What midwives and childbearing women should know

     

So, what should health and social care professionals be doing to play their part in reducing the number of infants affected by the virus? Given the devastating consequences for the neonate from contracting congenital CMV in utero, it is imperative that both health care professionals and women receive education about reducing the risks of transmission.

Education 

Routine provision of health information is a pivotal step in encouraging childbearing women to understand how to avoid CMV transmission. Transmission of CMV occurs via bodily fluids, e.g. urine, saliva, vaginal secretions, semen, breastmilk, blood transfusions and organ transplants. Primary infection of childbearing women occurs in around 0.15-2.0% of all pregnancies22 and can lead to catastrophic consequences for the infant who contracts CMV in utero. Hence, as part of routine preconception and antenatal care, midwives must provide childbearing women with advice to reduce their risk of contamination by CMV. The simple and most effective education that midwives can offer couples planning or already pregnant involves four very simple hygiene precautions.

Education costs little and is key to reducing the spread of CMV. Education regarding CMV is aimed at reducing infant risk of developing Intrauterine Growth Retardation (IUGR), hyperbilirubinemia, hepatosplenomegaly, thrombocytopenia, and microcephaly, all of which cause serious morbidity problems and often death.

Discussing CMV with childbearing women may make some feel anxious. Nevertheless, given the catastrophic consequences for the infant of contracting congenital CMV in utero, it is imperative that both health care professionals and women receive carefully measured educational messages about its prevention.23

Education could be further strengthened by widening general public health messages about how to prevent the spread of CMV infection. For example, by teaching adults and older children thorough methods of hand hygiene and how to avoid spread between children in day care facilities. Education programmes that extend midwives knowledge about CMV are clearly required, e.g. organising study sessions for all grades of staff and increasing the amount and level of CMV education in the midwifery curriculum. Further training
in prevention and management of CMV would profoundly improve long-term infant mortality and morbidity.

It is the responsibility of midwives to deliver information about CMV in a balanced way so as not to cause alarm. The spread
of CMV can be avoided and whilst it is hard for busy women to avoid every potential exposure, simply improving hygiene measures can markedly reduce the risk of transmission.
To this effect, CMV Action has developed a range of educational literature for childbearing women - click here to go to the publications page.

Midwife education 

The midwife is perfectly placed to increase delivery of CMV education to both staff and childbearing families, yet many have received minimal education on the topic since their initial training. Despite the growing body of published evidence that emphasises the importance of increasing health education in attempts to reduce CMV transmission 2,11,22,23,24, 25,26,27,28, in many countries there lacks provision of directives to vital health care professionals, such as general practitioners, midwives, neonatal paediatricians and nurses about this subject. This finding sharply contrasts with education designed for delivery in relation to other teratogenic infections in pregnancy, e.g. listeriosis and toxoplasmosis, which represent far less danger to the infant. Improving education that teaches people how to avoid contamination is key to reducing CMV spread. With this in mind, midwifery educators in the UK should consider advancing education for midwives as part of continuing professional development. For example, content of curriculum should include:

  • How to prevent CMV infection spread (Don’t Share, Wash with Care)
  • Provide a clear definition and description of CMV signs and symptoms
  • Discuss prevalence of CMV
  • Discuss brutal consequences for a fetus who has contracted congenital CMV

CMV Action and The Royal College of Midwives have developed an e-learning training module to promote support further education for midwives on CMV.
(ilearn.rcm.org.uk). It is aimed at enhancing midwives understanding as well as increasing their confidence to counsel women about CMV and its serious consequences. Evidence supports that high quality training in prevention and management of CMV markedly reduces mortality and morbidity of fragile infant lives.

To conclude, educating women to diminish CMV risk is enormously important if midwives are to make a difference. Clearly a lot is yet to be tackled if we are to eradicate CMV risk and spread. In essence, the key variable for reducing CMV transmission involves straightforward hygiene measures.

Professor Caroline
Hollins Martin

Professor in Maternal Health, Edinburgh Napier University

  1. Avoid placing objects in your mouth that have previously been in an infant’s mouth e.g. avoid food, cup and utensil sharing, or sucking a child’s dummy to clean it after it has been dropped.
  2. Avoid kissing young children on the mouth or cheek. Instead, kiss them on the head or give them a big hug.
  3. Wash your hands thoroughly with soap and water after coming into contact with any bodily fluids. This includes after a nappy change, or after wiping a toddler’s nose or mouth.
  4. Thoroughly cleanse items that have been in contact with bodily fluids and may have become contaminated. 
     

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