be offered due to midwife shortagesA lack of support is leading to “traumatic” natural births, say experts, resulting in women fearing a repeat experience.

Studies show that up to 10 per cent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia.

Now the National Institute for Curbing Expenditure (NICE) is recommending that women should always have the right to a caesarean, even if they have no physical or mental health need.

The guidelines, state: “For women requesting a CS [caesarean section], if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”

Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.

“It is a major operation, about as major as a hysterectomy,” he said.

Nonetheless, 25 per cent of births in Britain are now by caesarean. Between a third and a half of them are pre-planned.

Figures show that rates in Nordic countries are much lower, at about 15 per cent.

Many obstetricians want the UK rate to come down, but believe that is impossible without better midwifery services.

Mr Griffiths said: “I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries.”

Better midwifery care was “key to reducing the caesarean rate”, he added.

Nina Khazaezadeh, a consultant midwife at St Thomas’ Hospital in London and a member of the guidelines panel, said some women opted for caesareans because they feared childbirth after a “traumatic” first experience in an understaffed ward – a condition known as “secondary tokophobia”.

She said: “We might see a rise in secondary tokophobia where women have already had a birth that they have found very traumatic, and the perceived lack of support will have had an impact on their decisions for the next pregnancy.”

Cathy Warwick, chief executive of the Royal College of Midwives, said: “There is very clear evidence that one-to-one support in labour reduces caesarean rates”.

However, she welcomed the new Nice guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.

Coincidentally, the RCM publishes a new report today claiming that England faces “massive midwife shortages” and needs another 5,000 of them.

Even though numbers have increased since 2001, they have “failed to keep pace with the rocketing number and increasing complexity of births”, it warns.

The number of births has risen by 22 per cent in a decade, with midwives having to deal with 120,000 more in 2010 than in 2001.

Mothers also tend to be older and heavier than in the past, which both raise the chance of complications.

Belinda Phipps, chief executive of NCT, said: “Most women want a straightforward birth, some need a caesarean. When women are treated with respect, and are offered support and information tailored to their concerns, very few of them will choose a caesarean birth unless there are clear health reasons.

“However, our services fail women badly at the moment, with midwifery numbers well below the level required to guarantee safe and satisfying care.”

She went on: “If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need.”

The guidelines do recommend that a woman requesting a caesarean should be made to talk about her fear of childbirth before an operation is granted.

From: http://www.telegraph.co.uk/Caesareans-to-be-offered-to-all-amid-fears-over-midwife-shortages

Unions’ strike means thousands of operations to be postponed today

Hospital managers are planning to postpone thousands of non emergency operations today, because of the public sector unions striking over pension changes.Unions' strike means thousands of operations to be postponed todayPatients across the UK have been sent letters warning them of the disruption.

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions – the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.
999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

“I would ask staff to consider carefully whether going on strike is the right thing to do,” he said.

Midwife shortages in England risking lives

Parts of England are facing big midwife shortages putting mothers and babies at risk midwives have warned.Midwife shortages in England risking livesThe Royal College of Midwives says a 22% rise in births over 20 years has led to shortfalls across England, but some areas are worse than others – it highlights the East Midlands and East.

The RCM wants 4,700 more midwives and says the prime minister has backed away from a pledge to raise numbers.

The Department of Health said record numbers of midwives were now being trained.

Midwives say births are becoming increasingly complex because of growing numbers of obese and older mothers-to-be, who often need extra support.

The Royal College of Midwives says the extra 4,700 midwives are needed across England to keep pace with the added pressures.

And it says a new analysis of midwife numbers across England reveals big variations – with limited shortages in some areas and serious shortfalls in others.

The calculations were done by measuring the number of midwives in an area against the number of babies born there. The RCM estimates that one midwife is needed for every 28 hospital births and 35 births in a midwife-led unit or at home.

The North East and North West of England had a shortfall of less than 10%.

But according to the figures, the East Midlands and East of England need 41% more midwives, and the South East is also more than a third short of staff.

The college says the disparity is down to different levels of investment in different areas; women living in places with bigger shortfalls are at risk of having less choice over how and where they give birth.

It says Scotland, Wales and Northern Ireland do not have midwife shortages at the moment.

“This is a real problem in England,” said Cathy Warwick, RCM General Secretary. “We believe women should have the same choice over giving birth wherever they live. Once you get to really critical shortfalls, maternity services won’t be safe.”

It’s a sentiment echoed by the head of midwifery at Wansbeck hospital in Northumberland, where they say they have enough staff to offer high-quality care.

Janice McNichol has delivered more than 1,000 babies in her career, and prides herself on making sure every mother has a positive experience.

“It’s about safety and quality of care,” she said. “Making sure midwives are there when mum needs them, to answer questions and help her through the process.”

The charity Action against Medical Accidents, AVMA, said the situation in some areas was desperate.

“Having a baby should be the happiest time in a couple’s life, but failure to deal with this problem is all too often turning it into a tragedy,” said AVMA chief executive Pater Walsh.

“Maternity services should be the NHS’s first priority for improving patient safety and having enough trained midwives is an absolute must.”

From:  http://www.bbc.co.uk/news/health-14859228

Nurses and midwives urged to get flu jab

Nurses and midwives are being urged to get their flu jabs after figures reveal less than a third did last year.Nurses and midwives urged to get flu jabAll front line healthcare workers are meant to be vaccinated to stop them going off sick with influenza and spreading the virus to patients.

Last year only 30% of hospital nursing staff in England got immunised compared with 43% of GP practice nurses, 38% of GPs and 37% of other doctors.

Nursing and midwifery groups say having the jab is a “professional duty”.

This is the first time the figures have given broken down by occupation.

The number of healthcare workers getting the vaccine had increased from 26.4% in the 2009 winter to 34.7% in 2010.

However, the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life-threatening complications and passing it on to patients and family, says the Department of Health which released the figures.

The data also shows that only 25.2% of youngsters aged six months to two years in at-risk groups were vaccinated last winter, compared with 51.7% of those aged 16 to 65.

Those at risk include people with conditions such as asthma, diabetes, heart disease and liver disease, as well as the over-65s and pregnant women.

Last winter people in at-risk groups were 11 times more likely to die from seasonal flu than people with no underlying health problems.

Chief Medical Officer Dame Sally Davies said: “It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Dr Peter Carter, of the Royal College of Nursing, said while NHS staff should not be forced to get immunised, they had a professional duty to do so: “Patients and healthcare staff suffer when nurses are off sick.

“It is vital that nurses do all they can to take responsibility for their own health and of those around them. The RCN will be working with our members to ensure they have access to all of the relevant information to enable them to make the right decision about the uptake of the vaccine.”

Louise Silverton, of the Royal College of Midwives, said: “Midwives are strongly advised to encourage all pregnant women to be vaccinated against seasonal flu.

“In addition midwives as key health workers should themselves seriously consider being vaccinated to prevent transmission of influenza to the women for whom they care and also to their own families.”

A National NHS Staff Seasonal Flu Vaccination Campaign launches later this month and will use resources like Twitter and Facebook, as well as leaflets, to encourage more healthcare professionals to get vaccinated.

From: http://www.bbc.co.uk/news/health-14792570

Teenage pregnancies are contagious

Teenage pregnancy are “contagious”, according to a study which has found that younger sisters tend to follow the example set by their older siblings.Teenage pregnancies are contagiousWhen an older sister becomes a gymslip mum, the younger sister is twice as likely to do the same.

This “peer effect”, as Bristol University researchers called it, raised the chances of becoming a teenage mother from about one in five to two in five.

The effect was stronger when sisters were closer together in age, while it was also stronger in poorer households.

Being educated to a higher level decreased its effect, but the research found that the sibling effect “dwarfs” that of more years in school.

Professor Carol Propper said: “Previous research has shown that family background and raising the education of girls decreases the chances of teenage pregnancy.

“However, these findings reveal the positive sibling effect still dwarfs the negative effect of education. These findings provide strong evidence that the contagious effect of teen motherhood in siblings is larger than the general effect of being better educated.

“This suggests that more policies aimed directly at decreasing teenage pregnancy may be needed in order to reduce teen births.”

The analysis was based on census data from 42,000 Norwegian women born after the Second World War. Most gave birth in the 1970s and 1980s.

The study, a collaboration with academics at Bergen University in Norway, the Norwegian School of Economics and Imperial College London, has been published as a working paper by Bristol University’s Centre for Market and Public Organisation.

From: http://www.telegraph.co.uk/Teenage-pregnancies-contagious

UK has too many hospital births

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
UK has too many hospital birthsIt wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: “There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately.”

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women’s gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

“Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

From: http://www.bbc.co.uk/news/health-14145862

Maternity postcode lottery revealed in NHS figures

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
Maternity postcode lottery revealed in NHS figuresIn some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures