FAS: Support vs Blame

Switching from an 8.30 – 4.30 placement to shifts last week, I found myself within earshot of the Jeremy Vine show on Radio 2. I was shouting at the radio as people mansplained the catcalling video that’s still doing the rounds. However, that’s not what this post is about; we’ll leave the objectification of women and how they should be grateful for the attention (*sigh*) to another post, another day.

The story that struck me was that there is currently an appeal taking place for compensation to be awarded to a child who is suffering the effects of Foetal Alcohol Syndrome (FAS). The high tribunal found that the pregnant mother was not at fault as the nature of the crime alleged couldn’t be a committed against a someone who was classed as “not a person” in terms of the law. You can read it here.
Cases have been successful before, but the rules changed in November 2012, so only cases submitted before that date have paid out (if awarded) since that date. Just this September compensation of £500,000 was awarded to a girl whose mother “drank heavily” during pregnancy.

When alcohol is consumed during pregnancy it has the potential to cause physiological damage to the foetus and later behavioural issues too. Organ development, hormone function and dysmorphic facial features of children have been linked to the impairments presented by alcohol consumption of the mother. There is also the increased possibility that a child will have a lowered concept of consequences of their actions as they grow up and a lack of understanding boundaries making it difficult for them to socialise at their age level. Difficulty in communicating can lead to frustration, and subsequent lashing out both verbally and physically.

Where folic acid is most effective during the first 14 weeks of foetal development, alcohol is most damaging in the first half of that period – a time when a lot of women don’t even know they are pregnant.
The advice given by midwives is “We don’t know what would be classed as a “safe” amount of alcohol, so our advice is to avoid it completely.” avoidance in place of evidence is currently best practice when it comes to drinking. The word “excessive” is used in relation to the amount of alcohol being drunk, but as that’s a subjective term to most it’s not particularly helpful. Nor is it helpful to read or hear of news stories and studies proclaiming that it’s “nothing to worry about” – this creates blurred lines, confusion, and often leads to women having to interpret the recommendations for themselves.

So then, what of this story? It’s asking that women who have babies with FAS are to be prosecuted and the victim (child) to be compensated. I have endless sympathy with all children born with extra struggles and obstacles to be overcome…or insurmountable ones – but will criminalising women really help?

No.

Gosh that was black and white of me, wasn’t it? Yep.

In my personal experience caring for women with both drug and alcohol misuse, trust is a damned precious thing. In many cases, they have been engaging with the health services on and off for a long while for various reasons and may have been let down, reprimanded, or made to feel less than they are worth. When they choose to come to midwives with their pregnancy, the last thing they would want would be to hear about the legal implications of their actions; damnit it’s already difficult enough to sensitively assert the effects of the substances on the life growing inside them, and that’s without looming criminal proceedings.

Negative discriminatory attitudes exist in all walks of life, and I shudder to recall some of the things I have overheard from seemingly disillusioned health professionals. In my humble opinion, if you feel so strongly about a Daily M*il-type comment spinning around your thought process that you have to verbalise it perhaps working with people is not for you.

Honesty from women about what they are consuming is something borne of their trust, and if that has already been taken for granted, abused, and generally disrespected by others, why the hell are they going to give it to me? I have to earn it, and that would be made one hundred times harder if they are thinking that I’m helping with one hand, but writing secret updates for the Crown Prosecution Service over their “intrauterine child abuse” with the other.

Women who are smoking while pregnant are offered rightly support, not condemnation despite the health and behavioural problems this can cause children – including the anti-social disorders linked with FAS. Stop Smoking services are offered, but not compulsory. With women I’ve cared for, I have congratulated their efforts in cutting down on cigarettes, even if they are not at zero. The fact that they have reduced their smoking means they understand the health implications and are actively making an effort (much as the mother in this particular case did) – that should be applauded and encouraged. I can’t imagine they would share anything else with me if they thought they were always going to be met with negativity and reprimands.

I very much hope that there is a measured response to the appeal currently taking place; the suffering of the child in question is to be acknowledged, but if that is through the persecution and subsequent prosecution of their mother – I cannot support it.
When women with problems like alcoholism become pregnant, it is often the only regular contact that they will have with health services and we should be making the most of the opportunity to engage with them for support and help. If they think they will be deemed criminals of sorts we run the risk of them not engaging at all, further endangering their unborn child. I have had the opportunity to work with excellent specialist midwives and doctors so far who uphold the same ideals. Should the ruling for the appeal deem it necessary to wholly hold mothers accountable, the antenatal care will undoubtedly change and I fear this will be to the detriment of mothers, and subsequently their children.

 

 

 

 

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