In this post, there is information that could save a life (or a career) so if you know someone who could benefit do consider sharing it with them.
I'm proud to have worked with midwife, nurse and infant feeding specialist Samantha Nash for about 18 months now. Her expertise in The Secret Community For Midwives In The Making is very welcome. It's upsetting to me that Samantha can no longer practice in 'real life' because she has become ill from vitamin B12 deficiency.
Samantha is now a passionate advocate for those suffering from vitamin B12 deficiency. It's a frightening and little-known condition which we talked about in detail in this video interview. This post is based on her expertise.
EDIT: updates added 11/09/16 with expertise from Tracey Witty, founder of www.b12deficiency.info, supported by Sally Pacholok, expert ER Nurse.
There's a lack of education around treatment for vitamin B12 deficiency which means even if you're a highly educated practising midwife, you might not know that being around Entonox, colloquially known as 'gas and air', can be dangerous.
Entonox is nitrous oxide, a dissociative anaesthetic which is very useful in labour. But it can impact your vitamin B12, in terms of how much your body can use, if you're exposed to it a lot.
Vitamin B12 is essential for the way your nerves function.
Vitamin B12 deficiency causes the myelin sheath, which is the fatty covering of the nerve, to become frayed so messages don’t pass easily.
In pregnancy, it can cause problems with a baby’s neural tube forming, meaning the spinal cord or brain can be exposed or damaged.
In adults, vitamin B12 deficiency can present just as severely as Multiple Sclerosis and can kill you. You may know the disease by the old-fashioned sounding name 'pernicious anemia', pernicious meaning 'deadly'.
Nitrous oxide is a heavy gas, which means it collects in pockets at floor level when a client is using it for pain relief. Midwives spend a lot of time 'listening in' to fetal hearts, down on the floor while supporting active birth.
Additionally, pockets of nitrous oxide can be broken up and the gas can be dispersed around the room so it's not just midwives who get into funny positions who are exposed. Samantha tells me that the risk can still be present even if there is an effective gas scavenging system in place.
You may be thinking, ok, I'll pop to Holland and Barrett and get some supplements of B12 to mitigate the risk. But this can delay a diagnosis as supplementation prior to testing can skew results.
There's a difference between 'active' vitamin B12 which your body can use and 'inactive', which it can't. This means serum B12 blood tests can't tell clinicians what's happening at a cellular level. Essentially, if you take oral vitamin B12 you can skew the blood test results without treating the real problem.
Symptoms of vitamin B12 deficiency can include pins and needles, mental health issues, struggling to conceive and tiredness/forgetfulness and more (yes there are some jokes we could make about working in the NHS and tiredness but please do look after yourself if you think you're straying into abnormal territory!)
If you suspect you have B12 deficiency, do lots of reading, www.b12deficiency.info/what-to-do-next/ is a great place to start, and speak to a haematologist (blood specialist) – get tested yearly or if you have symptoms, more frequently.
It's easily treated with intramuscular injections - you often need quite high amounts, though this appears to be safe, and in fact, injectable vitamin B12 is used in huge quantities for cyanide poisoning.
There is some more clinical information below this post. If you email me I can send you references to journals and other resources ( firstname.lastname@example.org ).
There are also a couple of excellent books I can recommend: Could it be B12?: An Epidemic of Misdiagnoses and Could It Be B12? Pediatric Edition: What Every Parent Needs to Know.
If you have any extra information for midwives on vitamin B12 deficiency, please leave me a comment below. I'd also love to hear from you if you have been affected in any way by this condition.
Being at risk of vitamin B12 deficiency is a scary thought I know, but knowledge is power.
Much Love, Ellie x
To protect yourself and members of your team think B12D (Nash 2016)
B - Be aware of signs and symptoms of B12 deficiency.
An absence of anaemia does not exclude B12 deficiency.
Have once yearly screening , more frequently if symptomatic.
Treat clinical symptoms not levels of serum B12.
Serum B12 values are a poor indicator of B12 deficiency and can present as normal even when severely deficient. Best practice to identify B12 deficiency would be to test serum B12 and include either serum or urinary methylmalonic acid or holotranscobalamin. Hydroxocobalamin the parenteral treatment for B12 deficiency is considered safe and non- toxic.
D - Don’t supplement
Oral B12 supplements, sprays and patches can raise haematological values of B12 while allowing the neuropsychiatric damage to advance (e.g. serum B12 would show normal value even if you were severely deficient).