Valerie Gommon Midwife’s Blog

Archive for the ‘DoH’ Category

Valerie says: “I am NOT trying to convince you either way – the DoH strongly recommends that women have the flu vaccine, many women are cautious and have concerns – I am just trying to give you accurate information to facilitate your decision-making.  This article is a mixture of anecdotal evidence and research articles for you to follow up if you wish – it is necessarily quite “heavy” and at times frightening reading.  I wish you well in your decision-making.”

 

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_108154.pdf

www.dh.gov.uk/en/AdvanceSearchResult/index.htm?searchTerms=swine+flu+pregnancy

http://vran.org/about-vaccines/specific-vaccines/influenza-vaccine-flu-shot/commentary-on-influenza-the-vaccine/

www.cmace.org.uk/CMACE-Latest-News/December-2010/Urgent-advice-on-the-management-of-H1N1-winter-flu/Microsoft-Word—Final-171210-Advice-on-influenza-.aspx

The info below was written by a well respected researcher Angela Horn:

The problem with swine flu is that it appears to be affecting younger, previously healthy people with severe respiratory complications – it’s almost like seasonal flu plus an additional respiratory element.  In our small town, the brother of a local vicar died just before Christmas – in his late 40s, no existing health problems, and he had young children.  He went downhill very suddenly apparently.  We had a post on this list before from a mother who had swine flu so mildly she didn’t know she had it, but her baby died in utero as a result – what a shocking tragedy.  In contrast, when I search for ‘proven risks of swine flu immunisation’, I am struggling to find much hard evidence of known problems.  

Is there any evidence that the swine flu vaccine causes miscarriage?

There are a lot of women who were in the first trimester of pregnancy, had the swine flu vaccine, and then miscarried in the week or so afterwards.  I can understand how awful that would feel – I’ve had 3 miscarriages and each time was going over the past few weeks with a fine toothcomb, wanting to find a reason.  But in these cases of miscarriages following the vaccine – sadly there is a relatively high rate of first-trimester pregnancies which end in miscarriage, and there is very little evidence to suggest the vaccine was responsible.  If you are having your first pregnancy then estimates very, but you may have around a 1 in 5 risk of miscarriage.  If you’ve never had a miscarriage and have had a live baby before, then your risk of first-trimester miscarriage is still 1 in 10, and that is amongst women with a clinically-confirmed pregnancy. Those of us with a history of miscarriage have a 1 in 3 chance and rising with each m/c and with age.  From bitter experience I can say that strong sickness is little proof you won’t miscarry (my strongest sickness of all my 9 pregnancies, was the one where the baby died earliest – strong sickness indicates a healthy hormonal state but doesn’t tell you if your baby has chromosomal abnormalities). Even having a healthy heartbeat at 7 weeks, still appears to leave somewhere between 1 in 10 and 1 in 20 of those who won’t make it to 12 weeks. Even at the 11-12 week stage, about 3% of women who go for a scan, suspecting no problems, find that their baby has died. Therefore, even if you are in a low-risk group for miscarriage, and you have a flu jab in the first trimester, we would expect that a proportion of women would miscarry in the days and weeks after any vaccination, just by chance.  So finding a thousand stories on the internet of women who miscarried after the flu jab, is not evidence that the jab is related, unless every single woman who had the jab uneventfully, is also publishing her story and you can see that the vaccinated women have a higher rate of miscarriage.  I don’t want to disrespect people’s feelings, but there is a huge difference between finding a lot of stories from women who miscarried after having a jab, and having evidence of a link.  You might similarly find that 1 in 10 of women who’d been swimming in early pregnancy went on to have a miscarriage, but nobody’s worried about a link there.

Do we have any evidence on the safety of immunisations in pregnancy generally?

Anyway….  for me, the risks of the flu in pregnancy are known and confirmed, with massive evidence for them.  Even if you get flu with no complications, it’s still a horrible week or two.   But the concerns about the vaccine seem generally to be ‘unknown unknowns’.  All of the reviews I’ve looked at on PubMed say that no evidence of any harm has been found.  I know we’re all worried about 30 years down the line, but personally I couldn’t find anything to support that.  It is theoretically possible that this will turn out to be harmful – but is it **likely**?  If it was likely, I would expect that we would have some clues from women who had other vaccinations in pregnancy 30 years ago – OK it wasn’t routine then, but there have been other vaccinations.  For instance, in 1981 a registry was set up in the UK of women who were given MMR or rubella vaccinations while in early pregnancy, and it appears that no problems have arisen.  See http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1221202948790

This article on immunisation in pregnancy has some refs which may be worth following up:

http://www.medscape.com/viewarticle/735052_2

Here are the WHO articles on immunisation in pregnancy:

http://www.who.int/vaccine_safety/topics/influenza/pregnancy/en/index.html

The HPA page on pregnancy and flu vaccine:

http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1259152092520#what_do_we_know_safety

And a review on PubMed which might be a good starting point for exploration:

http://www.ncbi.nlm.nih.gov/pubmed/18156088

I had it last year, when pregnant.  I am sceptical  by nature, and not someone who immunises automatically – I used to be very anti vaccination in general, but have come round to being broadly in favour on a case-by-case basis, based on things like seeing whooping cough going round my children and those of my anti-vaccination friends ……  I found that the Dept of Health recommendations to immunise in this case were well supported by references and research, whereas most of the anti case seemed to be based on concerns about imms in general, plus the idea that this was a new vaccine.  But it’s no more ‘new’ than any seasonal flu vaccine, as far as I can see.  Flu strains vary so the vaccines vary year-on-year, but it looks like the basic bones of the swine flu vaccine are pretty much the same as any other flu vaccine.

I was rattled by the stat that pregnant women were 10x more likely to end up in Intensive Care with swine flu, and combined with the known increased risk of children developing schizophrenia when the mother caught any form of flu in pregnancy, I didn’t want to muck about.  I know that others have felt very differently!  I have had flu during one of my pregnancies and it was horrible. My sister-in-law was hospitalised with the same flu, while pregnant (caught off me 😦 ).  Also, one of my miscarriages was after a flu-like illness (probably Norovirus actually) and high fever is associated with miscarriage, so I did not want to take that risk again.

Here are some things I found helpful:

A New Scientist article, a general overview on swine flu.

http://www.newscientist.com/article/dn18014-swine-flu-myth-the-vaccine-isnt-safe–it-has-been-rushed-through-tests-and-the-last-time-there-was-a-swine-flu-scare-the-vaccine-hurt-people-why-take-the-risk-to-prevent-mild-flu.html

http://www.newscientist.com/special/swine-flu-myths-that-could-endanger-your-life

http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Adviceforpregnantwomen.aspx

http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx

With regard to the mercury content of the vaccination, one thing which surprised me was reading about the difference between Ethyl mercury and Methyl mercury.  We know that long-term exposure to mercury is dangerous and that methyl-mercury (the sort you find in low-energy lightbulbs….) stays in the body for ages.  However, the preservative used in vaccinations is Thiomersal/Thimerosal (spelling varies from UK to USA) and this is converted by the body to Ethyl mercury, which is rapidly excreted.  Something about this here:

http://combatingautismfromwithin.blogspot.com/2007/12/comment-ethyl-and-methyl-mercury-not.html

I know there will be many other interpretations of all this, but you asked for personal opinions.  After I had the jab last year, I had a sore lump on my arm for a week but that was all.  I’ve had the seasonal flu jab (which includes swine flu) this year – not pregnant, but want to minimize the risk of getting flu and nobody being able to look after my 6 children, DH needing to work and all that.  No sore arm or anything else this time.  My best pal was planning to go for the seasonal flu jab too but didn’t get round to it.  She got flu, and has been in and out of hospital for the past month with secondary pneumonia and pleurisy. She’s a health-conscious, organic-eating, non-smoker.  I’ve been looking after her kids for much of the last month – a dose of true flu has had a real impact on her family. She’s been told it will be months before she’s fully recovered.  I am very, very aware of all the unknown **possible** risks from vaccination, but my personal perspective is that here we are weighing a possible, theoretical, rare and unlikely risk against a known, actual, quantifiable harm.  For some people, there will never, ever be enough evidence to reassure them that a particular vaccine is acceptably safe, but personally I think at some point you just have to take a view and weigh up the evidence you actually have, and not give disproportionate consideration to concerns about evidence that you think is missing. ‘We still don’t know enough about the risks’ is used by many people as an argument about homebirth, after all!

http://www.cmace.org.uk/getattachment/15d82450-849a-4bbd-bacc-4cdb4483a150/Review-of-Maternal-Deaths-in-the-United-Kingdom-re.aspx

 

In a paper published yesterday in the British Medical Journal researchers from the University of London Institute of Child Health (UCL) claim that relying purely on breastfeeding for the first six months might not be best for babies. Interestingly, the study “acknowledges that three or four of the authors have performed consultancy work and/or received research funding from companies manufacturing infant formula” which brings into question the validity of the research; a further criticism is that research needs to be population specific.

Today, many prominent organisations have spoken against this paper, however it is confusing for members of the public and undermines the work that midwives and others do to promote breastfeeding.

The current advice in the United Kingdom based on World Health Organisation guidelines, says that babies should be exclusively breastfed for 6 months however the UCL team say that weaning could happen as early as four months as it is claimed that the later weaning might increase food allergies and lead to nutrient deficiencies.  This statement is heralded as a “retrograde step” by the Royal College of Midwives professional policy adviser Janet Fyle and others.   Indeed a Department of Health spokeswoman said: “Breast milk provides all the nutrients a baby needs up to six months of age and we recommend exclusive breastfeeding for this time. Mothers who wish to introduce solids before six months should always talk to health professionals first.

In summary the current best advice is to exclusively breastfeed for six months and then to continue breastfeeding with food supplements for at least a year.

Further discussion can be found at:
www.guardian.co.uk/lifeandstyle/2011/jan/14/breastfeeding-comment-joanna-moorhead

It is crunch time and we really need your help if independent midwives are going to be able to practise in the UK in future. If you recognise the value of personalised, high quality midwifery care throughout pregnancy, birth and after the baby is born that an independent midwife is able to provide, then please could you let the government know NOW.

For several years the government’s new policy that all healthcare professionals have indemnity insurance has been put on hold. Last year the government commissioned the Finlay Scott Review to look at the feasibility of indemnity insurance as a condition of every healthcare professional’s registration. The Review has now been published and recommends that indemnity/insurance should become mandatory and a requirement for registration. However it also recommended for those groups for whom the market does not provide affordable insurance or indemnity (independent midwives), the relevant Departments of Health in the four countries of the UK should decide if the continued availability of this service is necessary; and, if so, should seek to facilitate a solution to the problem. (See more information in the letter below)

The Departments of Health are due to respond imminently to this Review – and their responses will be a perfect vehicle through which to address this anomaly with solutions from policy-makers.

Can you please send an email to your MP and copy it to your relevant Department of Health. Could you also print your letter and send it as a hard copy to your MP and Department of Health as although slower, receiving lots of letters is more effective. Please feel free to use any information on this page, and/or include your own feelings and experiences.

Find your MP by clicking on: http://findyourmp.parliament.uk/ and click on his/her website to find their email and constituency postal address. Don’t use the House of Commons address for MP’s at this time of year as it is in summer recess.

Departments of Health:

England:
Mike.Lewis@dh.gsi.gov.uk

Mike Lewis
Senior Policy Manager
Professional Standards Division
Department of Health
2N10 Quarry House
Quarry Hill
Leeds.
LS2 7UE

Scotland:
Catherine.clark@scotland.gsi.gov.uk
Catherine Clarke
Regulating Unit
Chief Nursing Office
St. Andrew’s House
Regent Road
Edinburgh
EH1 3DG

scottish.ministers@scotland.gsi.gov.uk
Nicola Sturgeon
Cabinet Secretary for Health and Wellbeing
The Scottish Parliament
Edinburgh
EH99 1SP

Wales:
correspondence.edwina.hart@wales.gsi.gov.uk

Edwina Hart
Minister for Health and Social Services
Welsh Assembly Government
Cathays Park
Cardiff
CF10 3NQ

Northern Ireland:
private.office@dhsspsni.gov.uk
Michael McGimpsey
Minister for Health, Social Services and Public Safety
Room C5.10
Castle Buildings
Stormont Estate
Belfast
BT4 3SQ

Please inform as many other friends, family and supporters such as local NCT groups, Women’s Institute, etc as possible.

Without positive government intervention independent midwifery will become illegal in the very near future. If a solution is provided, it could benefit maternity services in the UK for decades to come.

Thank you for your support!

Sample letter

Dear MP

RE: Finlay Scott Review

I’m writing to ask for your help in giving thousands of families greater opportunity to have safe positive pregnancies and births with support into early parenting.

The Government recently heard from the Finlay Scott Review, which had been asked, to look at indemnity insurance as a condition of professional registration. The Review recommended that the Government should make indemnity / insurance a requirement of every healthcare professional’s registration. However it also recommended for those groups for whom the market does not provide affordable insurance or indemnity (independent midwives), it should decide if the continued availability of those services is necessary; and, if so, should seek to facilitate a solution to the problem.

There are currently approximately 100 independent midwives in the UK, providing high quality, one-to-one care to families throughout pregnancy, birth and early parenthood. It is this kind of genuinely personalised care, from their own midwife, that growing numbers of women want. It has significant public health benefits in terms of increased normal birth and breastfeeding rates and saves money.

Taking on independent status is also something which offers great advantages to midwives themselves, empowering them as frontline workers, to work closely with women and with more flexibility in their working lives – crucial if the drain of midwives from the profession is to be reversed.

The barrier to independent midwives providing this service is that they cannot be indemnified or insured. This is due to the number of independent midwives currently being too small to enable the risk to be pooled and spread in a way that produces an affordable premium. There is simply no insurance available for independent midwifery services. This is standing in the way of more pregnant women benefiting from this type of care and enabling more midwives to work this way.

In 2013, independent midwifery will be made illegal under EU law if a solution is not found. EU legislation by then will require all health professionals to have indemnity/ insurance.

The benefits of finding a mechanism to indemnify or insure independent midwives will be:
• independent midwives will be able to provide care within the NHS with improved public health outcomes, reduction in costs and increased choice for women;
• women’s choice will be maintained;
• the risk reduced of some women choosing to give birth unaided if unable to access care that is acceptable to them within the NHS;
• midwifery expertise in normal birth skills will not be lost;
• more midwives staying in the profession.

The government is due to respond imminently to the Findlay Scott Review. The Review recognises that a potential problem arises from its recommendations but also acknowledges that the government could intervene to provide an affordable solution.

Please support my request to recognise the importance of this service for the safety and wellbeing of mothers, babies and families by calling for the indemnity/insurance issue to be resolved by the Department of Health.

Regards

Thank you so much for your support!

Valerie Gommon

Independent Midwife

www.3shiresmidwife.co.uk

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

Understandably, one of the “hot topics” of the moment is should pregnant women accept the Swine Flu vaccine.

On discussions with women I have met with many women who are concerned about the vaccine and unsure whether to be vaccinated

Pregnant women are not known to be more susceptible to catching swine flu but if they do the risk of complications is higher because their immune system is naturally suppressed and the Department of Health is recommending and prioritising the vaccine for pregnant women.  It is important to remember that for the vast majority of people (including pregnant women) that, although unpleasant, influenza is self-limiting and the vast majority of people will make a quick recovery.  Should a pregnant women develop flu the recommended treatment is early instigation of antiviral therapy.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_107768.pdf

Recent Department of Health advice is available at: www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_107340

Obviously if you are unwell do follow the Government’s advice http://www.direct.gov.uk/en/Swineflu/DG_177831 or contact your doctor or midwife for advice.

However a recent Guardian article quoted a survey, published by the website mumsnet.com, confirmed the uncertainty felt as almost half – 48% – of pregnant women who responded said they probably or definitely would not have the jab if it is available. Only 6% said they definitely would and 22% said they probably would.

http://www.guardian.co.uk/world/2009/sep/02/swine-flu-vaccine-pregnant-women

Another recent article www.examiner.com/x-4079-SF-Sexual-Health-Examiner~y2009m10d23-California-suspends-ban-on-thimerosal-containing-H1N1-vaccine-for-pregnant-women  also raises concerns about the immunisation programme.

I am unsure which vaccine is being given to pregnant women in the UK – this may be something for you to research further.

Good luck with your decision making.

When a mum is breastfeeding she is giving her baby the very best – breastmilk is full of antibodies and is therefore hugely protective.

The Department of Health has issued advice on what to do when breastfeeding if you have contracted the flu.  If a mum is receiving antiviral treatment or prophylaxis, they are advised to continue to breastfeed as frequent as possible and continue to have as much skin to skin contact as possible with the baby.  Ensuring hands are washed as frequent as possible as well as limiting the sharing of toys.

For more information on breastfeeding and swine flu go to www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965

I have just “appeared” on 3 Counties Radio to discuss a local news item.  A Sainsbury’s employee refused to sell local woman, Janet Lehain, unpasteuried cheddar because she was pregnant!

Whilst applauding the employee for pointing out the recommendation that pregnant women do not consume unpasteurised products I have to say that I believe they overstepped the mark by refusing to sell her the cheese!  The woman could have been buying the cheese for her husband and whatever happened to freedom of choice? 

I am a firm believer in Informed Choice, we are very cautious where pregnancy is concerned because although the risks are very low there could be serious implications for the baby SHOULD the mother contract food poisoning.

The Department of Health guidance in early pregnancy is to be extra careful with hygiene; food poisoning is bad news for your baby. They suggest that women don’t eat any unpasteurised foods – most food is pasteurised, but some speciality milks, cheeses/diary are not.

The recommendation is to avoid moulded or veined cheeses and pate/salami. Eggs should be well cooked not runny. Fruit and vegetables should be washed prior to eating. It is suggested that you don’t eat swordfish or marlin and limit the consumption of “oily” fish to twice weekly. Sea food should be cooked not raw. Liver is not recommended for pregnant women.

Whilst pregnant the current recommendation is not to drink alcohol at all, and it is better to limit the amount of caffeine you take (tea, coffee, cola and fizzy drinks), and obviously it would be wise to stop smoking and avoid any “recreational” drugs prior to getting pregnant.

We are still evaluating the evidence regarding eating peanuts in pregnancy – the best current advice is that if you have nut allergies in the family it may well be best to avoid eating nuts in pregnancy; it there are no nut allergies then use your own instinct and judgement as to whether you feel safe to eat nuts (bearing in mind they are a good source of protein, particularly if you are vegetarian or vegan).

Having made a huge list of foods to avoid, you are encouraged to eat plenty of fruit and vegetables (aim for at least five a day), plenty of protein (at every meal if you possibly can) and plenty of iron rich foods (red meat, pulses, green vegetables).

You can read articles I have written at:

www.birthindex.co.uk/Planningababy.pdf and www.birthindex.co.uk/SOYOUAREPREGNANT!.pdf or

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=59

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=64

When a mum is breastfeeding she is giving her baby the very best – breastmilk is full of antibodies and is therefore hugely protective.

 The Department of Health has issued advice on what to do when breastfeeding if you have contracted the flu.  If a mum is receiving antiviral treatment or prophylaxis, they are advised to continue to breastfeed as frequent as possible and continue to have as much skin to skin contact as possible with the baby.  Ensuring hands are washed as frequent as possible as well as limiting the sharing of toys.

For more information on breastfeeding and swine flu go to www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965


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