A study published last week suggested that being stressed in early pregnancy could be responsible for a lower sperm count in some men: Stress in pregnancy reduces the chances of grandchildren, was the Telegraph’s take. It was a pertinent example of the way in which increasingly many child (and adult) outcomes are traced by researchers back to what a woman did or didn’t do in pregnancy, or in this case how she responded to events beyond her control – death of a relative for example, or a job loss.
Women today are subject to many messages about how to secure the best possible outcomes for their pregnancies, which is of course is what we all want. Sometimes these messages may be empowering, at other times they may feel overwhelming and cause anxiety, particularly if women have no means to act on them. There is concern that the evidence underpinning messages is not always clear – and that the precautionary principle may be what some women want, but may not give others the depth of information they require to inform their own choices.
Public health messages are designed to help us protect our pregnancies from all possible harm; but we also need to ensure women themselves aren’t put at risk of harm in the process. Mumsnet users for example frequently discuss the use and safety of medications in pregnancy. Women who are pregnant or planning a pregnancy sometimes find they are denied medications by their GP, like antidepressants, or worry about whether they may be harming their pregnancies if they continue to take them, even under medical advice. Women still suffer with extreme pregnancy sickness because they can’t access the treatment they need, or think they should wait until they are absolutely desperate before taking the medications they are prescribed. At bpas we have seen the fallout of risk messaging that isn’t evidence-based and doesn’t appreciate women’s needs: women can end up terminating wanted pregnancies because they couldn’t get the treatment they need for pregnancy sickness and simply could not cope anymore.
At worst, women can die when we do not get discussions about risk right. The last Confidential Inquiry into Maternal Deaths found women who died after being taken off antidepressants or where essential blood clot treatment was delayed because of fears it could interfere with breastfeeding.
We think we need a more woman-centred approach to the way in which we talk about risk in pregnancy – from the way in which the initial research gets framed to the public health messages which eventually result, which are of course aimed at women. With funding from the Wellcome Trust we have established the WRISK project, in partnership with academics at Cardiff University. Drawing on the expertise of advocates from a range of women’s organisations (the National Childbirth Trust among others), this is a project which aims to put women’s voices centre-stage and influence the discussion going forward.
This project may not change things overnight, and it is also a work in progress. We don’t know how widely our concerns are shared, where women wish to see improvements, or what the issues are that matter most – so we are starting with an exploration of women’s perspectives of risk messaging. Lessons drawn from women’s experiences will be considered by a group of stakeholders, including scientists, public health and risk communication specialists, women’s advocacy groups, and specialists in women’s sexual and reproductive health. This work will lead to the development of recommendations for respectful risk communication in pregnancy.
We need Mumsnet users' help with this project – and would be thrilled if you would fill in our survey to share your experiences and thoughts with us, and help us get the agenda right.
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Guest post: “Communicating risk in pregnancy – we need a woman-centred approach”
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MumsnetGuestPosts · 20/06/2019 13:56
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