The forgotten victims of drinking culture

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    Editorial

    Thalidomide, radiation, mercury and rubella are all recognized as harmful for unborn babies.

    Alcohol is in the same group. It is a teratogenic agent, which means that it can interfere with normal development as a baby grows from conception until birth by causing different ill effects, depending on the strength and amount of alcohol consumed and the stage of development in the womb when the foetus is exposed to alcohol.

    The only thing more terrifying than the cold, hard scientific hypothesis is the social consequences of ignoring it.  Scotland’s Chief Medical Officer Dr Harry Burns has said prenatal exposure to alcohol is the leading cause of brain damage and developmental delay amongst children in industrialised countries.

    There are too many gaps in the research about foetal alcohol syndrome (FAS) to provide a reliable guide on what level of drinking is safe or during pregnancy or whether alcohol should be avoided entirely.  A study in 2010 by the University College London suggested woman can drink a 175ml glass of wine, a 50ml glass of spirits or just under a pint of beer each week without damaging their child’s intellectual or behavioural development.

    However, the Health Evidence Network of the World Health Organisation did a study in England, Finland, Denmark, the US and Australia and found a significant association between prenatal alcohol exposure and cognitive and socio-emotional deficits.

    What the disparate international research does validate is a cultural fact; we all look to justify our choices based on externalized logic.  Who doesn’t love finding out that eating chocolate has health benefits?

    Meanwhile, we tend to undervalue everyday common sense as blindingly obvious yet we don’t face up to what needs to be done. Our culture engenders and tolerates more excessive drinking by more people and the focus for pre and post natal care is often about women. One area of the debate that is ignored is that men have a crucial role to play in the prevention of FAS.

    As we slowly come round to the idea of equal, shared parenting and implement more flexible working policies in the UK, we acknowledge that men have as much of a role to play in determining the life chances for their children as women do.  Take a look at any parenting or pregnancy forum and the chances are you will see questions posted by expectant fathers.

    From lifestyle to the environment the baby is conceived in, a man’s attitude to his partner’s drinking during pregnancy is critical.  When midwives and doctors talk to women about the risks, equally, we need to make sure our health services and campaigns work with men on this issue.

    Women who understand the risks and decide it’s worth the calculated risk of occasional or moderate drinking in pregnancy are perfectly entitled to make their own decisions.  Research doesn’t prove it’s harmful.  But neither does it prove incontrovertibly that it’s not. The only certainty to take comfort in is that no alcohol from conception until birth always results in no foetal alcohol harm.

    Our health services need rigorous training and support in working with alcohol misuse.  The last thing we want to hear from midwives at the coal face is ‘give me a heroin addict any day’.  Dishing out methadone is easy because it doesn’t treat the root causes of addiction.

    For women already struggling with an addiction, intensive pre and post natal support is needed.  And as a society we could develop a more compassionate attitude to working with those who fall into the spiral of alcohol addiction.  We too easily assume, while we are egged on by over simplified stereotypes played out in the media, alcohol addiction, school exclusions or repeat offending are simply down to bad attitudes, laziness or lack of will power.

    It’s likely that people who suffer foetal alcohol harm are disproportionately represented among the learning disabled, convicted criminals, substance abusers and those who struggle with alcohol dependency.  Some studies suggest foetal harm is the leading cause of learning disabilities; FAS is often misdiagnosed as ADHD or attributed to bad behaviour.

    The recent Scottish Government appointment of a new FAS coordinator represents progress; we will begin to unravel the latest research and develop a clinical policy.  But the impact will be zero of we fail to invest enough in early prevention and support services to break cycles of drug and alcohol abuse or tackle the socio economic causes of addiction.{jcomments on}

    Jolene Cargill