Introduction to Psycho-SocialPerspectives of Childbearing and Childbirth. MWY_4_002 Preventing Toxoplasmosis in Pregnancyand the Role the Midwife has in Preventing Toxoplasmosis. Student ID: 3109169 Word Count: Toxoplasmosis is an infectious diseasecaused by a single- celled parasite known as Toxoplasma Gondii (Atrid et al,2001).
There are around 350,000 cases a year in the UK but only 350 cases areever reported (NHS, 2017). In most people the immune system is strong enough tofight off toxoplasmosis before the disease causes any serious illness orsymptoms. However, in some circumstances individuals do experience symptoms,which are misinterpreted as being influenza (flu). This suggests the lack ofsymptoms, or the misidentification of toxoplasmosis as the flu, leads to aminimum number of diagnosis each year. While in most cases toxoplasmosis isunthreatening to individuals, those with a weak immune system are at risk ofdeveloping serious illness. Examples of which are ocular toxoplasmosis, cerebraltoxoplasmosis and congenital toxoplasmosis.
Pregnancy has been found to lower a woman’simmune system, putting them at higher risk of contracting toxoplasmosis andexperiencing one of the serious illnesses associated with this risk. Thisespecially includes congenital toxoplasmosis where the health of the unbornchild is at risk. The parasite has been found to invade tissue and damage thebrain of a foetus or newborns (Findal et al, 2017). In some cases the disease,if untreated, can cause miscarriage and newborn death (Prusa et al, 2017). Dueto these reasons prevention of toxoplasmosis needs to be promoted, especiallyto pregnant women. Part of a midwife’s role is to promote health to expectantmothers, following current research and recommendations from trust and nationalguidelines (NICE, 2008), to ensure good health for mothers and babies. Midwivesare an expectant mothers main source of information and guidance, especiallythroughout the antenatal period.
Therefore, it is important midwives take thisopportunity to understand and advise pregnant women on how they can preventtoxoplasmosis. This essay will discuss toxoplasmosis,preventions of the disease, the definition and role of health and healthpromotion, and the role of the midwife in promoting prevention oftoxoplasmosis, specifically during antenatal consultations. This will bepresented by reviewing previous literature, applying Ewles and Simnett (2003)Educational Approach and Antonovsky Salutogenesis (Benz et al, 2014). The importance for preventing toxoplasmosisin pregnant women is because of the risks the disease pose to the mother and tothe unborn child. The disease is most likely contracted and more dangerous whenpeople have a lowered immune system (e.g. undergoing chemotherapy, contractingHIV or being pregnant).
Thus when a woman becomes pregnant she is more likelyto be at risk of contracting toxoplasmosis, of which there are different types includingocular toxoplasmosis, which causes scarring and inflammation in the eyes andcerebral toxoplasmosis, where the brain swells causing headaches, poorco-ordination and in some cases seizures (REFERENCE). Another form iscongenital toxoplasmosis, where toxoplasmosis can spread through the placentato the foetus possibly causing fluid on the baby’s brain (hydrocephalus),epilepsy, brain damage, hearing loss, learning disabilities and cerebral palsy.Congenital toxoplasmosis can also cause miscarriage or stillbirth. This form ofthe disease only occurs if the woman becomes infected for the first time duringpregnancy or the weeks before conception.
The risk of passing the infection onto a foetus is around 10-15% if the mother contracts toxoplasmosis in the first12-13 weeks of pregnancy and around 70% if the mother becomes infected fromweek 26-28 onwards. This research suggests the congenital toxoplasmosis is morelikely to occur if the mother contracts the disease for the first time in thelater stages of pregnancy. Due to these reasons pregnant women need to beinformed and advised of the risks the disease poses for themselves and theirbabies and most importantly what they can do to prevent the disease. The Toxoplasma Gondii (t.gondii) parasiteis found in the faeces of infected cats and meat of infected animals. It isalso found in soil contaminated with cat faeces meaning produce grown in thissoil can carry the disease.
Toxoplasmosis is only contracted via ingestingcontaminated food, such as unwashed fruit or vegetables, undercooked or rawmeat, contaminated meat, unpasteurised milk or cheeses and by drinkingcontaminated water and by contaminated hands coming into contact with themouth. Prevention of the disease can be successful by being aware of the causesand avoiding them. When a midwife has first contact with a pregnant woman,usually at the booking appointment, a past history is discussed, including the woman’scurrent lifestyle. During this appointment, prevention of toxoplasmosis shouldbe discussed along with other good health promotion to ensure a woman has asafe and healthy pregnancy. Due to the damaging effects toxoplasmosis cancause, midwifes need to be aware and ensure they inform mothers how they canprevent toxoplasmosis.Literature suggests that not all women areadequately informed about this preventable infectious disease.
Knowledge of thedisease and its causes plays an essential role on the prevention of thedisease. One piece of research (Munoz-Zanzi, 2013) conducted a cross-sectionalserosurvey, where blood samples where taken and tested for toxoplasmosis frompeople in urban slums, farms and rural villages in an area of Chile. Resultsfound 55.9%, over half, of the participants used were positive fortoxoplasmosis. More participants from the farms tested positive fortoxoplasmosis than those in rural villages and slums. The knowledge oftoxoplasmosis was also reviewed along with any preventive actions used. Theresearch found a lack of knowledge of the disease with the only noticeablepreventive technique being boiling hot water, however when the participantswere asked why they boil the water it was not specifically to preventtoxoplasmosis. This research suggests when there is a lack of knowledge oftoxoplasmosis and how to prevent the disease, people are more likely tocontract the disease.
Other studies have shown when toxoplasmosisand preventions are promoted the infectious disease is less likely found. Breugelmans,M. (2004) conducted a study with three different conditions. Condition one, nopromotional information sent to pregnant women.
The second condition, pregnantwomen were sent a list of recommendations of how to avoid toxoplasmosis and thethird condition pregnant women were sent a leaflet with information of whattoxoplasmosis is and actions to prevent it. They found there was a reductionrate of 92% of women found to have toxoplasmosis after receiving the leafletinforming them of what toxoplasmosis is and how to prevent it. This researchsuggests that informing women about the disease and its side effects andinforming them of the ways they can prevent contracting the disease the lesslikely they are to contract this disease. This suggests that because they knowthe dangers and possible outcomes of the disease they are more likely toactively follow the preventions. Therefore evidence suggests the more informedpeople are about the disease and the preventive actions the less likely theyare to contract the disease, emphasising the importance of promotingtoxoplasmosis preventions. To promote positive promotion of health,health itself along with health promotion definitions need to be considered andreviewed. Collins Dictionary (2011) defines health as ‘the condition of thebody and the extent to which it is free from illness or is able to resistillness’. The Medical Model states good health is when there is an absence ofdisease, established by examining the individuals biological or physical state,which requires diagnosis and in some cases a cure, to re-establish health.
TheMedical Model supports Collins (2011) definition of health reinforcing thedefinition that health should be defined as being without disease or illness.However, this definition does not have holistic approach by ignoring otheraspects of an individual’s health, for example emotional and social health (Engel,2012). Due to these reason the World HealthOrganisation, WHO, has redefined health as “a state of complete physical,mental and social well-being and not merely the absence of disease or infirmity”(WHO 1946). The Wellness model incorporates six dimensions, which are physical,emotional/ mental, social, intellectual, occupational and spiritual health, andstates that concurrence across all of these areas makes an individual healthy.The Wellness Model supports WHO’s definition that health is more than just the absenceof disease or infirmity (Hettler, 1976). Richard Smith (citied in Godlee, 2011)suggests that the current accepted WHO definition of health needs updating becauseit “would leave most of us unhealthy most of the time”. This is becauseresearch has found that the definition does not contemplate the ever-changingsocial circumstances and people’s ability to adapt in these circumstances. DK Medical Dictionary (2013) defines Healthpromotion as “programs designed to inform the public about health risks andmethods to prevent or reduce them; the programs are often targeted at specificpopulations”.
In the early 19th Century John Snow traced the sourceof a Cholera outbreak to a single water pump in Soho and convinced theresidence to stop using the pump, which stopped the Cholera outbreak (Shiode etal, 2015). This shows how by promoting specific health behaviours a wholepopulation health can be affected supporting the DK’s definition of health. However DK’s definition does not encompassthe concept of the individuals in making a decision for their own health. WHO(2005) defines health promotion as “The process of enabling people to increasecontrol over their health and it’s determinants, and thereby improve theirhealth”. The Health Belief Model (Chesnay & Anderson, 2015) suggests aperson will consider the perceived threat (developing congenitaltoxoplasmosis), the perceived benefit of specific behaviour (not developingcongenital toxoplasmosis by avoiding cat faeces) and the individuals believethey can initiate and maintain the specific behaviour to reduce their risk (believethey can avoid cat faeces and lower risk of congenital toxoplasmosis)(Becker’s, 1974).
This undermines the DK’s definition of health promotion beingfor a whole population but supports WHO’s definition that a person can havemore control over their choice of health control which makes them more likelyto improve their health. In 2005 the International Confederation ofMidwives (ICM) redefined the definition of being a midwife. Part of thatdefinition was ‘The midwife is recognised as a responsible and accountableprofessional who works in partnership with women to give the necessary support,care and advice during pregnancy…’ (Marshall, Myles, 2014). Therefore, part ofthe role of a midwife will be to educate mothers of how to preventtoxoplasmosis, support women into making the correct behavioural changes inorder to prevent the disease and advice them on their prevention options.
During pregnancy a woman’s entire health, thesix dimensions are affected. This includes their immune system being loweredand their knowledge about health being altered. It is part of a midwife’s roleto promote normality of a healthy pregnancy, which can be successfully done byeffectively informing women to enable them to make a coherent and cleardecision about their health and pregnancy. Midwives need to take a holisticapproach to advising and supporting their clients.
The holistic model explainshow the application of the six dimensions of wellness, mentioned earlier, canallow an individual to contribute their own health. This is achieved throughallowing individuals to see how their own actions can affect their health inorder to be “healthy”(Hettler, 1976). For example, if they participate intoxoplasmosis prevention behaviours then they are less at risk of contracting toxoplasmosis,which can affect themselves or their unborn baby. Antonovsky Salutogenesis (1993) is anapproach, which views each woman as unique and recognises the need forwoman-centred care. This approach looks at the prerequisites for successfulcoping such as meaningfulness, manageability and Comprehensibility. A woman will decide howmeaningful preventing toxoplasmosis is to her, how easy prevention will be toprevent the disease and whether or not she has the correct amount ofinformation and resources to make the decision. Midwives can increase a woman’sresources, by making sure she has access to the correct information to make aninformed decision, also by checking she has the ability to actively do theprevention e.
g. access to clean water. This will aid her manageability and meaningfulnessor toxoplasmosis. Part of the ICM’s definition of the role ofthe midwife is ‘the midwife has an important task in health counselling andeducation, not only for the woman, but also within the family and community(Marshall and Myers, 2005). A midwifemust be knowledgeable, not only about toxoplasmosis and its prevention butabout the resources in the community such as the availability and accessibilityof information to all women. For example, creating health promotion posters, toinform woman of the disease and how to prevent this. These could be displayedin antenatal clinics, garden centres, pet stores and fresh food stores. This isbecause women or family members who are in these areas, are likely to beparticipating in the activities (e.
g. if they are in a pet store they may havea cat). By presenting information in these areas it can encourage woman toconsider their current behaviours, for instance may make them find someone elseto remove cat litter. By also presenting information in a variety of placesfamily or friends of pregnant woman may also see this and can also advice her.
Amidwife should also have good communication skills with clients, this willmainly be verbally but it is important they check all written information is alsowell communicated. In the UK there is a diverse amount of cultures andeducational levels. Therefore something for midwives to consider is overcomingcommunication barriers by, for example, using interpreters or creating postersor leaflets about toxoplasmosis and prevention in different languages and usingsimple language for all reading levels. By doing this all woman should be ableto be educated on the disease and can make an informed choice of whether or notto participate in preventive behaviours. In the UK the NHS provides free antenatalcare services, which includes a booking appointment, where a previous historywill be taken as well as information to help aid a healthy pregnancy, as wellas regular antenatal consultations.
During the Booking appointment the role ofthe midwife is to determine how at risk the mother is for various issues, suchas gestational diabetes or preeclampsia. This is done by taking a thoroughmedical and lifestyle history of the woman and also included questions about first-degreerelatives health. During this time a midwife can take this opportunity todetermine the risk of toxoplasmosis. The woman may know whether she hadtoxoplasmosis before or she may reveal lifestyle risks, for example if she is avegetarian her main source of food will be fruit and veg so will need to beinformed of how to safely prepare her food. The pregnant woman may also revealif she has any pets. The woman may also inform the midwife of any other immunelowering disease she may have, such as HIV, which would mean she is even moreat risk of contracting toxoplasmosis since her immune system will be loweredfurther when pregnant. Part of the antenatal booking appointmentis to give brief but informative information for during the woman’s pregnancyto maintain or improve the clients health. This includes speaking about safesex during pregnancy, exercise, foods to avoid, food safety and hand hygieneect.
This part of the appointment is also a good opportunity to discusstoxoplasmosis and its preventions. Pereboom et al., 2013, conducted across-sectional survey of pregnant women and their knowledge of toxoplasmosisand other infectious disease.
They found 75.3% of pregnant woman had heardabout toxoplasmosis with their main source of informing coming from health careprofessionals, such as a midwife. However, respondents showed limited knowledgeof preventive practises of toxoplasmosis, suggesting women are informed abouttoxoplasmosis and it’s risks but not how to prevent toxoplasmosis and lower theirrisk. This suggests midwifes are effective at educating women of toxoplasmosisand their risks, but need to focus time on explaining and informing women onits preventions. During every antenatal consultation thewellbeing of the mother is observed. Firstly, the client’s urine and bloodpressure is checked for any abnormalities, as this can be an indication ofother problems. During this consultation the midwife has the opportunity to observethe woman noticing any of the signs or symptoms of toxoplasmosis. While thesesymptoms may also be associated with the flu, it is important the midwifeconsiders toxoplasmosis and follows the NICE Guidelines (2003) appropriately,e.
g. offering screening for the disease and informing women of toxoplasmosis sothe woman themselves feel empowered to make their own choice but also allowsthem to question their health.In conclusion, toxoplasmosis and itspreventions need to be promoted to ensure the safety of both mother and baby. Ifprevention of toxoplasmosis does not take place pregnant women are moresusceptible to contract extreme cases of the disease such as ocular toxoplasmosis,which causes scarring and inflammation in the eyes and cerebral toxoplasmosis,where the brain swells causing headaches, poor co-ordination and in some casesseizures.
They are also more at risk at developing congenital toxoplasmosis,which can have devastating consequences such as brain damage to the baby and insome cases newborns death. Research has shown that by educating mothers andcommunities they can make informed decisions to begin and maintain preventiontechniques of toxoplasmosis (Breugelmans, 2004). The midwife has an extremelyimportant role in this, which includes informing mothers in accessible ways,e.g.
posters and leaflets in different languages and reading levels, supportingthem through this time, encouraging them, giving them different copingtechniques along with empowering them throughout their pregnancy to preventtoxoplasmosis. This is mainly achieved through the one to one antenatalconsultations. These consultations need to be seen as an opportunity to discussand help pregnant women to have a safe and healthy pregnancy, as well as givingthe Midwife an opportunity to observe any signs or symptoms that could meantoxoplasmosis.
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