Pregnant in Sweden - I'll drink to that

While recently awaiting the arrival of a new baby, Elizabeth Dacey-Fondelius found herself not so much restricted by her bulging belly as by the opinions of those around her - especially when it came to alcohol consumption.

• Sick benefit reform puts people back to work (14 Jul 10)
• Health experts warn against obesity drugs (14 Jul 10)
• Swedish women equate jogging with sex: survey (13 Jul 10)

Somehow my body became public property when I got pregnant. People I barely know elatedly rub my belly when they’d feel highly uncomfortable giving me a hug. Then there’s the rest of the public who feel it’s their prerogative to tell me what I am allowed to eat, drink and do.

Everyone seems to be an expert and while there is more than anyone’s fair share of advice available, the advisory experts can’t seem to agree.

Cultural taboos vary country to country, yet you’d think that medical advice would be internationally uniform. But it’s far from uniform, and nowhere near in agreement especially when you mix pregnancy, breastfeeding and alcohol. While all experts have access to the same research and studies, different countries interpret and advise based on culture and political whim.

Zero tolerance for alcohol has been the general norm here in Sweden for quite a while. Americans take it to its most extreme with no-go zones condemning not only alcohol and smoking but all forms of caffeine. Coffee, cola and even chocolate are off limits to the mother-to-be. Until recently moderate alcohol consumption was okay for pregnant and breast feeding mothers in the UK.

However, the new advisory of zero tolerance for mothers has recently stirred up controversy in Britain. I sympathize with the mums like Zoe Williams who wrote a great piece in the Guardian. I agree strongly with her that much of the popular advice to pregnant women is unnecessarily restrictive.

The strict alcohol consumption guidelines set up by Swedish, UK or US health care authorities, agencies and associations all share the aura of scientific and medical credibility. However, a study in 2006 by the British Journal of Obstetrics and Gynaecology concluded that there was no convincing evidence of adverse effects of prenatal alcohol exposure at low to moderate levels, where moderate was defined as 10.5 units per week (not at one sitting).

Messages to eliminate all alcohol are purely motivated by the true danger of a fetus’ exposure to high levels of alcohol which results in Fetal Alcohol Spectrum Disorders (FASD).

The presumption: ”If large amounts are dangerous, small amounts are probably dangerous too” argument is unfair. Instead of fact, fear is used to support a “better safe than sorry” defense for zero tolerance while pregnant or breastfeeding.

Those of us mothers who raise a glass of anything containing alcohol can and often do get publicly spanked by the do-good brigade. Pregnant woman is apparently equivalent to–public incubation container.

Here in Sweden, during your first visit to a midwife you will be asked to fill out a form regarding your attitude to alcohol. It resembles the questionnaire you’d expect from a self-evaluation for Alcohol Anonymous.

In my first pregnancy I thought I’d be upfront and honest. I had every intention of abstaining from alcohol, however I would sporadically partake of the grape should the occasion call for it. Instead of the midwife applauding me for my prudent response from a responsible mother-to-be, she started rambling off medical studies linking alcohol to pretty much anything that sounded even remotely scary.

That’s when I decided to play it safe from there on in and answer when asked how much I drink: “I abstain totally from any alcohol intake under any and all circumstances while pregnant and breastfeeding.”

American friends and acquaintances can be even more militant. A friend second-guessed my choice of ordering a cola during lunch, kindly informing me in my supposed ignorance that it contained caffeine. Just to put an end to the well-meant lecture I replied, “I know. And I occasionally have a glass of wine, too.” It effectively steered us away from any more pregnancy “advice” for the rest of our lunch date.

I suppose I can’t really blame him since nearly all advice offered to pregnant women and fathers-to-be echoes the same message – just say no to alcohol. It’s backed by a rather “reputable” source, the US Surgeon General.

In 2005, the Surgeon General, Dr. Carmona, urged “Women who are pregnant or who may become pregnant to abstain from alcohol.” If you take that literally, you are talking about every woman of child-bearing age.

The warning stated, "We do not know what, if any, amount of alcohol is safe.” What I wonder is all the other things that cannot be determined as safe. There’s got to be a long list.

That too much alcohol is bad does not necessarily mean that a tiny bit should also be too. Too much sugar consumption can lead to diabetes during pregnancy which is potentially harmful for the unborn child, yet the US Surgeon General doesn’t discourage all pregnant or able to get pregnant women abstain from all sugar.

Sweden uses a similar scare methodology. The midwife I saw for my first pregnancy kept referring to a study that demonstrated that a baby’s heart rate increased when a mother drank as little as a glass of wine. She said outright that they had no idea what that could mean for the fetus’ development, but came back with the usual argument, “You don’t know that it isn’t doing any harm.”Geesh, when I exercise my child’s heart rate increases. But no one is advising me to stop walking.

In Sweden they add guilt to the fear using the zero tolerance argument, “You wouldn’t drive a car after drinking a glass of wine because your judgment is impaired; think of the bad judgments you could make to put your unborn child at risk.” It makes me wonder how anyone allows me to make any decisions on my own at all.

I guess I can’t be too critical of the better safe than sorry mentality. I chose to not scuba dive while I was pregnant even though I was beach front in the Cayman Islands. So little is truly known about the effects of diving on the body that I felt I wouldn’t risk it. But moderate alcohol intake has been a part of women’s diet for thousands of years. But moderate can be a subjective word.

That’s really what this comes down to: How do you decide how much is too much and how little is harmless? I don’t have the answer, but a pregnant friend living in French-speaking Switzerland told me that the literature she read in French advised women to not have more than one glass of wine per day. Perhaps that’s too liberal for the zero-tolerance brigade, but something to keep in mind when weighing “medical advice”.

Elizabeth Dacey-Fondelius