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?

They can fuck off. It took me two years to get pregnant with DD and I drank the weekend before my positive test, because I’d pretty much given up trying by then. I also had 1 small glass of champagne at 2 weddings during my pregnancy and DD is fine. If I get pregnant again, I’m just going to tell them I’m tee total, I’m not but it’s non of their business.

@LittleGwyneth

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

All significant maternal conditions are recorded in baby notes at birth though. Eg maternal antibodies, any infections eg covid status, any use of narcotics. Lots of things. This is vital to ensure that baby receives the correct treatment. I cannot imagine why anyone would object ot this breach of their data, given the impact it may have on their baby.

Alcohol consumption, whether we like it or not, does at times lead to the irreversible and life changing condition FAS. Why is that nay different to the other things that we already record?

@PlanDeRaccordement

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.

But where do you draw the line?

My son was exposed to alcohol and class a drugs, his birth mother would have also experienced stress, physical abuse, it is very unlikely she had an adequate diet in pregnancy. The trauma my son experienced before he was born could have a greater impact on him than being exposed to both alcohol and drugs.

Where do you draw the line?

I am three months pregnant. Have never been asked to have a CO test in either this or previous pregnancy. Never even heard of it - just reliance on me saying I am a non smoker.

And the booking questions were skewed to their assumptions of me - assuming my husband's last name was same as mine, saying "I assume that he is the father of the baby" etc. I was totally fine with this, but it was definitely clear what the expected answer was likely to be - either profiling based on my appearance etc, or just that the other scenarios are less likely. But I guess if my surname didn't match my husband's or if my husband was not my baby's father, it "might" have made it harder to disclose.

I only seem 'determined' to make the point because you interrogated me and said I was wrong when I was describing discussions with my friends and my sister-in-law where we agreed that it was pretty poor that it was so obvious that midwives in our area pick and choose who to ask to test! It was a very fleeting point, not in the original OP, it's probably distracting from the original OP now and I think maybe we should drop it. My broader point is that there is always a risk with routine monitoring that it will be done more zealously, in ways that feel more off-putting or officious, for some groups than others: often BAME populations, low-income groups, groups with lower education, etc. Research has shown this over all sorts of such monitoring, from routine HV visits to school attendance monitoring to police 'routine' searches or car stops. This isn't something I'm making up and it's a risk of any increased monitoring and it will almost inevitably put some groups particularly at risk of not disclosing sensitive medical information if they think it will be put on their child's medical record and possibly 'used against them'.

@Dinosauratemydaffodils

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?

Those things you mention can cause harm, yes. But are not linked to one specific condition that is on the increase, and impossible to get a confirmed diagnosis of without having the information on file. It really is not comparable.

I would love there to be more research into FAS, to allow mothers to make more informed decisions - for obvious reasons, we know very little about FAS and what safe levels are. However I don't think asking mums for the information in this way is helpful or likely to be revealing, for all the reasons others have said. Surely the way to do this is to choose a selection of expectant mums and give each a barcode (ie data is held separately to their medical notes) and ask them to record their drinking each week linked to this barcode. Details of the child's development and any issues could then be linked after birth. No invasion of privacy, no parental data shared with child without permission, more likelihood of honest responses from mums who know they are anonymous.

@Hardbackwriter

I only seem 'determined' to make the point because you interrogated me and said I was wrong when I was describing discussions with my friends and my sister-in-law where we agreed that it was pretty poor that it was so obvious that midwives in our area pick and choose who to ask to test! It was a very fleeting point, not in the original OP, it's probably distracting from the original OP now and I think maybe we should drop it. My broader point is that there is always a risk with routine monitoring that it will be done more zealously, in ways that feel more off-putting or officious, for some groups than others: often BAME populations, low-income groups, groups with lower education, etc. Research has shown this over all sorts of such monitoring, from routine HV visits to school attendance monitoring to police 'routine' searches or car stops. This isn't something I'm making up and it's a risk of any increased monitoring and it will almost inevitably put some groups particularly at risk of not disclosing sensitive medical information if they think it will be put on their child's medical record and possibly 'used against them'.

Yes, will leave it there. The use of the word 'interrogated' says a lot, as I simply was replying to your assumptions which needed challenged I didn't read past 'interrogated', sorry

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

It isn't, and in I'd say probably the majority of cases where FASD is suspected the mother is no longer around to ask; most children who have investigations for FASD are in care or adopted (there are probably others out there still unsuspected and living with birth families, but where a mother's drinking is so problematic that it leads to FASD, it's also likely to be so problematic that she can't care for her child).

But there is still the problem that mothers will not tell the truth (especially if they fear care proceedings), and that they will not realise they are pregnant (if their lives are that chaotic) or conceal it (if they fear care proceedings).

Many adopters wish that their children's birth mothers would now admit that yes, they drank in pregnancy (even if they downplay it) as this would open the door to a diagnosis.

You’re not going to get accurate information from asking women. Everyone knows that you’re not supposed to drink during pregnancy and that there is no established ‘safe’ level.

When it comes to adoption, which seems to be a particular concern in the guardian article, I think it’s fair that if alcohol and or drug use was a factor in the decision to remove the child from the home (the article says alcohol is a factor in 7/10 cases) there should be a note on the child’s records. The Guardian article says that there are much better outcomes for children diagnosed before the age of 6 and having information about exposure to alcohol during pregnancy helps to get a diagnosis.

In answer to @SimonJT, the line is drawn on private information that has no scientific link to a poor outcome or health cinsequence for any baby I am carrying. Everything I do or consume that could affect my baby is fair game and open to be questioned and advised on.

Now, just because these type questions can be potentially asked rudely or unprofessionally is no reason to reject them. This would be worked out during implementation- the best way to query and advise women without causing offence or undue distress.

On a side note, it is curious that some posters who are against this are posting graphic details of their pregnancy drinking. Do they not know this is going into their permanent digital record? Why be happy to share on mumsnet just to score points on a thread, but not share with a doctor so for benefit of your child? I am baffled.

@AuntyPasta

You’re not going to get accurate information from asking women. Everyone knows that you’re not supposed to drink during pregnancy and that there is no established ‘safe’ level.

When it comes to adoption, which seems to be a particular concern in the guardian article, I think it’s fair that if alcohol and or drug use was a factor in the decision to remove the child from the home (the article says alcohol is a factor in 7/10 cases) there should be a note on the child’s records. The Guardian article says that there are much better outcomes for children diagnosed before the age of 6 and having information about exposure to alcohol during pregnancy helps to get a diagnosis.

Completely agree. The vast majority of women state they drink no alcohol in pregnancy, yet we know this isn't true. I think that might be why some are asked things like 'I assume you don't drink' by midwives. They only ever get told 'no' so the question becomes tiresome. More declare their smoking status, mostly because it is very apparent from their smell, it is harder to hide! Though I wouldn't necessarily say many are honest about numbers. It makes it difficult to target help to women who need it, when most won't declare the problem in the first place. I honestly don't know what the answer is.

Now, just because these type questions can be potentially asked rudely or unprofessionally is no reason to reject them. This would be worked out during implementation- the best way to query and advise women without causing offence or undue distress.

I just very strongly feel that the best way to talk to women about their drinking in pregnancy in a way that encourages honest dialogue and makes women feel able to seek help, is not to tell them that this is information that will be permanently recorded and put in their child's medical records.

I think it’s a great idea. Pregnant women shouldn’t be drinking for the safety of their own child, and if they do so knowingly while pregnant they are being negligent and it should of course be recorded no matter how small.

The really big thing that no one is talking about with things like this is that the birth rate is dropping like a stone. Is it any wonder? Be treated like a shameful incubator, earn less, achieve less professionally, be looked down on as ‘just a mum’ when frankly it’s the most difficult job I’ve ever done. It’s unappealing enough to many young women, to have kids that is, and recording them having a small glass of red once a week is just another symptom.

With first two pg we were in a middle class area - and being late20/30s proffesionals were belived about alcohol and smoking.

Move area much more depirvaed area - they did blood tests for Co2 levels in that area - insisting it would also let us know about any gas appliances not working properly - weeks later test results were read out loud by another MW and was told well done for not smoking - I've never fucking smoked it did feel like I hadn't been believed.

They were similarly sniffy about me saying I hadn't drunk any alcohol since DD1 was born - I hadn't and rarely drink now.

Coincidentally we never had such a good relationship with those MW as with first two pgs - there were extremely paternalistic to point of lying about test results becuase they knew best - which did lead to complaints

I heard on news this morning there's no evidence low level of alcohol cause any harm so I do wonder what's behind this.

@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.

I thought middle class women in their 30s+ would be more likely to drink regularly!

the birth rate is dropping like a stone. Is it any wonder?

Do you have any evidence that women choose not to become pregnant because of the way they are treated during pregnancy?

Most women who make choices about when/whether to become pregnant take into account things like existing family, jobs, housing situation, schooling where they are, childcare, money.

Unless you know of a study saying being treated poorly in pregnancy is a factor?

@ameliajoan

I think it’s a great idea. Pregnant women shouldn’t be drinking for the safety of their own child, and if they do so knowingly while pregnant they are being negligent and it should of course be recorded no matter how small.

And that will benefit the child how, exactly?

User, they absolutely are. Research shows this time and time again.

Maybe because I’m in Scotland but this was a standard question at every MW appointment when I went a decade ago. Along with the drug and cigarette questions. None of them struck me as a problem.

We had quite a high prevalence of FAS, particularly in the Central Belt area and there were a few initiatives to reduce it, I assume the question was part of that.

With and estimated 172,000 people in Scotland alone being affected by FAS, something needs to be done to identify the estimated 15% of mothers who are drinking to excess in pregnancy. If that means asking me if I’ve had a drink, I can live with that.

@SnuggyBuggy

To be fair in my area everyone blows into that machine. I'm not sure this is a good idea. As people have said a lot of people are going to be in denial and round down how much they've been drinking.

What's this, pregnant women are being required to take a breathalyser test?! . Thank god all of that is behind me, I would be telling them where they could stick their test

I had problems with my liver when pregnant.(cholestasis) Both times they asked me how often I drank. Maybe they are asking in case of problems picked up in tests.

I would be so tempted to respond to questions on my drinking habits with enormous exaggeration like I consume at least a bottle of wine a day.

The truth is, I don't really drink alcohol at all and these days am so out of practice that I can barely manage half a glass of wine over a lunch which is boozy for everyone else. Ah well, times past......

Either way, the suggestion's not going to help is it?