Midwifery management of asthma and allergies during pregnancy, birth, and the postpartum
Asthma and allergic rhinitis are two of the most common health problems worldwide and can present serious complication during pregnancy. While these diseases may improve, remain unchanged, or become exacerbated during pregnancy, they are frequently under-diagnosed and under-treated. The inflammatory processes involved in asthma and allergic rhinitis are superimposed on the normal respiratory changes of pregnancy, making early intervention crucial. Recognition of factors that can aggravate asthma, implementation and adherence to treatment guidelines, and diligent follow-up are important in midwifery management. Patient education is particularly important for prevention of asthma exacerbations. With careful control of asthma and allergic rhinitis, if present, excellent obstetrical outcomes can be expected.
Asthma, often complicated by allergies, is a common health problem that can cause complications in pregnancy (World Health Organization (WHO), 2014). The UK has an asthma prevalence during pregnancy of around 8% (Clark et al, 2007), although more recent epidemiological data is unavailable. With the prevalence and morbidity associated with asthma increasing, midwives are likely to care for women with varying degrees of asthma control. It is therefore imperative that there be prompt recognition and intervention to promote optimal perinatal outcomes. Asthma, often accompanied by allergic rhinitis (Angier et al, 2010), can be well-controlled and devastating consequences avoided with careful attention.
Asthma is a ‘chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, T-lymphocytes, macrophages, neutrophils, and epithelial cells’ (Murdock, 2002: 28). It is characterised by exposure to a precipitating factor (or trigger), which narrows the airways and obstructs airflow (National Asthma Education and Prevention Program (NAEPP), 2007). The obstruction is usually reversible, either spontaneously or with treatment. Asthma triggers, including allergens or irritants, can lead to several responses in the initial acute stage where there is a susceptible individual who is exposed for a long enough period of time. These responses are classified as early (immediate), late phase, dual phase, and recurrent asthmatic reaction.
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