In July, the Royal College of Midwives (RCM) and the Royal College of Obstetricians & Gynaecologists (RCOG) updated their guidance for antenatal and postnatal services during the pandemic. The new guidance says women should be advised to continue to attend all routine antenatal appointments, and healthcare professionals should ask about mental wellbeing at every contact, as well as signpost those who require further support to relevant mental health resources and local services.
Pregnancy can be a time of uncertainty. According to February 2020 research for The Baby Show, 70 per cent of women experience some sort of mental health problem during or after pregnancy. The most common mental illnesses experienced by new mothers are anxiety (36 per cent), ‘baby blues’ (18 per cent) and post-natal depression (12 per cent).
Research conducted by Emma’s Diary in November 2019 revealed that over a third of pharmacists had seen an increase in pregnant and perinatal women suffering with mental health illnesses in the last two years. Yet many pharmacists find that women are still reluctant to seek help because they believe their symptoms are normal, fear they will be judged for not doing a good enough job, or are embarrassed.
Community pharmacies have been even more of a source of information and advice during the pandemic, with GPs not as accessible as usual. “The pharmacy has become the place where mums-to-be can speak with a healthcare professional face to face,” says Elvy Mardjono, senior brand manager for Deep Freeze Pregnancy at The Mentholatum Company. “Most pregnant women are determined to do the best for their baby and want to be reassured about products they can use during pregnancy and while breastfeeding.”
A recent poll of 2,000 mothers commissioned by Vitabiotics Pregnacare found that 67 per cent felt the internet was their lifeline during pregnancy, allowing them to ask questions they were too embarrassed to ask in real life.
On average, the surveyed mothers would ask more than a thousand questions over the nine months, with internet searches the most usual way to ask (67 per cent), followed by asking a midwife (59 per cent), speaking to their own mother (48 per cent) or friends (46 per cent).
Morning sickness remedies were high up in Vitabiotics’ top 50 questions. According to a University of Warwick study published in the British Journal of General Practice in June, ‘morning sickness’ is a misleading term as analysis of symptom diaries kept by 256 women showed that nausea and vomiting in pregnancy can occur at any time of day. The study found that vomiting is most common between 7am and 1pm, while nausea is highly likely throughout the day and many women still report it into the evening.
The pharmacy has become the place where mums-to-be can speak with a healthcare professional face to face
Professor Roger Gadsby, honorary associate clinical professor at Warwick Medical School, says using the term can trivialise the condition for women who experience severe symptoms. “Women say their midwife or GP tells them: ‘You just have a touch of morning sickness’,” he says. “If a pregnant woman experiences sickness in the afternoon, she may feel this is unusual or wrong. If she experiences no vomiting but feels nauseated all day, she might think she’s not covered by the term.”
If it occurs, nausea and vomiting usually starts between week five and seven of pregnancy and fades away at 12 to 14 weeks. However, Professor Gadsby says this varies widely. Around one per cent of pregnant women experience severe symptoms (hyperemesis gravidarum) that can have a significant impact on their lives. “Nausea and vomiting in pregnancy is the most common cause of hospital admission in the first trimester of pregnancy,” he says. “Red flag symptoms include weight loss and dehydration.”
Registered midwife Lesley Gilchrist, co-founder of website My Expert Midwife, says pregnant women experiencing nausea or vomiting should rest as much as possible, try to eat and drink little and often and use self-help remedies before resorting to medicines or medical help. “Ginger can be a good solution as it is known for its anti-nausea properties,” she says. “Pregnant women can try ginger in different forms – hot water with chopped fresh ginger, crystallised ginger, ginger biscuits – to see if one type helps more than another. It may help to avoid eating rich, creamy, or spicy foods, and stick to smaller portions rather than eating large meals.”
According to the RCOG’s 2016 green-top guideline, The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum, women who are vomiting but are not dehydrated can be managed in the community with oral anti-emetics (antihistamines and phenothiazines), support, reassurance, oral hydration and dietary advice. Acupressure may also help. A combination tablet of an antihistamine and pyridoxine is available on prescription for women who don’t respond to conservative management.
According to Laura Crossland, Weleda brand manager, pharmacies can differentiate themselves from other stores and other local pharmacies by developing a dedicated ‘natural medicine cabinet’. “Organic products, in particular, are seeing significant growth,” she says. “For expectant mothers and breastfeeding mums who are unable to take conventional medicines, offering complementary health products is an area of potential growth for pharmacies. Build local networks by contacting nearby mother and baby groups or National Childbirth Trust (NCT) classes, to communicate what’s in store.”
People are feeling vulnerable, so the personal touch matters more than ever
Pregnant women are advised to take folic acid and vitamin D supplements, but other nutrients may also be important. Julia Cameron-Wallace, UK brand manager, and Sofia Rizzo, head of professional education for Spatone, say iron is a large category in pharmacy. “Most of us should be getting enough iron from a balanced diet and healthy lifestyle, but many people will turn to their pharmacy for information when they discover their iron levels are too low,” they say. “Consumers are switching to natural based iron supplements as they become more conscious of what they eat and drink.”
Dr Kate Stephens, gut microbiologist at OptiBac Probiotics, says probiotics can help to support a woman’s health during pregnancy. “We see some significant changes to the gut, vaginal and oral microbiome, which can all impact mum’s and baby’s health during gestation and post-birth,” she says. “Common pregnancy health concerns such as constipation, low energy and even vaginal issues such as bacterial vaginosis can be linked to these changes.”
Alice Bamford, senior marketing manager for Sudocrem, says customers welcome a pharmacy’s community feel, and many are choosing to shop locally to avoid queues in supermarkets. “People are feeling vulnerable, so the personal touch matters more than ever,” she says. “Talk with customers. Ask how they are and provide advice, including which OTC product is suitable for their needs. Also, stock new and interesting products because people may shop less but buy more.”
Helen Curran, head of marketing at Nuby, says customers generally go to a pharmacy with a problem that needs to be solved. “Pharmacies should concentrate on products for common issues, such as breastfeeding, reflux, crying, sleeping, teething, weaning and transitioning to and from bottles and cups,” she says. “Consumers vary from new parents looking for expert advice to those needing a product in a hurry (e.g. lost dummy, teething relief, etc). Grandparents often purchase gifts they hope will help make life easier for their offspring while visiting their local pharmacy.”
According to Christopher Blincoe, director of Bickiepegs Healthcare, teething and weaning are important issues within pharmacy. “A teething baby in pain needs solving urgently, so customers are more likely to go to their pharmacist for a solution,” he says. “With weaning, customers are more likely to shop around or buy online, so proportionately less space should be given to these items.”
Another common concern is nappy rash, a condition that affects around one in three babies. Lucy Rigby, Metanium brand manager, says: “There are certain trigger times when nappy rash is more likely to occur. Pharmacists may find it useful to advise on nappy rash prevention if a parent asks for advice about any of the following: diarrhoea, teething, colds, antibiotic use, baby sleeping through the night, weaning or any change in diet.”
According to the latest Public Health England data, 48 per cent of mothers are breastfeeding at six to eight weeks, but the NHS website says that by three months, only one in six babies are still being exclusively breastfed, despite the national recommendation of breastfeeding exclusively until six months.
Breastfeeding support helps to encourage more women to breastfeed for longer. Lisa Craven, UK marketing manager at Lansinoh, recommends pharmacies stock a wide range of breastfeeding products, such as those for sore, cracked nipples, especially for the early days when new parents don’t want to travel far for supplies. Eden Fraser, UK brand manager of Karo Pharma, says offering products that support mothers who want to breastfeed is really important, as this will help to ensure repeat custom.
Many parents with babies will turn to their local pharmacy for help to resolve the issue
Since not all women breastfeed, Amanda McPherson, head of pharmacy at Nutricia, says pharmacists should familiarise themselves with the range of formula milks available. “This can help cater for mothers who are unable to breastfeed, whose babies might have an intolerance or a sensitivity to regular formula milk, or for those women whose baby has a problem such as reflux, colic or constipation,” she says.
Fiona-Jane Kenworthy, marketing manager at Dr Brown’s, says parents may ask about the best bottle to use for their baby or for a preventative/non-invasive solution for colic. “Many parents with babies will turn to their local pharmacy for help to resolve the issue,” she says. “New parents are always hungry for advice, and this is where community pharmacies are ideally located within the neighbourhood.”
Gareth Evans, Wansford Pharmacy, Peterborough
“We don’t have much space, so we have to be selective in what we stock. We tend to go with brand leaders and best sellers, such as Clearblue. Queries during pregnancy are frequently to do with reflux; Gaviscon sells well here. New mums ask about constipation and laxative use. For babies, our best sellers are Oilatum and Aveeno. It’s important to emphasise the advice you can offer to new mums as they might not be aware of it. Make the most of link sales opportunities with products like folic acid. And make sure stock is visible – don’t hide things away.”
Lila Thakerar, Shaftesbury Pharmacy, Harrow
“Babycare is a big sector for our pharmacy. Colic pain is the reason for most queries, but we also get asked about breastfeeding issues such as sore nipples, and parents will ask about nasal sprays when baby gets a cold. Dentinox and Infacol are our bestselling brands. Health visitors are referring new mums to pharmacies these days for colic or congestion issues as it’s much quicker than seeing a GP. All our pregnancy and babycare products are on display for parents to browse. Keep them together so parents can compare products and read the labels.”
Selina Gill, locum pharmacist, West Midlands
“This is the most exciting phase in parents’ lives and they look to community pharmacists to ease their fears. Common queries range from vitamin D supplements to smoking cessation. With sales every day, Infacol is our best seller. We have seen more anxious parents during the pandemic, worried about who to contact for help should they need it, and wanting to ensure they and their babies stay well to prevent any unnecessary visits to a GP or hospital. To boost sales, advertise products with special offers to ensure economic value in bulk and use natural based products to drive sales.”