I have had this article from the New Statesman (a British magazine) in my files for decades. I’ve given it to many women to underline the importance of daily quality protein in pregnancy. I can’t find any reference to it on the internet and I publish it here in order to have this history preserved. Remember when reading it that no one had home computers in 1984 and there were no search engines. We had to rely on TV, magazines, newspapers and medical libraries back then. There was no email so the British postal service was the way these women contacted each other. For this young woman to undertake this project in those days is truly amazing.
The terms toxemia (spelled toxaemia by the British), and pre eclampsia have both been retired and now all these words are under the umbrella term of “Pregnancy Induced Hypertension” (PIH). Enjoy the read and leave comments. Thanks Gloria
New Statesman 6 January 1984
WOMAN HEAL THYSELF
John Hargreaves on a new approach to toxaemia
FEW PROFESSIONALS care to be lectured in their own field by their clients. But when Dawn James faithfully followed her doctor’s advice during pregnancy and succumbed nevertheless to a disease which kills an average twelve women and hundreds of fetuses every year in Britain, no one could tell her why. This 27 year old woman, living in a council flat in Hackney—‘shy, and not a speaker type at all. . . from a working class background and a secondary modern school’ –determined to find out for herself.
Two years later, she was invited back by the Senior Nursing Officer to the hospital where her baby was born, to explain to the midwifery staff what she believes are the causes of toxaemia of pregnancy and how it can be prevented.
Pre-eclamptic toxaemia (a misnomer because it is now recognized that no ‘toxin in the blood’ is involved) is a condition unique to pregnancy, generally diagnosed upon appearance of two of a triad of symptoms—high blood pressure, swelling, and protein in the urine. Abdominal pains, headaches and blinding flashes of light may alert a pregnant woman that something is seriously wrong. At its extreme, the condition becomes eclampsia, the epileptic-like convulsions that can be fatal to mother and baby.
Diagnosis of pre-eclampsia is confused by the fact that all three of its cardinal symptoms may arise from other causes, many of which are entirely benign. This is often not recognized by doctors, who may begin treatment of healthy pregnant women, sometimes causing problems where none in fact existed. Even in genuine cases, standard medical treatment with bedrest, sedatives, drugs to control blood pressure, and early induction of labour does little to ameliorate the condition. Many doctors believe that the only effective treatment is to end the pregnancy.
Pre-eclampsia is still hailed as ‘the ancient enigma’ in obstetric journals, and a consultant dealing with a reader’s problem for ‘Woman’ magazine wrote recently ‘the cause of pre-eclampsia is not known. . . Because of this it is not possible to give advice on how to avoid it.’ While midwives have taken Dawn James’s findings seriously, the obstetric profession remains obdurate and aloof.
It was in the women’s magazines that Dawn James began her own search, with a request that others who had suffered pre-eclampsia write to her. She had 200 replies. She sent them a questionnaire, and compared her findings with what she had learned from the textbooks. Pre-eclampsia was supposed to be more common in twin pregnancies, overweight women and diabetics, and to run in families. None of these categories fitted Dawn James, and none was common among her correspondents. These women, anxious about their future, had invariably been reassured by their doctors that pre-eclampsia was a disease of first pregnancies only. Yet out of the 32 respondents who had undertaken another pregnancy, 23 had suffered pre-eclampsia again! With the support of many of these women, Dawn established P.E.T.S., the Pre-Eclamptic Toxaemia Society.
DAWN BEGAN a massive educational effort involving correspondence with the experts’ across the three continents and delving through the medical journals reaching back over a hundred years. But alongside continuous reportage of this work in the quarterly P.E.T.S. newsletter, Dawn kept publishing the personal experiences of her members – tragic accounts of unsuspecting women meticulously following their doctors’ orders and yet succumbing quite suddenly to convulsions and coma and having either a premature, low weight baby (with a much higher risk of mental or physical disability) or a stillbirth.
An underlying theme did begin to emerge from Dawn’s reading, and that was the supreme relevance of the mother’s diet. John Lever at Guy’s in 1843 was probably the first obstetric physician to take a dietary history, noting a single daily meal of bread and tea from a woman with puerperal convulsions. The work of Hamlin in Australia, Strauss in North Carolina and, especially, Brewer in California made a strong impression. Here was an account of the aetiology of pre-eclampsia – from inadequate nutrition, through liver dysfunction, low blood albumin and reduced blood volume—which made sense and was supported by the evidence amongst the severely undernourished subjects involved. But how could this apply in Britain in the 1980s?
By the time the next newsletter was compiled, Dawn had made the most significant step of all, by simply asking herself, as so few obstetricians have asked of their patients since John Lever, ‘what exactly had I been eating?’ ‘During the first twelve weeks of my pregnancy, I was constantly vomiting day and night and survived a few weeks mostly on bottles of lucozade. . . then, at about 5 months, I was told I had gained ‘too much’ and that I should cut down on my food. I felt really hungry all the time and would sneak a potato or some bread until my husband would remind me of the expert advice and I would go back to mostly salads. . . . When I was in hospital. . . I hardly ate at all during those two weeks prior to my induction.’
Underweight and premature
Again and again, the personal experiences indicated maternal under-nutrition, sometimes instigated by doctors setting artificial weight limits. And more scientific studies, conducted by dieticians and public health physicians rather than obstetricians were given a new prominence in P.E.T.S. They showed that pre-eclampsia could be effectively prevented by thorough nutrition counselling or diet supplementation.
The obstetric profession doesn’t like this idea. ‘I would counsel that you drop any reference to Brewer’s work,’ wrote Professor Ian MacGillivray about the California champion of the nutritional thesis, ‘if you wish to have any support from research workers into this problem in the United Kingdom or for that matter, any part of the world.’
Nancy Stewart, another P.E.T.S. member and recent editor for the Association for Improvements in the Maternity Services, believes that this is inevitable given the training and role of obstetricians. ‘Prevention through good nutrition is a woman-centred approach, which means being in touch with women’s daily lives. And it has to do with health, rather than disease. This is the approach of midwives, as the guardians of normality. Obstetrics is not about health, but about diagnosing and treating disease. It is a male science, and within the political structure of maternity care it is these men, trained to approach pregnancy as a medical event, who have the power to define health care.’
Pre-eclampsia is more prevalent among unskilled working class people and teenaged, Asian and single mothers—those statistically least likely to meet the extra nutritional demands of pregnancy. How can a few informed women hope to change the system of maternity care to benefit these in greatest need? Midwives may learn eagerly from P. E. T. S., and may even recall the days when their duties included baking and delivering egg custards to get concentrated protein into poor pregnant women, but their role as independent practitioners is being rapidly diminished into one of obstetric nurses.
Perhaps P.E.T.S. can work its approach into the health care system through the back door, women taking the lead. But in the meantime as many as 15 per cent of women in pregnancy are diagnosed as pre-eclamptic, and very few of them discover in time the protective effects of sufficient high quality foods. Instead, they are categorized immediately as high risk and referred to the obstetric clinic, where sophisticated, expensive diagnostic procedures chart with scientific precision the worsening and irreversible damage to their babies.