Valerie Gommon Midwife’s Blog

Archive for the ‘www.nhs.uk’ 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

 

Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html

Last night I watched Louise Redknapp’s documentary entitled “The truth about super skinny pregnancies” – wow … what a sad world we live in.  Women and, in particular, celebrities seem to be obsessed about maintaining an unnatural body shape.  Redknapp tried hard but, in my opinion, failed to make a balanced documentary and planned an underwear shoot nine weeks after giving birth to her second baby.  Indeed she even managed to leave her young baby to go to the USA to film the documentary!

According to one expert, as many as one in 20 women could be putting their unborn child’s health at risk by extreme dieting during pregnancy – so-called “pregorexia” – what message are “celebrities” sending to our pregnant women?  In the programme Louise met one woman who, despite being two weeks away from giving birth, had put on just eight and a half pounds – apparently only eating one apple every two days.   As I have said before, it is true that the baby will take what it needs from the mother, but what state will the mother be in?  She may well suffer complications of pregnancy or childbirth and may well not be healthy enough to feed and care for her baby.

So many “celebrities”, Redknapp included, opt for caesarean sections (obviously I don’t know her reasons) which are so much riskier for both mother and baby.  Our caesarean section rate is over 25% in many maternity units, partly fuelled by women requesting them on “social” grounds.

The NHS website www.nhs.uk/Conditions/Caesarean-section/Pages/Risks.aspx?url=Pages/what-is-it.aspx details the risks of caesarean as:

  • infection of the wound,
  • inflammation of the membrane lining your uterus known as endometritis, this can cause fever, uterine pain and abnormal vaginal discharge, which can be treated with antibiotics,
  • decreased bowel functions the surgery may mean your waste material moves slowly through your intestines, leading to constipation,
  • thrombosis (clot) formation in your legs, which can be dangerous if part of the clot breaks off and lodges in the lungs,
  • excess bleeding, and
  • temporary problems with bladder control, or damage to your bladder
  • the major risk for your baby is that it may be affected by temporary breathing difficulties. Directly after the birth, and in the first few days of your baby’s life they may breathe abnormally fast; this is called transient tachypnea, admissions to special care are more common following caesarean sections
  • there are additional risks and complications for women who have multiple caesarean sections

There is also a very small risk of death during a delivery for both you and your baby.  This risk is three times greater for a caesarean section than for a vaginal delivery.

It goes on to say that, it is important to remember that this procedure has saved the lives of many women and babies over the years. Where a danger to health has been identified, the risks of a caesarean section are usually far outweighed by the risks of not doing it, particularly in an emergency situation, and I wholeheartedly endorse this.  I am not writing this to scare anyone.  Caesarean sections are incredibly safe, BUT they are much more risky than a normal birth, and recovery time is generally so much quicker following a vaginal birth.

It is true that your body will be different after a pregnancy, but what price to pay for a beautiful baby?  I believe that body changes are a mother’s “badge of honour” – we should be proud of our bodies, stretch marks and all!


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