Women And Alcohol Case Study
In 2002, the charity Turning Point indicated that 3.8 million people in England and Wales are dependent on alcohol. Of these, 800,000 are women. This is six times as many people as are dependent on Class A drugs. The study also showed that 13 people die every day as a results of alcohol misuse (Waiting for Change, 2002).Figures released by the NHS Information Centre revealed that 55 per cent of women in the UK admitted drinking alcohol while pregnant. Of the women who drank before they conceived, only a third gave up alcohol altogether while pregnant and the rest said they cut down (Smith, 2008).Heavy drinking carries a higher risk of heart and liver complications for women than men and the alcohol-associated mortality rate for women is 50-100 times higher than it is for men (Smith and Weisner, 2000).Whilst out on placement with my community midwife, I witnessed the care of a woman who was 35 weeks pregnant.
She was 38 years old and a primip. She had been dependent on alcohol for the last five years. Once she discovered she was pregnant she decided she wanted to stop drinking alcohol. Due to the fact she had been drinking for so long it was unsafe for her to just stop, so she had to be weaned off it. Her midwife advised her to see her GP who then referred her to an outpatient substance misuse centre to be treated for her alcohol misuse.
She subsequently went on to a local in-patient unit where so completed her detoxification. She was then provided with specialist care for herself and the fetus. She also attended many counselling sessions, some of which she still goes to.By the time we saw her at 35 weeks she was not drinking anything. However, harm may already have been caused to the fetus as she was drinking when she conceived and then for the first five months.The National Institute for Health and Clinical Excellence (NICE), are an independent organisation that monitors standards in the National Health Service (NHS). In 2008, they published a separate set of guidelines about drinking alcohol during pregnancy.They advise that during the first three months of pregnancy women shouldn't drink at all as it may increase the risk of miscarriage and harm to the fetus.
If women choose to drink they should consume no more than one to two units once or twice a week. There is no evidence of harm to the fetus at these low levels, according to NICE (NICE, 2008).Alcohol passes to the placenta, through the blood, from the mother to the fetus. The liver of the fetus does not mature until the second half of the pregnancy. Therefore, the fetus cannot process the alcohol as well as an adult can and it is exposed to greater amounts of alcohol for longer periods of time (NHS, 2008).The exact level of alcohol intake is not yet known in relation the risks increasing of miscarriage or damage to fetus. However, a woman is taking a risk with the health of the fetus if she drinks more than the recommended guidelines.
If a mother binge drinks (drinks more than six units on one occasion) then she faces the chance of miscarriage, stillbirth, premature birth and small birth weight (Gray & Henderson, 2006).Fetal exposure to alcohol results in a spectrum of adverse effects known as Fetal Alcohol Spectrum Disorders (Sokol et al, 2003), with the brain and central nervous system being particularly susceptible to alcohol throughout gestation (Streissguth and O'Malley, 2000). Approximately 7,000 children are born with FASD each year (Mather, 2009). Symptoms of FASD include learning difficulties, problems with emotional development and behaviour, memory and attention deficits, hyperactivity, difficulty in organising and planning, and problems with language. Also facial deformities, being small, at birth and throughout life and poor muscle tone.As a result of their difficulties with learning, judgement, planning and memory, people with FASD may experience additional problems.
These include psychiatric problems, a disrupted education, trouble with the law, alcohol and drug problems, and inappropriate sexual behaviour (BMA, 2007). Children with FASD can have one or several of these symptoms. If a child displays all of the symptoms they are diagnosed with Fetal Alcohol Syndrome (FAS). It depends how much a mother drinks and at what stage of her pregnancy as to how the fetus will be affected.
For example, heavy drinking is most likely to cause damage to the organs in the first three months (BMA, 2007).Epidemiological studies show that more women in the UK are now drinking at hazardous and harmful levels than ever before (Plant, 2006). The Government now work in partnership with local authorities, police and other enforcement agencies, the NHS, voluntary and community organisations, the prison and probation services, alcohol industry and wider society.Provisions of local services vary in different areas but the following services should be available: community alcohol team, community alcohol team, alcohol specialist psychiatrist, specialist alcohol unit and community psychiatric nurse (CPN) with alcohol remit (UK Alcohol Forum, 1998).Since the Government published the Alcohol Harm Reduction Strategy for England in 2004, real progress has been. Most of the commitments within the Government's strategy have been delivered.
The strategy aimed to reduce the harm caused by alcohol misuse through a programme of joint government and industry action for: better education and communication;improving health and treatment services; combating alcohol-related crime and disorder; and working with the alcohol industry.The Faculty of Public Health define public health as "the science and art of preventing disease, prolonging life and promoting health through organised efforts of society" (Acheson, 1988). Public health is about promoting physical, mental or emotional well-being by inspiring, educating and empowering the public to stay healthy. Midwives play a very important role in achieving this.Inequalities in health are defined as the difference in morbidity and mortality between individuals of higher or lower socio-economic status, to the extent that the differences are perceived to be unfair (Bostock, 2003).
Income, education, employment, environment and lifestyle behaviours such as smoking, drinking, diet and risk taking are all factors which contribute to inequality and have an impact on ill health (DoH, 1998).In spite of universal health care, poverty still negatively affects prenatal, infant and maternal health. Women in the lowest socio-economic group are four times more likely to have pregnancy related complications that require hospitalization (Mustard et al, 1995). Some research shows that pregnant women who live in poverty may not be a special needs group, but are the mainstream maternity population (Braverman et al, 1999).Women have higher poverty rates than men in almost all societies (Casper et al.
1994). The widely accepted definition of poverty is having an income which is less than 60% of the national average (excluding the wealthiest members of society). On this measure, the proportion of the UK population defined as in poverty is roughly one in five (Knight, 2005). Drinking over the sensible drinking guidelines is more common in areas of high deprivation. For women living in the most deprived areas, alcohol-related death rates are three times higher than for those living in the least deprived areas (DoH, 2007)."Poor conditions lead to poorer health.
An unhealthy material environment and unhealthy behaviour have direct harmful effects, but the worries and insecurities of daily life and the lack of supportive environments also have an influence."(Wilkinson & Marmot, 1998).The central findings of new research from the Institute for Social and Economic Research (ISER) state that children are more likely to leave home early, to do less well in school and to be economically inactive after they reach adulthood if they have grown up in poor families.Also, adolescents who grew up poor have lower self-esteem, are more likely to plan not to marry, they believe that health is matter of luck, play truant and expect to leave school at the age of 16, compared to who never experienced life in a low-income family (ISER, 2001).Higher risk of early childbearing was associated with growing up poor. Particularly girls aged 11-15 living in poorer households (ISER, 2001).Social disadvantage has an enormous impact in childbearing.
It often goes hand in hand with health inequalities, which therefore increase the risk of perinatal morbidity and mortality, for example in the birth of low birth weight babies (Boyle, 2002). The importance of the social context of childbearing and health inequalities were highlighted in the Winterton report (House of Commons Health Select Committee, 1992). It expressed the view that the outcome of pregnancy was dependent to a large degree on an woman's social environment.The next steps for the national alcohol stratergy include sharpened criminal justice for drunken behaviour; a review of NHS alcohol spending; more help for people who want to drink less; toughened enforcement of underage sales; trusted guidance for parents and young people; public information campaigns to promote a new 'sensible drinking' culture; public consultation on alcohol pricing and promotion; and local alcohol strategies.Midwives play a very important role in this as they are quite often the first point of contact with pregnant women, and alcohol should be being discussed in every one's booking appointement.Final Word Count: ****
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