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Facing issues in practice that are controversial

By: Dr Sara Wickham

This podcast explores some of the issues behind prophylaxis in general and antenatal anti-D in particular. It explores the nature of prophylaxis, the different standpoints that exist in relation to the routine antenatal administration of anti-D to rhesus negative women, and considers how midwives can best help women to understand the issues and enable informed decision-making.

Dr Sara Wickham is a midwife who has practised in the UK and USA, and is currently working as a freelance midwifery lecturer and consultant. She has written and edited a number of books, including 'Anti-D in midwifery', the 'Midwifery: Best Practice' series and 'Appraising Research into Childbirth'. Sara speaks and consults internationally and, together with Lorna Davies, co-hosts the website http://www.withwoman.co.uk, where many of her articles can be found. Sara's PhD thesis explored holistic midwifery knowledge around post-term pregnancy. This podcast is entitled, 'Facing issues in practice that are controversial'. Of the different kinds of interventions that are offered to women and babies around the time of pregnancy and birth, prophylaxis or the use of a drug or treatment to prevent a possible disease, rather than to treat an existing one, is arguably the most controversial. Prophylactic interventions around childbirth include anti-D, vitamin K, antibiotics for group B Streptococcus and the practice of managed third stage. There has been a great deal of debate about the notions of risk and safety in childbirth, and increasing emphasis on looking at the bigger picture and informing women about the risks of such treatments, as well as the benefits. How can a balance be struck between the management of risk at the population level and the attention that needs to be given to helping individual women make the choices that are right for them?

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