After trying for a baby for 2 years, we became pregnant with our first child just 2 days before we were due to sign the paperwork to undergo IVF treatment. I've been a midwife for 11 years, with experience mostly on the labour ward but also in teaching and community, so seeing people every day and hearing their ‘lucky’ stories of falling pregnant made my 2 years feel very long indeed. However, we too were lucky; we had no bleeding, no blood pressure issues, the Down syndrome screening came back very low and, despite sickness that lasted until 22 weeks and severe heartburn, I couldn't complain.
My midwife started measuring me at 26 weeks, when she picked up that I was small for dates. I also never felt my baby move. I started undergoing serial growth scans. I send women for these scans all the time and they generally come back fine, so I wasn't worried. My consultant did a TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV) blood screen for infections. I knew I was fit and healthy so, again, I wasn't worried.
But then my world began to crumble. I'd had cytomegalovirus (CMV) at some point during the first trimester, meaning my baby could be infected. While I'd heard of it, I had never known anyone who'd had CMV. How on earth had I picked this up?
Most people won't know they have CMV, but if a woman contracts the virus while she is pregnant, she can pass it to her unborn baby with catastrophic results.
CMV belongs to the Herpes family. This group of viruses includes herpes simplex, varicella-zoster (which causes chickenpox and shingles) and Epstein-Barr (which causes infectious mononucleosis, also known as mono or glandular fever). CMV is a common infection and is usually harmless; however, once a person is infected, the virus remains with them for life. Although CMV can cause serious disease in people with a weakened immune system, most healthy children and adults infected with CMV have no symptoms, and may not even realise that they have contracted the virus. Others may develop a mild illness at the point of infection, accompanied by symptoms including fever, sore throat, fatigue and swollen glands. Owing to the common prevalence of these symptoms, most people do not recognise that they could be associated with CMV.
During pregnancy, the immune system changes so that it can protect both mother and baby from disease. Some parts of the immune system are enhanced while others are suppressed. This creates a balance that can prevent an infection in the fetus without compromising the defences that keep the mother healthy. These alterations in the immune system protect the baby from the mother's defences and induce an immune rejection response. However, due to depressed T-cell function, the body is more prone to opportunistic and viral infections. In addition to the immunologic changes that occur during pregnancy, hormonal changes may also predispose women to infection.
Pregnant women can contract CMV through bodily fluids such as saliva and urine, primarily from young children. Simple measures such as not sharing cutlery, drinks, food or dummies, avoiding kissing young children on the mouth, and good hand hygiene after contact with any bodily fluids, significantly reduce a woman's risk of catching CMV (Griffiths et al, 2015).
If a pregnant woman contracts CMV, the consequences can be disastrous. Around 20% of babies born with CMV will have problems such as hearing loss, cerebral palsy and physical impairment, while others are stillborn or miscarried (Griffiths et al, 2015).
After finding out that I'd had CMV, we searched the internet and found out that our baby may have some learning disabilities or mild hearing loss. As far as we were concerned, this wasn't really a problem, if he was otherwise healthy. The consultant suggested an amniocentesis, which we had at 33+1 weeks. We had a brain scan, which showed ventriculomegaly, some brain abnormalities. We went on to have an MRI scan at the John Radcliffe Hospital in Oxford. Our baby was diagnosed with severe CMV; there was poor growth, enlarged liver and abdomen, a small head, and no brain activity.
Our beautiful baby, Oscar William, my shining star, was stillborn at 33+6 weeks, on 9 March 2015.
Raising awareness of CMV
There is a growing body of research demonstrating that, by raising awareness of how CMV is transmitted, we can reduce the risk of pregnant women acquiring the infection (Griffiths et al, 2015). Midwives are ideally placed to advise women about simple hygiene precautions in pregnancy. However, many midwives will have received minimal education on CMV since their initial training. Educators should prioritise continuing professional development on CMV to equip midwives with the knowledge to make a vital difference.
There is an urgent need for more research into vaccines and treatment. In the meantime, it is important that midwives, obstetricians and other professionals involved in antenatal care improve their understanding of CMV. The Royal College of Midwives (2015) offers an online module on CMV, and national charity CMV Action has produced publications that are available to download for free from its website (www.cmvaction.org.uk).
It will take time and collaborative working to achieve our overall vision of reducing the number of babies being born with CMV, and to ensure better support for those affected. But it is crucial to achieve this if we are to reduce the burden to so many children and families affected each year by congenital CMV infection.