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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Some Replies to Long Piece on Fetal Alcohol Syndrome

You seem angered/upset. I don't know if I'm one of those suggest "accused you of spreading misinformation". The point is as follows:

There is overwhelming evidence that a significant group of women who consume regular excessive amounts of alcohol during pregnancy give birth to babes affected with fetal alcohol syndrome.

Another group of women consume excess alcohol and also probably have other risk factors and have growth retarded babes.

Many women abstain totally from alcohol, most of them have a good pregnancy outcome, sadly not all do.

A few women do not totally avoid alcohol, but maintain what would otherwise be accepted as sensible intake. Again most of these have a good pregnancy outcome, sadly a few don't. Faced with the sort of unsubstantiated "evidence" quoted they are made to feel guilty.

The problem with alcohol intake in pregnancy is not so much that no-one knows the safe upper limit, is that no-one equally knows the lowest harmful intake. It has often been assumed that if excess is bad, moderation must be moderately harmful. It just doesn't make sense.

We all know that to take several grammes of aspirin for a headache is toxic, to take a couple of tablets occasionally for a headache is perfectly safe, and to take 75mg daily, in certain high-risk pregnancies is actually beneficial. Just because a lot of something is bad it doesn't mean a little is a little bit bad !

None of the sources you quote seem to be referring to any actual observations, but simply giving vent to prejudice.

I'm sure it does no harm to stop alcohol intake in pregnancy ( or other ties too ), but baseless criticism of those who don't does no good and makes a large minority of women feel guilty for no reason.

Bennett, V., R., Brown, L., K. (1990). Myles Textbook for Midwives. New York. Churchill
. . .
Wong, D. L. (1995). Nursing Care in Infants and Children. New York. Mosby.

From Sweden

You do know that we have special monopoly alcohol stores, don't you? Alcoholic beverages are very expensive, you have to be 20 to buy it and the stores are only open Monday-Friday 9:30-6 pm. A decent bottle of wine costs $ 10, in a restaurant $ 30. A pint of lager in a restaurant about $ 7. This is why Swedish tourists on visit in your countries always get extremely drunk and stupid. We feel let out of prison. We have a wonderful countryside, though...

A midwife, who feels it's quite OK for a man to say that he wants his wife to quit alcohol while pregnant as long as he in solidarity refrains from drinking too. Nine months, plus nursing time, say... two years at the least.

In the March/April issue [of a Dutch midwifery organization's - NOV's - monthly compilation of articles] we read in an article that appeared in the newspaper "Algemeen Dagblad": 'Een glas alcohol is al taboe tijdens zwangerschap'. -- Imagine this is an answer you are ought to give on your final exam!

Switching to English: the header tells us that 'One glass of alcohol is already taboo during pregnancy'. This is the advise G. Visser, professor in obstetrics gives us (well, in fact those who are pregnant), after profound research at the hospital of the university of Utrecht. With ultrasounds was only a delay seen of half and hour between the alcohol level (in the blood) of the mother and the reactions of the unborn child.

Noticing the reactions of the foetus in correlation to the alcohol intake seems an objective criteria to me. Smart people in The Netherlands.

According to Visser the baby reacts almost immediately on maternal alcohol consumption: it stops practicing respiration movements and the REM sleep also is said to be disturbed. (-- I strongly guess that wasn't proven by ultrasound... But who am I.)

According to that newspaper article the Dutch Organization of Midwives (NOV) was considering to review its guidelines.

That was thus about a Dutch study covered in the Newspaper in February and copied in the NOV periodical of March/April.

In the cutting-periodical of the NOV issued in May an other study is mentioned. One that took place in the UK.

'According to a report issued by the Royal College of Obstetricians and Gynaecologists there are no indications to a woman harms her unborn child in the case she uses no more then 15 units of alcohol a week.' A standard unit is said to be 'half a pint of ordinary beer, a small glass of wine or a single measure of spirits. To play it safe women are advised to limit their (and their babies) consumption to one glass a day. (The Times, 3 March '97).'

From a report I made during the nurse/midwife training (I really went through that) I remember, what I share with all of you now thanks to this list, the percentage of alcohol in a glass of beer is about the same as the one in a small glass of liquor (= strong alcoholic beverage; not amnion fluid-- unless real FAS). I don't know how the producers of glasses came up with that standard but they did. So, if you wanne know how many 'units' of alcohol you (can) have you better stick to the right glass for the right drink. -- and don't combine with other drugs because that's certainly no good for the research. --

The article continues mentioning these are the first guidelines regarding alcohol consumption during pregnancy, on an issue few consensus has been reached until now. - Good we have this list to have at least a good debate isn't it? -

The latest research (the report of the RKOG), reveals there is no consistent link between social drinking and miscarriages or premature birth. The consumption of more as 15 units a week is said to have 'a small negative effect' on the growth of the baby. Kids of women who consumed more as 20 units a week are said to have an IQ that is 7 points lower as those born out of women who drunk not much. (If you know I had only 117 at age 6 while my brother was over 140 at that age how much did my mother then drink? I can't figure it out and that keeps me puzzling).

Dr. Thomas Stuttaford, medical commentator for "The Times", concludes that "now all future mothers can sleep well in the knowledge that normal social drinking during pregnancy is not a risk".

The bottom line of this Dutch article reviewing the research published in "The Times" mentions that "The Time" warns 'heavy social drinkers' have the risk to get a FAS baby. 'British women should here think about a consumption over 18 units a day; to our (The Netherlands) norms an unknown amount but to British norms still within the limits of a 'drinker for sociability'.

Britain certainly rules the waves here. Some of the terminology is not well defined in this article as the meaning of terms like 'drinker for sociability' seems to be culturally defined. That way we never come to define guidelines that are objective and maybe, after all, that hasn't to be such a problem always. As long as we have a good debate and are able to make up our own mind to give advises in the interest of our clients we can't do much wrong, I think.

okay, everybody, I have a question for you re the fetus and alcohol. Same topic, different angle.

I remember in my earlier years reading a report on alcohol intake in pregnancy. A statement was made that the baby's blood alcohol level is the same as the mother's. And that you could basically figure out the baby's "experience" of the mom's alcohol intake by determining percentage of body weight, comparing baby's size to mom's. In other words, if mom has a glass or two of wine, the baby is fairly toasted.

Also, due to the immaturity of the fetal liver, that the baby wouldn't process the alcohol as well and could therefore stay drunk for quite a while.

What do you think?

The way i understood the metabolism was that the baby's blood alcohol content is NOT exactly the same as the mother's (remember mom and baby have different circulatory systems) and that the amount of blood alcohol that DID get to the baby depends on the mother's ability to process (her liver) this is why, as many have mentioned, there is NO WAY to quantify EXACTLY how much alcohol is "safe" or "unsafe" the whole problem is that every woman's ability to metabolise alcohol is different, and it is even different for the same woman at different times in her life.