The modern mother needs to be wearing internal andexternal armour to battle the hidden enemy, and the modernmidwife needs to provide the right types of weaponry toprepare women for their pregnancy journey. Every day weread news reports, research papers and alerts that identifythe harm to the mother and baby from ingested chemicals.Some are prescribed and we refer to them as ‘medications’and others are consumed for recreational purposes and werefer to them as ‘drugs’. There is a vast difference betweencompliance with prescribed medication for life-threateningconditions, such as cardiac anomalies, diabetes and asthma,and recreational drugs, such as marijuana, cocaine, ecstasyand ketamine. The known enemies are alcohol and cigarettes.Another hidden harm is the potentially unknown effects ofnon-ionising radiation emissions from computers, mobilephones and other household items, such as microwaves,alarms, electric doors, electric blankets and televisions. Butit will take data from case-controlled studies to give us thenecessary evidence and that will take years.Pregnant women need to know where to go to if they needinformation about the safety of using products, such as deetfound in flea sprays and insecticides. Threats from the socalled‘fresh air’ include viruses and bacteria and we advisewomen to become vaccinated. The battle against infection isprobably the most dangerous of all and has a mortality ticketfor both mother and baby, as we have observed in the pasttwo years with the number of mothers who have died fromH1N1. It is understandable that the DH issued new advicefor pregnant women encouraging them to take the pertussisvaccine as the number of new cases reported in 2011/2012was approximately 5000 (DH, 2012).Advice was given without the highest-quality evidence tosupport its universal adoption, but this is understandableas the risks from epidemic proportions appear to be toogreat. What we need to learn from these events is thatinfection is a major threat and we need to be constantlyalert. Our attention has just been focused on the harmfrom ‘chips and crisps’. Unbelievable. I am sure some ofyou are asking yourselves, ‘Whatever next?’ However,this research warrants serious consideration. It was theresult of robust research evidence demonstrating a smallerhead circumference for babies whose mothers ingestedthe chemical acrylamide, found in starchy foods heatedto very high temperatures. The research involved 20 siteswith 14,000 participants across Europe. The UK arm tookplace in Bradford and 186 mothers participated. The datafrom mothers about food consumption was based on selfreportusing the Food Frequency Questionnaire, but one ofthe major scientific measures in the study was cord bloodanalysis to detect the levels of acrylamide (Pedersen, 2012).The potential for harm to the infant was alarming andlinked to longer-term outcomes impacting on neurologicaland psychological development. The UK cohort of infantshad significantly higher levels of the drug in their cordbloods and dietary patterns indicated higher consumptionof chips and crisps. So we advise pregnant women to cutdown on these foods. This new evidence is likely to beadopted by us, because it fits well with the key behaviouralchange messages around prevention of obesity in pregnancy.Now I want to touch on an even more sensitive subject:‘breastfeeding’ and harm from dioxins emanating fromman-made products such as PVC and bleached chlorinatedpaper and microwave plastics. These polychlorinateddibenzodioxins (PCDDs) or plastics, commonly referred toas dioxins, are transferred in breastmilk and accumulate overtime and are known carcinogenics. The US Department ofHealth and Human Services Public Health Service Agency forToxic Substances and Disease Registry (ATSDR, 2006) statesanimal studies have indicated that PVC is likely to increasethe risk of cancer in infants and young children.Twenty years ago, Greenpeace campaigned about thisharmful toxin being transferred in breastmilk and formulafood. Dioxins accumulate in the body over time and can effectbrain development. In 1998, the WHO reported that dioxinconcentrations in breastmilk had reduced by 50% (WHO,1998). The current mantra remains: ‘Breast is best and thebenefits outweigh the risks.’ But it is important to note, thereis no evidence to state there are no risks associated withbreastfeeding. Weighing up the balance between harm and goodis complex and midwives need to refer mothers to the websiteOtis for advice about fear of birth defects (otispregnancy.org/files/deet.pdf). The battle against harm of one kind or anotherwill always be with us and we need to be constantly vigilant.
|Journal||Evidence Based Midiwfery|
|Publication status||Published - Dec 2012|
- evidence-based midwifery