“I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol

Abstract

"I think we should all be singing from the same hymn sheet"-English and Swedish midwives' views of advising pregnant women about alcohol Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n=7) and Örebro County, Sweden (n=9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use.

“The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

“…However, as the findings demonstrated, practitioner support can be limited [ 30 , 39 , 42 , 43 , 45 , 50 , 53 , 55 ]. Conflicting information from the media and evolving guidelines can influence practitioners to doubt their overall abstinence or alcohol reduction messaging [ 15 , 65 ]. It can result in confusion, mixed messaging, and misinformation among those who wish to know more about alcohol use in pregnancy [ 29 , 30 , 39 , 40 , 42 , 43 , 45 , 46 , 48 , 50 , 51 , 53 , 54 ].…”

Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

“…Engagement with women to promote health is in line with the public health role of the midwife in the UK and internationally [46][47][48]. Reassuringly, professional role and identity was a strong enabler of advising abstinence at antenatal appointments other than booking, indicating that midwives see advising women to abstain as part of their role and that it is expected of them and that they have intentions to do so.…”

Drinking in pregnancy

“…Midwives tend to support the contention that women are 'confused' by messages from different sources providing variable advice and that a clear, unambiguous message is the preferred option However, very often midwives are reluctant to advise total abstinence as they are aware of the lack of good evidence for that message or feel that small amounts do no harm (Van der Wulp, 2013;Schölin et al 2018;Crawford Williams et al, 2015).…”

“…In a study comparing English and Swedish midwives, it was generally felt that, '…we should all be singing from the same hymn sheet' regarding delivering an abstinence message (Schölin et al 2018, p.5), and that any drinking during pregnancy could indicate an underlying alcohol problem. Comparing the risk discourses of the nine Swedish and seven English midwives interviewed, Schölin et al (2018) reported that English midwives' views were quite nuanced and the uncertainty around the risk of drinking small amounts was mentioned. By contrast, Swedish midwives' risk discourse was binary: either women stop drinking or they continue because they have an underlying drinking problem.…”