Over the last couple of weeks I have been very pleased and proud to be working with ABC radio national to make a contribution to this most amazing audio documentary about stillbirth in Australia. Its a fantastic story well worth listening to!
Late last week the reporter contacted me regarding comments made by Dr Michael Gannon president of the AMA, about what a woman should do if she noticed her baby moving less. He said "We need to communicate this message to mothers that if they cannot awaken their baby from its sleep with simple measures like a cold drink ... then they should present to their maternity unit and then an appropriate test is done to either reassure the mother or to act on it and deliver the baby."
I was totally astonished that any doctor, let alone an obstetrician, would say something so obviously WRONG. The thought that the mother ingesting something cold has any possible way to wake an unborn baby whether that baby be well or not is not only inconceivable but outright baffling and yet he did say it, and then he tried to explain his rationale and defend it as evidenced by "anecdote."
Let's have a look at this because It is my experience that MANY midwives and doctors across the globe believe that a fetus can be woken from sleep by its mother drinking a cold drink and it has also been my experience that, just like Dr Gannon, they firmly believe it and staunchly defend it.
The fact that whatever goes into the mothers stomach is then at body temperate and therefore cannot possibly pass through her blood stream and placenta , to the unborn baby still cold enough to wake the baby, seems to escape them. In fact I was speaking to a midwife just yesterday who said " well yes I realise that, but it still is my observation and experience that it works" I think this can only be confirmation bias at work, whereby the maternity care provider notices when the baby happens to move after cold water ingestion, but not when it doesn't. I have such a bias about backing out of my driveway. I'm convinced that whenever I go to reverse out of my driveway, my across -the -way neighbour chooses the exact same time to back out of theirs! Of course this isn't true, anymore than ingestion of cold water makes an unborn baby wake up, but it doesn't stop me from thinking , in fact firmly believing, the two things are related ! So we can only assume that Dr Gannon probably has a confirmation bias about his observation that drinking cold water can wake a sleeping unborn baby BUT.....this actually is not the worse part of what he said.
He suggested drinking cold water as a " simple measure" ...something for the woman who is concerned about her unborn baby's movements to try FIRST before contacting her care provider. Again, I imagine this was meant with the best of intentions, not to worry the woman and cause her to present unnecessarily with a baby that can "easily be woken." But this recommendation can only result in a delay in a woman getting the assessment that her unborn baby may need. But worse still IF the unwell baby does happen to move shortly after the mother has a cold drink she may be falsely reassured and THAT could potentially result in disaster.
Dr Gannon then said it was the responsibility of the midwife or the obstetrician to "make sure that the baby is safe" as the vast majority of quiet babies are not "necessarily sick". This is very true it IS our responsibility and he is right the vast majority of babies won't be sick BUT the problem is that we can't tell , other than in retrospect , which baby was sick at the time of decreased movements and which wasn't. We certainly know from a mountain of published evidence ( not anecdote) that when a baby has one episode of decreased movement they are at much higher risk of stillbirth , surely playing that kind of Russian roulette with a baby's life is not a risk worth taking?
Finally, Dr Gannon said "What we don't want to see is armies of women whose babies are perfectly healthy presenting to hospitals unduly," I certainly hope most midwives and obstetricians would disagree and be very happy to see a whole army of pregnant women if that meant that they had a better chance of detecting and saving the baby at risk. Certainly I would happily do a whole slew of " unnecessary" CTGs if that meant I didn't have to say those most horrible words ..." I am so sorry your baby died"
So my suggestion for ALL pregnant women? " Don't was time drinking cold water, if you are concerned about your unborn baby, trust your instincts and get your baby assessed"
As for my suggestion for maternity care providers Dr Gannon is right "Obstetricians and midwives should be in the business of reassuring mums, who are often very anxious about their babies." BUT reassuring women shouldn't involve making them feel, "silly" "overly anxious" or a "bother" and certainly shouldn't involve fobbing them off with incorrect , outdated advice. SURELY the only way to provide real reassurance is to listen ...truly listen, and properly evaluate the baby with the best tools we have available?
Late last week the reporter contacted me regarding comments made by Dr Michael Gannon president of the AMA, about what a woman should do if she noticed her baby moving less. He said "We need to communicate this message to mothers that if they cannot awaken their baby from its sleep with simple measures like a cold drink ... then they should present to their maternity unit and then an appropriate test is done to either reassure the mother or to act on it and deliver the baby."
I was totally astonished that any doctor, let alone an obstetrician, would say something so obviously WRONG. The thought that the mother ingesting something cold has any possible way to wake an unborn baby whether that baby be well or not is not only inconceivable but outright baffling and yet he did say it, and then he tried to explain his rationale and defend it as evidenced by "anecdote."
Let's have a look at this because It is my experience that MANY midwives and doctors across the globe believe that a fetus can be woken from sleep by its mother drinking a cold drink and it has also been my experience that, just like Dr Gannon, they firmly believe it and staunchly defend it.
The fact that whatever goes into the mothers stomach is then at body temperate and therefore cannot possibly pass through her blood stream and placenta , to the unborn baby still cold enough to wake the baby, seems to escape them. In fact I was speaking to a midwife just yesterday who said " well yes I realise that, but it still is my observation and experience that it works" I think this can only be confirmation bias at work, whereby the maternity care provider notices when the baby happens to move after cold water ingestion, but not when it doesn't. I have such a bias about backing out of my driveway. I'm convinced that whenever I go to reverse out of my driveway, my across -the -way neighbour chooses the exact same time to back out of theirs! Of course this isn't true, anymore than ingestion of cold water makes an unborn baby wake up, but it doesn't stop me from thinking , in fact firmly believing, the two things are related ! So we can only assume that Dr Gannon probably has a confirmation bias about his observation that drinking cold water can wake a sleeping unborn baby BUT.....this actually is not the worse part of what he said.
He suggested drinking cold water as a " simple measure" ...something for the woman who is concerned about her unborn baby's movements to try FIRST before contacting her care provider. Again, I imagine this was meant with the best of intentions, not to worry the woman and cause her to present unnecessarily with a baby that can "easily be woken." But this recommendation can only result in a delay in a woman getting the assessment that her unborn baby may need. But worse still IF the unwell baby does happen to move shortly after the mother has a cold drink she may be falsely reassured and THAT could potentially result in disaster.
Dr Gannon then said it was the responsibility of the midwife or the obstetrician to "make sure that the baby is safe" as the vast majority of quiet babies are not "necessarily sick". This is very true it IS our responsibility and he is right the vast majority of babies won't be sick BUT the problem is that we can't tell , other than in retrospect , which baby was sick at the time of decreased movements and which wasn't. We certainly know from a mountain of published evidence ( not anecdote) that when a baby has one episode of decreased movement they are at much higher risk of stillbirth , surely playing that kind of Russian roulette with a baby's life is not a risk worth taking?
Finally, Dr Gannon said "What we don't want to see is armies of women whose babies are perfectly healthy presenting to hospitals unduly," I certainly hope most midwives and obstetricians would disagree and be very happy to see a whole army of pregnant women if that meant that they had a better chance of detecting and saving the baby at risk. Certainly I would happily do a whole slew of " unnecessary" CTGs if that meant I didn't have to say those most horrible words ..." I am so sorry your baby died"
So my suggestion for ALL pregnant women? " Don't was time drinking cold water, if you are concerned about your unborn baby, trust your instincts and get your baby assessed"
As for my suggestion for maternity care providers Dr Gannon is right "Obstetricians and midwives should be in the business of reassuring mums, who are often very anxious about their babies." BUT reassuring women shouldn't involve making them feel, "silly" "overly anxious" or a "bother" and certainly shouldn't involve fobbing them off with incorrect , outdated advice. SURELY the only way to provide real reassurance is to listen ...truly listen, and properly evaluate the baby with the best tools we have available?
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