Abstract
BackgroundInfants exposed to alcohol in the womb are at increased risk of experiencing health problems. However, mixed messages about the consequences of prenatal alcohol consumption have resulted in inconsistent attitudes and practices amongst some healthcare practitioners. Screening and alcohol brief interventions (ABIs) can reduce risky drinking in various clinical settings. Recently, a program of screening and ABIs have been implemented in antenatal care settings in Scotland. However, current evidence suggests that midwives’ involvement in alcohol brief interventions activities is patchy. This study explored midwives’ attitudes and practices regarding alcohol screening and ABIs in order to understand why they are relatively underutilized in antenatal care settings compared to other clinical settings.MethodsThis was a qualitative study, involving semi-structured interviews with 15 midwives and a focus group with a further six midwifery team leaders (21 participants in total) in Scotland. Interview transcripts were analysed using thematic analysis.ResultsMidwives were positive about their involvement in the screening and ABI program. However, they were not completely convinced about the purpose and value of the screening and ABIs in antenatal care. In the midst of competing priorities, the program was seen as having a low priority in their workload. Midwives felt that the rapport between them and pregnant women was not sufficiently established at the first antenatal appointment to allow them to discuss alcohol issues appropriately. They reported that many women had already given up drinking or were drinking minimal amounts prior to the first antenatal appointment.ConclusionsMidwives recognised the important role they could play in alcohol intervention activities in antenatal care. As the majority of women stop consuming alcohol in pregnancy, many will not need an ABI. Those who have not stopped are likely to need an ABI, but midwives were concerned that it was this group that they were most likely to alienate by discussing such concerns. Further consideration should be given to pre-pregnancy preventative measures as they are more likely to reduce alcohol-exposed pregnancies.
Highlights
Infants exposed to alcohol in the womb are at increased risk of experiencing health problems
In order to understand and improve the quality of screening and alcohol brief interventions (ABIs) in antenatal care settings, we explored how midwives’ skills, knowledge and attitudes to alcohol consumption in pregnancy influence their practice
Attitudes to alcohol consumption Prompted by previous research findings that there were uncertainties regarding the effects of low-moderate levels of drinking on the fetus, we explored how this message had influenced midwives’ attitudes to prenatal alcohol consumption
Summary
Infants exposed to alcohol in the womb are at increased risk of experiencing health problems. Screening and alcohol brief interventions (ABIs) can reduce risky drinking in various clinical settings. This study explored midwives’ attitudes and practices regarding alcohol screening and ABIs in order to understand why they are relatively underutilized in antenatal care settings compared to other clinical settings. Current evidence supports the use of screening and ABIs to reduce hazardous and harmful drinking in a range of healthcare settings, including primary care and general hospital settings [8,9]. The delivery of ABIs is preceded by the use of alcohol screening tools to detect hazardous or harmful drinking. These tools are usually setting and populationspecific. The number, nature and size of drinks consumed are explored in order to estimate alcohol units [15]
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