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?

How is asking a mother about her alcohol consumption going to prevent FAS? If a woman is drinking enough to cause FAS, then is she really going to stop once she has had a good telling off?

And as for access to better healthcare for children, don't make me laugh. When your child gets an ASD diagnosis, you get a plastic folder with some photocopied leaflets and discharged. There isn't suddenly going to be a load of support for children with FAS

@Clymene

How is asking a mother about her alcohol consumption going to prevent FAS? If a woman is drinking enough to cause FAS, then is she really going to stop once she has had a good telling off?

And as for access to better healthcare for children, don't make me laugh. When your child gets an ASD diagnosis, you get a plastic folder with some photocopied leaflets and discharged. There isn't suddenly going to be a load of support for children with FAS

This is spot on. And whatever your initial diagnosis is, that's usually it - if your child has co-morbidities, best of luck getting diagnosed, much less treatment. My son has ASD. Had to go private to get treatment for his OCD.

That's why I asked, what does the support involve on the other thread? Tell me more. Because I can already guess what it involves.

@PlanDeRaccordement

For anyone actually giving a fuck about babies born with conditions related to maternal alcohol consumption, the absolute best thing you could do is campaign for proper mental health provision. So that anyone who does have an alcohol addiction is able to get the best help possible when they're ready to access it. Unfortunately we do not currently have this.

But this does fuck all for the actual babies born with FAS and those are born every day. And how do you even identify which pregnant women ARE alcohol dependent if you can’t even ask a woman how much she drinks? If you can’t identify them, then what use is a MH service when no one get referred to it?
I agree some women who abuse alcohol will lie, but not all will. This assumption that self reporting by women will always be a lie is a misogynist belief, it thinks so little of pregnant women. Even if a huge 1 in 10 lie, surely it will be good prevent 9 in 10 babies born with FAS?

It prevents the babies of women who would have been able to stop drinking with appropriate support, which is by no means all addicts but some, from being exposed to as much alcohol in utero. For those women who can stop before pregnancy with help, it prevents the exposure altogether.

Also, who said anything about not asking about consumption? This is about recording it on another person's medical notes. And where did this prevention of 9 out of 10 babies being born with FAS come from?

Lastly, it isn't misogynistic to say that people may lie to HCPs if they're fearful of the consequences. It's just what humans do. We already know how barriers to healthcare deter people. Men too, but since they don't get pregnant it doesn't apply here. This is why, like it or not, if your concern is FAS then better and non-judgemental addiction support is the low hanging fruit.

They already ask about alcohol consumption though?
This is about whether it should the. be put on the child’s health record.

Goes to my previous point about people not reading what the actual proposal is here.

Yep. A weird number of responses appear to think I started the thread because I approve of women drinking in pregnancy, because I hate midwives and wanted an excuse to make up stories about them or because I want midwives to be banned from mentioning the word 'alcohol' to pregnant women. All of which completely miss the point.

Yep they already (and have done for years) ask you at your very first appointment about whether or not you have been drinking alcohol, inc if you have had any before realising you were pregnant. If I recall correctly they write it down on your notes . The midwife then goes over the risks and advises about no alcohol etc. If women admit to being drinking and unable/unwilling to stop then they will deal with that to try and help.

This proposal is about the alcohol consumption being put down on the child’s permanent health record, a document separate to the mother. Including if it was just the one drink.

According to the thread in FWR though, all of that is already on the child's records, including whether their mother had an previous pregnancies and what the outcome of those were.

It's a bit confusing!

If it is, it shouldn't be, and I wonder how the proposal got as far as it has on the NICE committee.

Are they going to be adding this retrospectively - my mother was told to have a glass of Guinness two or three times a week by the midwife (presumably to wash down the liver sandwiches she was also told to eat)

@PrivateD00r "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."

Is it? I can't find any studies that support that assertion

This is why, like it or not, if your concern is FAS then better and non-judgemental addiction support is the low hanging fruit.

Sorry I do not understand your word salad @OpenlyGayExOlympicFencer
I see you don’t address how these women access said non judgemental addiction support if they are all supposedly lying to every health professional and saying they do not drink.

Lastly, it isn't misogynistic to say that people may lie to HCPs if they're fearful of the consequences.

That’s not what I said @OpenlyGayExOlympicFencer. I said in my first post to OP she is correct, some women may lie, but where I differ in opinion is that it is not reason to not record the information in the child’s record because not everyone lies and if it helps even a few children, surely it is worth the effort.

I see you don’t address how these women access said non judgemental addiction support if they are all supposedly lying to every health professional and saying they do not drink.

Do you really, honestly not see how much less likely it is that women will disclose that they drink if it'll be recorded in their child's medical history than if it's a confidential conversation aimed solely at signposting them to services and support?

Yes, your failure to understand is very obvious plan. As is your inability to explain how recording this evidence on the mother's notes would help even one child.

So once again: the low hanging fruit is provision of better MH services, not just during pregnancy either. Addicts of both sexes who aren't ready to seek help minimise the extent of their addiction (which is not the same as claiming not to use at all, you made that up) and they're less likely to seek it if they face barriers, judgement or are afraid of consequences. We know all this. None of it is controversial. That's why this proposal is a terrible one.

@OpenlyGayExOlympicFencer

Yes, your failure to understand is very obvious plan. As is your inability to explain how recording this evidence on the mother's notes would help even one child.

So once again: the low hanging fruit is provision of better MH services, not just during pregnancy either. Addicts of both sexes who aren't ready to seek help minimise the extent of their addiction (which is not the same as claiming not to use at all, you made that up) and they're less likely to seek it if they face barriers, judgement or are afraid of consequences. We know all this. None of it is controversial. That's why this proposal is a terrible one.

The alcohol use is already on the mothers notes Gay. This thread is about adding whatever information is already given voluntarily to the child’s record.

I don’t see how that add judgement or anything because it’s jist writing the same information already given in two places instead of one place.

@Hardbackwriter

I see you don’t address how these women access said non judgemental addiction support if they are all supposedly lying to every health professional and saying they do not drink.

Do you really, honestly not see how much less likely it is that women will disclose that they drink if it'll be recorded in their child's medical history than if it's a confidential conversation aimed solely at signposting them to services and support?

It’s still a confidential conversation. The child’s medical records are just as private as the woman’s records.

The alcohol use is already on the mothers notes Gay. This thread is about adding whatever information is already given voluntarily to the child’s record.

I don’t see how that add judgement or anything because it’s jist writing the same information already given in two places instead of one place.

Yes, we know the information is already recorded on the mother's notes and this is about it later going on the child's. That has been pointed out multiple times this thread, by me and others. And you still haven't been able to tell us how this intrusion into the mother's privacy would help even one child.

The problem with this issue is that people see that FASD is a problem, think we must do something, and then support any useless suggestion because hey, it counts as something.

How will it help children @PlanDeRaccordement?

Also, it's nonsensical to say it's confidential because the other person's medical records it will go on are private. It's still another person's medical records!

I don’t see asking women about their alcohol consumption is any different than getting women to log their food and sugar levels when they have gestational diabetes.

Both if uncontrolled have very negative impacts on the infant.

Have you read the thread? This isn't about discussing women's alcohol consumption with them.

@OpenlyGayExOlympicFencer

Also, it's nonsensical to say it's confidential because the other person's medical records it will go on are private. It's still another person's medical records!

Yes, to the extent that I don't think plandeaccordement understands the word 'confidential'.

I am totally astounded. Of course it should go on a child's record if they were exposed to alcohol in utero. When doing a child's developmental assessment the question is asked and goes on the child's notes.

It's not about the mother it is about the child.

Where is the line otherwise. Do we not record cannabis /heroin ? Are there some substances that it's ok not to mention on the child's notes but not others?

Well, yeah .