To think that recording pregnant women's drinking is pointless as well as invasive?

[Hardbackwriter]

If I've understood correctly, NICE have proposed that the mother's consumption of alcohol should be recorded on a child's medical record, to help with any future diagnosis of fetal alcohol syndrome. The British Pregnancy Advisory Service (quoted in this article: www.theguardian.com/lifeandstyle/2020/sep/16/plans-to-record-pregnant-womens-alcohol-consumption-in-england-criticised) have pointed that this breaches data protection rules, and that "Women do not lose their right to medical confidentiality simply because they are pregnant".

I have sympathy with this view, but I also just fundamentally think that it's quite pointless to record this information as it's surely self-reported? Women who have been drinking heavily are unlikely to admit to it, surely (and maybe even less so if it's going to go on their child's medical record for all time)? Are you not going to miss a lot of cases of FAS if you're ruling them out if the child's record said the mother swore she didn't drink, or did so only moderately? I assume there's a lot of under-reporting already - I've seen people on MN insist they know someone whose child has FAS 'even though she only had a couple of drinks in the whole pregnancy'; I'm guessing in the vast majority of cases the mother is drastically underplaying what she drank. Maybe she's even convinced herself.

I just can't see the point of this, and worry that it'll put off someone who could benefit from help with alcohol dependency in pregnancy seeking help if they know it'll go on the child's record. AIBU?

@PurplePansy05

I would put a bet on that if these rules come into force they'll be challenged in courts at the first opportunity, there'll be a test case based on the right to privacy and potentially data protection laws, and this will be the end of this malarkey. Quite rightly so.

There won’t be a case.

If it was a pregnant man, that would be different.

Also it’s REALLY funny how so many people lately are tying themselves in knots trying to define what a woman is.

However when it comes to controlling what we do, ever fucker seems quite capable of knowing what a woman is.

Surely people would just lie, plus a lot of pregnant women drinking heavily may also be the ones who don’t reliably attend their appointments.

With children in the care system incidents of being exposed to alcohol before birth is very common, this data is available as it forms part of the case proceedings. It doesn’t however then go onto the childs medical notes, my son was exposed to alcohol and drugs throughout his birth mothers pregnancy, this is recorded in his SS file, but it is not anywhere on his own medical records, because they are HIS medical records not his birth mothers.

Where it isn’t possible to gain information about alcohol consumption it is presumed that FASDs may be a factor so it is a diagnosis that is explored anyway if there are any developmental concerns, physical characteristics etc. With LAC children its easy to automatically explore it as you’re not dealing with the birth parent. But how could that ever be sensitively handled when you are dealing with the birth parent?

New link
www.theguardian.com/lifeandstyle/2020/sep/16/plans-to-record-pregnant-womens-alcohol-consumption-in-england-criticised

@Hardbackwriter

Realistically, it'll also be certain kinds of women that are interrogated over it - in my booking-in appointment for my current pregnancy the midwife just said 'take it you've not been drinking alcohol?' and I said no - I strongly suspect that this is because I'm middle-class, in my 30s, had described a long and difficult history of trying to have a baby, etc. In both this and my pregnancy with my DS I said that I was a non-smoker and that was just recorded; my SIL - in the same area, but 22 with an unplanned baby - was made to blow in one of those machines.

She wasn't 'made' to - you are reading too much into it. NICE guidelines ask that everyone is offered the carbon monoxide test, I am not sure how anyone could be 'made' to do it. Also, it has been suspended over the last 6 months, for obvious reasons, so I ma not surprised you were not asked to.

These questions require a tick in a box, so everyone will be asked the same, regardless of their age.

@Sexnotgender

You're bang on the money there, it's infuriating.
Yet another reason I've decided against having kids is that a pregnant woman's body is no longer her own, it's public property, and women are infantilised enough as it is.

She wasn't 'made' to - you are reading too much into it. NICE guidelines ask that everyone is offered the carbon monoxide test, I am not sure how anyone could be 'made' to do it. Also, it has been suspended over the last 6 months, for obvious reasons, so I ma not surprised you were not asked to.

I was referring to my pregnancy with my son, not my current one, so it was 2017. And she may not have been 'made to' - I'm sure she had the right to refuse - but she was offered it and made to feel that they didn't believe she didn't smoke; I was just believed and I certainly wasn't offered it. It actually came up in conversation in my postnatal group once and there was a definite 'pattern' as to who had and hadn't been given a CO test (and those who had did describe it as 'made to', because that's how it felt to them).

For both my booking-in appointments (my other pregnancies didn't get that far) the midwife just didn't ask certain questions that are 'tick boxes' - e.g. whether it was a planned pregnancy - because they assumed from my other answers. I don't think it's paranoid or even surprising to say that certain 'types' of women are questioned more closely and that just making sure that the question is on every form doesn't solve that. As I said, in my current pregnancy the question was asked as 'I take it you haven't been drinking alcohol?', which hardly opens a dialogue about it.

YANBU,
Everything you say is true. Women who know they are drinking too much will lie. But, I’m in favour of the question being asked and the response being noted in the medical file. Simply because many women truly do not know how much alcohol is too much to drink while pregnant. Others think they know, but can’t count units properly and so may be unknowingly over drinking. These women deserve to hear some guidance from medical professionals regarding drinking alcohol in a non judgemental way and a routine question is a good open ended way to start that discussion.
Not everything is a stick to beat pregnant women with. I have met so so many women who did zero research, who had no desire to be active in managing their pregnancy and just placed themselves in the hands of their midwife/doctor and expected all aspects their pregnancy to be managed for them. These are women who later complain “no one told me x or y” about the most obvious pregnancy topics from eating soft cheese/high mercury fish to episiotomies to pain relief to the fact a baby poos meconium the first few days.
If it helps only a few women avoid unintentional harm to their baby or babies, it is worth it to me so long as the delivery is done in the spirit of informing the woman and not being all judged and mean.

Surely FASD would be apparent enough that if suspected clinicians would just ask the question.

FASD is a spectrum disorder and can be very hard to diagnose - there’s overlap in symptomology between FASD and other concerns including trauma, neonatal abstinence, ASD and BPD. Recording the birth mums self reported alcohol intake during pregnancy is pretty useless because if someone is drinking to the point where FASD is a concern, there tends to be other lifestyle issues at play too.

Besides my child’s medical records are their records, and shouldn’t hold information about someone else. It stigmatises women and removes their right to privacy, and also presents a significant barrier to ante-natal care for a population of women who would struggle to access health services at the best of times.

I drank in the first three weeks of my first pregnancy as I didn't know. He's fine. I had two glasses of wine during 2ww in my second pregnancy (it was a work lunch and I didn't want to tip anyone off), and nothing else for the duration. He was born with birth defects. For my 3rd it was totally unplanned and I got absolutely blotto at exactly 14 days pregnant, and she's fine. But I'll carry that "maybe" forever vecaaue one of the surgeons asked and I told him the exact truth. He never said it was linked, but then asked me outright at a f/up appointment whether I'd drunk in my 3rd pregnancy. The only alternative here is just to prohibit women between 15 and 50 from drinking, because we can all potentially be pregnant without knowing. It's just life so they can all rack off.

@Hardbackwriter

She wasn't 'made' to - you are reading too much into it. NICE guidelines ask that everyone is offered the carbon monoxide test, I am not sure how anyone could be 'made' to do it. Also, it has been suspended over the last 6 months, for obvious reasons, so I ma not surprised you were not asked to.

I was referring to my pregnancy with my son, not my current one, so it was 2017. And she may not have been 'made to' - I'm sure she had the right to refuse - but she was offered it and made to feel that they didn't believe she didn't smoke; I was just believed and I certainly wasn't offered it. It actually came up in conversation in my postnatal group once and there was a definite 'pattern' as to who had and hadn't been given a CO test (and those who had did describe it as 'made to', because that's how it felt to them).

For both my booking-in appointments (my other pregnancies didn't get that far) the midwife just didn't ask certain questions that are 'tick boxes' - e.g. whether it was a planned pregnancy - because they assumed from my other answers. I don't think it's paranoid or even surprising to say that certain 'types' of women are questioned more closely and that just making sure that the question is on every form doesn't solve that. As I said, in my current pregnancy the question was asked as 'I take it you haven't been drinking alcohol?', which hardly opens a dialogue about it.

Well, ok I was just responding to you saying 'in both this and my current pregnancy'. I am sorry if your midwife did not follow NICE guidelines, but please don't reflect your assumptions from your anecdotal research onto how the midwife may have felt. You are making a lot of judgements here based on how you perceive your acquaintances.

It is well known that middle class women in their late 30's to early 40's drink more alcohol in pregnancy than other groups so I really don't understand why you are reaching this assumption. This is despite women in this age group already have increased risks of various complications.

Perhaps look at it the other way around. A child presents with possible symptoms of FAS, the paediatrician asks for information on the mothers alcohol intake, and the GP says" oh, we didn't ask'.

My ex drinks a lot. Last year he had to have a hip op and the dr asked how much alcohol he drank. Ex said 'the odd glass' when the truth is more like 80 units a week, every week. As a result, he was not given an anaesthetic suitable for alcoholics and nearly died.

Are you saying that doctors must assume all their patients will lie to them about such issues? Where does it end?

Certainly gps are aware people lie to them, but surely they have to start with an assumption of honesty?

I mean, you're the one telling me that my friends (who said acquaintances?) and I's experiences are wrong, so maybe you should also think about the assumptions and judgements you make. I just don't know why you're so defensive about the idea that midwives ever have preconceptions about the women they treat or that societal prejudices might make routine monitoring more intrusive for some women than others?

www.bristol.ac.uk/news/2018/november/first-uk-prevalence-estimate-fasd.html

Some people are asking how prevalent is FASD anyway, well, that's the whole point. There's been recent research that suggest that in a mild form, it's much more common than we suspected. About 17% in a national study had at least one of the (quite distinctive) symptoms which shocked the researchers at the time- I know one of them.

Given that drinking rates are quite high in pregnancy in the UK compared with other countries, there is a feeling 'something must be done'. I don't know what that is, and I'm sure lots of people lie or just delude themselves about their drinking, but I have friends who absolutely bristled at the idea in their pregnancy that two large glasses a night wasn't absolutely fine and it's normal to slur a bit when on the phone.

I'm not into surveillance of women's bodies, but I am into informing them of the facts, and judging by some of the comments here, actually people aren't very realistic about some of the risks of drinking in pregnancy which are now known to be a bit more substantive than we thought, they may also downplay their own drinking as I've seen that myself.

Besides my child’s medical records are their records, and shouldn’t hold information about someone else.

I was thinking the child records could legitimately record their exposure to alcohol as a foetus without it being “about someone else”. What is so bad about recording what and how much of known toxins the child was exposed to in the womb?
What is more important, the child’s health and a correct diagnosis of any disorder OR a woman feeling good, guilt free and oblivious to harm she may cause?
I think if anyone is going to prioritise their feelings over a child’s health, they really shouldn’t be getting or staying pregnant. I was an open book to my midwives and no question was too great an invasion of privacy when it came to my babies health.

@Tootletum

I drank in the first three weeks of my first pregnancy as I didn't know. He's fine. I had two glasses of wine during 2ww in my second pregnancy (it was a work lunch and I didn't want to tip anyone off), and nothing else for the duration. He was born with birth defects. For my 3rd it was totally unplanned and I got absolutely blotto at exactly 14 days pregnant, and she's fine. But I'll carry that "maybe" forever vecaaue one of the surgeons asked and I told him the exact truth. He never said it was linked, but then asked me outright at a f/up appointment whether I'd drunk in my 3rd pregnancy. The only alternative here is just to prohibit women between 15 and 50 from drinking, because we can all potentially be pregnant without knowing. It's just life so they can all rack off.

In those early days, before implantation and the development of the placenta, I genuinely don't believe that you will pass any alcohol etc to your baby. I have done a lot of research and whilst no one really knows for sure, physiologically it doesn't make sense that alcohol will harm your little baby at that time. Most birth defects are idiopathic (no known cause), I don't for one minute think that you caused this. I know it is hard to accept that and it is in our nature to blame ourselves, but actually look at the positives - look at those beautiful perfect children that you created and raised.

I am always so torn about this, I hate that women like you are made to feel guilty for something that was completely out of your hands.

But on the other hand, is it right to hide away the facts? The only way to ensure that your baby does not develop FAS is to ensure you don't drink any alcohol in pregnancy. No one can be sure of what is a safe limit. I know people never want to hear that and shout out its making women feel guilty etc. However is it right to withhold the facts? Personally I would rather know that.

As for recording the data in their children's notes - no I don't think this should routinely occur. It does however happen if a child is believed to be at risk due to known maternal drinking, drug taking, smoking etc. There is no other option as sometimes it leads to the necessity of special observations being carried out on babies. It also can be used to explain why, for example, a placenta is in very poor condition.

It's also a massive breach of your medical data. But of course what is medical privacy worth once you're a walking womb?

What is so bad about recording what and how much of known toxins the child was exposed to in the womb?

Are we then meant to report how many times we left the house in pregnancy because every time we do so, we expose ourselves and our child to toxic fumes from cars, industrial gases etc?

Are we then supposed to report how many times our heart rate has gone up above the recommended level because, well, this may have caused harm?

How many times we've had our hair dyed or nails done, well, because again, there are some toxins and some exposure there too?

Life is toxic and some risks will always be present, recorded or not. We have to stay reasonable though, this isn't RL Big Brother.

It sounds pointless to me. Women who drink alcohol will lie, or completely disengage with antenatal services. I can't see it doing any good.

In both this and my pregnancy with my DS I said that I was a non-smoker and that was just recorded; my SIL - in the same area, but 22 with an unplanned baby - was made to blow in one of those machines.

I was 40, middle class and with a father dying of lung cancer with dc2, still had to blow in the machine. Here at least, everyone has to do it. Midwives should not be making assumptions.

@Hardbackwriter

I mean, you're the one telling me that my friends (who said acquaintances?) and I's experiences are wrong, so maybe you should also think about the assumptions and judgements you make. I just don't know why you're so defensive about the idea that midwives ever have preconceptions about the women they treat or that societal prejudices might make routine monitoring more intrusive for some women than others?

I said 'acquaintances' because you described these women as part of a postnatal group, you did not say friends. What an odd thing to pick out of my post. I cannot see where I said anyone was 'wrong'? It feels like you really aren't reading what you are writing, or indeed what I am writing. My point was that you are judging your 'friends' on how they look and measuring that against their experiences and deciding midwives are judging people based on age/class and using that when asking questions. This feels quite unusual to me. You seem determined to make this point. Yet the 'booking in' consists of various screens of tick box questions, the midwives have so many of these appointments back to back that I can assure you, they are barely looking at you, never mind judging you.

To be honest, I don't even know what any of that has to do with the original post. Do you think midwives will just make up data and record based on how someone looks? If that were actually true, I think it would go very differently to how you are assuming. As I already said, older women are much more likely to drink alcohol in pregnancy than younger women.

This is n no way enforceable, you'll have the mums that have a thimbleful at a wedding who report, and the ones that drink a bottle of vodka a day that don't.

@Dinosauratemydaffodils

In both this and my pregnancy with my DS I said that I was a non-smoker and that was just recorded; my SIL - in the same area, but 22 with an unplanned baby - was made to blow in one of those machines.

I was 40, middle class and with a father dying of lung cancer with dc2, still had to blow in the machine. Here at least, everyone has to do it. Midwives should not be making assumptions.

Absolutely, it is offered to everyone. I am sure there are cases of the machine not being available or not working correctly. However the result has to be recorded, as does the reason if the test isn't carried out (eg declined). Would a midwife record the reason as 'appears too middle class to smoke'? I don't think so

What is so bad about recording what and how much of known toxins the child was exposed to in the womb?

I lost my father when I was six months pregnant, that's tied to negative outcomes. Should that be on dc2's file? What about the odd can of pepsi max I consumed? The antibiotics I was prescribed for a chest infection?

Where do we draw the line?

I see in the guardian article that nice say that this is based on practice in scotland. i'm in scotland and wasn't aware of this.

Like most people i know i was asked/told about avoiding alcohol in pregnancy (2013) in my case I tested on 6th January and had drunk through xmas and new year as i only stopped the pill in December and being late 30s thought it would take a lot longer to even ovulate again never mind conceive!

I just don't think that mothers who have an alcohol dependency and need help are more likely to disclose it if they know it's going to be on their child's medical records forever :(