Women’s views on moderate and low alcohol consumption: stages of the subjective transition from pregnancy to postpartum

Abstract

Background Alcohol consumption during pregnancy and breastfeeding is associated with a risk for the child’s healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman’s perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period. Methods The longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth. Results In our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women’s perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling. Conclusion Many women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.

Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis

“…In many categories, the results showed how thread starters were confused or worried about safe limits, including whether it is safe or not to consume products that may contain traces of alcohol. This is in line with previous research, showing that the concept of abstinence is not always clear, with confusion about, for example, if food containing alcohol is safe or if it is acceptable to consume non-alcohol options during pregnancy [20].…”

“…Those who posted threads on Mumsnet were also expressing how the guidelines and research were not clear, and quotes illustrated that some felt that no 'real people' could follow all the rules. This is in line with previous research about how women feel like there are too many guidelines [20] and how the abstinence message can be perceived as policing women [22]. Interestingly, posts asking for the guidelines or asking for more information were only observed before the introduction of the updated CMOs' lowrisk drinking guidance on alcohol in pregnancy [17].…”

“…While some welcomed the introduction of the revised guidelines [18], others claimed that the new guidelines would lead to women having feelings such as guilt and anxiety if they were consuming alcohol during pregnancy [19]. Pregnant women feel there are too many guidelines to follow, arguably leading to increased stress [20]. It has also been expressed that pregnancy can lead to a perceived lack of agency and control [21] in this context; the abstinence guideline can be perceived as 'policing women' [22].…”

“…Furthermore, the concept of abstaining from alcohol during pregnancy is not always clear, with some women experiencing confusion about, for example, if food containing alcohol is safe or if it is acceptable to consume so-called 'NoLo' (no-or low alcohol) products [20].…”