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?

Would asking the question help to reduce drinking in pregnancy?
Possibly igniting a conversation about the risks?

Theway, absolutely not, it was just a bit of confusion caused when a pp went from talking about alcohol to blowing into a machine. They were actually meaning a carbon monoxide monitor for smoking. NICE guidelines are to offer this to every pregnant women. Seemingly it has become contentious because not everyone has had the opportunity to do so, whilst others apparently were 'made' to do it. It definitely is not a breathyliser!

Ideally, antenatal care does include a conversation about smoking and drinking as well.

Many people don't lie as they actually want help to quit or cut down during pregnancy, but only if it is done in a non-judgmental way and without feeling like there's a risk of being 'marked out' as a consequence. Really great midwives can do this but it can feel tick-boxy or come over in the wrong way.

Many people do quit smoking in pregnancy using services to help them, but fear of others judging them (not just health professionals but people in general) does stop them asking for help or realistically discussing the situation.

Don't a mother's mental health records also automatically transfer to her children's medical records? I have always thought that was a massive infringement of privacy and I think this is too.

And then they go and double whatever you report anyhow. YANBU.

Don't a mother's mental health records also automatically transfer to her children's medical records? I have always thought that was a massive infringement of privacy and I think this is too.

Yes. Had a new hv tell a student hv about my rape and subsequent ptsd in front of me at dc2's 13 to 15 month check up.

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 doubt very much it will lead to correct diagnosis though. I have two children who I adopted, both were exposed to alcohol in the womb, one of whom has significant developmental issues, the origins of which are very complex and go far beyond alcohol exposure. There were many other things in the mix however FASD becomes a pretty quick and dare I say it lazy diagnosis when you consider the child’s pre-birth experience, in fact for there are many reasons for her challenges.

The danger is that someone notes alcohol exposure and puts everything down to that, ignoring the other issues which means the child doesn’t get the care and support they need for the wider issues at play.

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

Same.. Saw a video made about children with FAS and it affects them for life. Holding off booze/tobacco/ drugs- even prescribed ones..is obviously best for the fetus/baby

9 months is such a short time, comparatively to give a DC the best chance possible..
But hopefully if a woman does have a drink/drug problem that she will get sympathetic treatment, and not be made to feel bad.

@PrivateD00r

Theway, absolutely not, it was just a bit of confusion caused when a pp went from talking about alcohol to blowing into a machine. They were actually meaning a carbon monoxide monitor for smoking. NICE guidelines are to offer this to every pregnant women. Seemingly it has become contentious because not everyone has had the opportunity to do so, whilst others apparently were 'made' to do it. It definitely is not a breathyliser!

Ah ok, thanks for clarifying. Although I would say the same to being asked to do that one (and I've nothing to hide, I've never smoked).

To be clear, I think routine enquiry about drinking, drug use and smoking should form part of maternal health care, but sound to them form part of the child’s medical records ongoing.

shouldn't then

What if someone saw a woman filling a baby bottle full of wine and feeding it to their child. Everyone would be outraged then. I don’t see how it’s any different.

If someone can’t go without alcohol for 9 months for the sake of their child I think they have a problem.

I mean, why would you risk it?

@PrivateD00r

Theway, absolutely not, it was just a bit of confusion caused when a pp went from talking about alcohol to blowing into a machine. They were actually meaning a carbon monoxide monitor for smoking. NICE guidelines are to offer this to every pregnant women. Seemingly it has become contentious because not everyone has had the opportunity to do so, whilst others apparently were 'made' to do it. It definitely is not a breathyliser!

I thought ''IS there a test for booze?'' I did the CO monitor, in a help to stop smoking service, when quitting smoking, {not pregnant} and someone claimed to have not smoked at all, all week and his readings were really high...19? or something like that, compared to the 0.4 of a non smoker..

There is no fooling the machine!
He then admitted to having smoked on the way in.
At least it enabled him to be more honest with himself.

I’m pregnant and I don’t have a problem with this. I know women who have continued to drink through their pregnancy and haven’t hidden it, some have been very open about it. If it helps prevent pregnancy loss in the future then I would be happy to support in whatever they need.

I had the occasional drink during 2nd pregnancy, no more than 2 or 3 units a week. I think you have to be seriously drinking a lot more for FAS.

@PrivateD00r

Theway, absolutely not, it was just a bit of confusion caused when a pp went from talking about alcohol to blowing into a machine. They were actually meaning a carbon monoxide monitor for smoking. NICE guidelines are to offer this to every pregnant women. Seemingly it has become contentious because not everyone has had the opportunity to do so, whilst others apparently were 'made' to do it. It definitely is not a breathyliser!

Yeah I think it’s the same with a lot of things that are supposed to be ‘offered’ to pregnant women but in practice it’s never presented as a choice.

@PatricksRum they already ask about alcohol and smoking and talk about the risks antenatally

What some of you on this thread are effectively saying is that any woman who is sexually active and of child bearing age (so let's say 16 to 50) should never drink any alcohol. Don't you see?

@Hardbackwriter
I absolutely agree

What some of you on this thread are effectively saying is that any woman who is sexually active and of child bearing age (so let's say 16 to 50) should never drink any alcohol. Don't you see?

I think it's very surprising to many people how many unplanned pg there are.

My three pg were all planned so I abstained from everything took prenatal vitamins as did DH ate healthily and exercised regularly few months before we even tried and then didnt have long to wait to get pg. So I could do everything you're "supposed to".

GOV.UK:Health matters: reproductive health and pregnancy planning

Currently, 45% of pregnancies and one third of births in England are unplanned or associated with feelings of ambivalence.

I didn't mind the questions I think the reponse in third pg to my answers I had an issue with so I can see why any judgement associated with this could be harmful to open and good working relationships with MW.

@Dinosauratemydaffodils

Don't a mother's mental health records also automatically transfer to her children's medical records? I have always thought that was a massive infringement of privacy and I think this is too.

Yes. Had a new hv tell a student hv about my rape and subsequent ptsd in front of me at dc2's 13 to 15 month check up.

That's awful. There's no excuse for that.

Unfortunately, as this precedent exists, I think this is quite likely to be adopted. Despite there being no evidence there will be a benefit to the child and good reason to think it will damage trust with clinicians.

If the motivation for this is to collect evidence to analyse effects of low levels of alcohol in pregnancy, it should be done as part of a properly consented trial, not an invasive blanket provision.

It's a terrible idea, and nobody who gives a shit about foetal welfare should support disincentives to women seeking antenatal care. Which this is.

I drank during both of my pregnancies. And by drank, I would have a small glass of wine on a Sunday with my roast dinner. I never hid it during pregnancy and outwardly told them that was what I was doing. There is no risk to baby by having one small glass of wine a week.

I haven’t read the whole thread just the first few pages but I’m shocked at the amount of people who state “most women won’t tell the truth” about their alcohol consumption.

As a midwife I find that women are generally happy to disclose their alcohol consumption. Most women I come into contact with who have drunk alcohol don’t receive judgement they get reassurance because the truth is we don’t know if their NYE binge or their glass of sherry with granny last Sunday is going to do anything!

If they (and some women do) disclose that they are a alcoholic or had problems in the past they are OFFERED a referral for further support, extra scans etc. If this is declined and there are no SG issues then that’s it, no more we can do apart from continue to offer further support at each contact.

No one is MADE to do anything, but we would not be responsible healthcare professionals if we did not give the risks. We don’t do this to “scare” women or make them feel bad, we do it because we use evidence based practice and informed consent to deliver care.

As more midwives qualify and midwifery becomes open to a wider range of social backgrounds I hope Mumsnetters start to have a more positive experience. It’s deeply upsetting to read some of the comments of a profession that I love and put my heart and soul into.

To also add a point to those talking about medical records, the antenatal notes that has ALL the pregnancy information in is kept for 25 years so that the baby can access that information when they grow.

I was so annoyed when I read this. There's already a host of issues when a woman is pregnant about the unborn, as yet non-existent, baby getting priority over the patient, who is an adult female. "You want what's best for the baby, don't you?" Not at the expense of an induction / hospital birth / Cesaerean I don't want, no etc.

This is simply a further slippery slope. Women's medical notes are private. Are women's use of anti-depressants recorded on their children's note? Prior conditions such as diabetes? It is outrageous to suggest that this is appropriate. I can't believe that levels of FAS are at such heights that this sort of gross invasion of privacy is warranted.

There's no issue with asking and it is helpful for doctors to know. The reality is some Mums would refuse a breath or blood test, regularly miss appointments and misreport. I'm not against being asked about it, but I don't see how it helps in a number of cases as information would be unreliable and so actually may put GPs and Paeds off the the diagnosis if not included in the notes. FASD can be hard to diagnose, many more children than diagnosed will have FASD but present with autism, ADHD etc. Mums can sometimes be unaware of a pregnancy, as a PP mentioned, or not realise that a single glass of wine can cause issues. It's always been advertised that very light drinking during pregnancy is acceptable (a glass of wine) and an easier cut off can be just no alcohol at all. Recently, with new information about FASD and FAS, there is now guidance that no alcohol through pregnancy is safe. Again, with studies and self-reporting, it can be hard to pinpoint if one glass is or isn't an issue and why it effects some neonates much more than others. Many women also seem unaware of what a small glass of wine or measure of spirit is.

In the same way in adoption, Mums sometimes say they haven't drunk and there will be no record of them 'presenting intoxicated' to professionals during the pregnancy, but sometimes the child is found to have FASD or a related condition much later on (6+). Not all by any means, but some. It won't actually help hugely in adoption due to the unreliability of information and the fact if a women turns up with no alcohol in her system, they cannot guarantee she will not go home and drink that night. I do have empathy for women struggling with addiction issues through pregnancy, some of these women are in (and have been through) terrible situations and are not able to put their child first. It's horrendously sad for the child, but it's sad for the mother too.

I think raising awareness is the best way. Educate all women (and men too) about FASD, FAS and alcohol in pregnancy. Educate around amount of alcohol during pregnancy (ideally none), the risks of drinking (related foetal alcohol spectrum disorders and the mental, emotional and physical risks this poses eg. memory problems, inability to understand consequence, vision problems etc.), show women what a baby withdrawing from alcohol looks like (there are dolls used as aids) etc. Give women knowledge and support they can access if they want to stop drinking and are struggling. Give GPs a good awareness around recognising possible FASD and FAS (can be hit and miss). Not only this, but help teachers to understand it too. That would help in adoptive families - if more schools understood foetal alcohol related conditions and what they meant! Support needs to be wider reaching, as does diagnosis (there is only one centre for complicated diagnosis, I believe, in the UK). A lot of children with foetal alcohol issues are complicated to diagnose, they do not present with facial features and may be within milestones. There needs to be much more education and support around the whole issue.