News outlets, especially in Britain, have been abuzz with discussions of the appropriate precautions against (H1N1) swine flu infection for pregnant women. While pregnant women may be slightly more vulnerable to flu because pregnancy compromises the immune system, some of the suggestions for limiting exposure and preventing infection (aside from basic handwashing and hygiene) sound impractical and unworkable for most women.
In Australia, several medical groups suggested that pregnant women wear masks, and some U.K. health agencies have suggested that women “limit the movements” of their children to prevent their bringing the virus home, and avoid public transportation, as well as crowds and unnecessary travel.
Dr. Annabel Bentley, writing at BMJ Group Blogs, calls the advice “at best confusing and at worst completely impractical and non evidence-based.”
Facemasks, for example, are sometimes suggested to prevent an infected person from transmitting the disease to others, but are not generally recommended for widespread prevention. Bentley also wonders how, exactly, women should define “unnecessary travel” and avoid crowded places, and she alludes to the certain amount of privilege necessary to even contemplate staying home and avoiding others:
Perhaps now is the time to switch from travelling to work on the underground and finally hire a chauffeur (one that’s already had swine flu preferably) to keep you away from the virus-breathing hordes?
Some advice on the topic does at least acknowledge the problem with these recommendations — that “complete isolation at home would be regarded as extreme for most women” — although the advice provides little help for women hoping to find a reasonable balance.
A U.S. News blog post also illustrates the confusion pregnant women face over a swine flu vaccine, when it becomes available:
On the one hand, healthy pregnant women who get infected with the flu are at increased risk of serious illness and hospitalization. In fact, the second H1N1 flu death in the United States was a pregnant woman. Because of this greater risk, pregnant women are advised to get annual flu vaccinations. On the other hand, pregnant women also are advised to be very cautious when taking any medications — especially the newest ones — because of unknown health risks to the developing fetus [...] Just today, public health experts said that there’s no way to know if any rare side effects will occur in the new vaccine until millions of people are vaccinated. Those unknowns would make an expectant mom especially nervous.
Swine flu concerns also arise when it’s time for women to give birth. One statement (from RAZCOG, linked below) highlights a potential problem with the recommendations, with regards to pregnant women limiting their potential to infect others: “Whilst women with possible influenza should avoid crowded antenatal clinics (to avoid transmission to others), they will still need to attend hospital for birth” — where they could presumably infect others, but which also goes against the advice to stay home and avoid crowded places.
In the United States, some home birth midwifery advocates have also suggested that women may prefer to stay away from hospitals when rates of infection are high. The Midwives Alliance of North America, for example, has suggested that out-of-hospital births may be preferable or necessary in some cases during pandemic flu.
Meanwhile, in the UK, where midwives and home births are better-integrated into pregnancy care, hospitals are drawing up emergency plans in which “Home births would be refused and planned caesarean sections abandoned if there were not enough staff to carry them out safely.”
Here’s guidance from health agencies on swine flu and pregnant women:
The American College of Nurse Midwives also has links to a number of additional resources.
Added: According to AP, a federal vaccine advisory panel is meeting Wednesday to discuss priorities for who should be first to receive swine flu vaccination, and pregnant women are likely to be high on the list [hat tip to the Daily Women's Health Policy Report]