New research published in BMC Pregnancy and Childbirth suggests that midwife advice about the low risk alcohol guidelines for pregnant women beyond the initial booking appointment can ‘lead to improved outcomes for women and infants’.

Current medical advice – announced by the UK Chief Medical Officers in 2016 – is that the safest approach for those who are (or think they may be) pregnant is to avoid alcohol. Funded by the Institute of Alcohol Studies, a research team investigated UK midwives’ practices regarding those guidelines, and the factors influencing their implementation during antenatal appointments.

This was done by an online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments.

Of 842 midwives who responded to the questionnaire, nearly three fifths (58%, 484) were aware of the 2016 Alcohol Guidelines, of whom 91% (438) cited abstinence as a recommendation.

Awareness and perceived content of CMO guidelines

The findings also found that the vast majority of midwives would always (90%) or usually (7%) advise women to abstain from alcohol during pregnancy at the booking appointment. Just over a third (38%) did so at subsequent antenatal appointments.

Midwives were asked about their usual practice regarding assessment and advice on alcohol consumption at booking for women with a suspected alcohol problem. The vast majority always (89%) or usually (9%) advise women to reduce or abstain from drinking, and almost all (99%) always or usually referred women onward to the appropriate agencies. However, fewer midwives always or usually further explored a woman’s drinking behaviour regarding previous referral for an alcohol-related problem and alcohol consumption during previous pregnancies (74%), and fewer still always or usually enquired about a potential family history behind the alcohol-related problems (51%).

At antenatal appointments other than booking, the proportion of midwives who always or usually continued to assess current alcohol use (63 and 20%), advise abstinence (67 and 15%) and discuss alcohol effects (54 and 22%) remained substantially higher if an alcohol-related problem was suspected, compared with all respondents.

Regarding midwives’ opinions about the usefulness of the low risk guidelines, the research team found that the biggest barriers to advising women using those guidelines were: a lack of belief that the guidelines are accurate and represent the best available evidence on alcohol and pregnancy; a belief that the guidelines do not support building a rapport with women; that women do not like being advised about abstinence and a belief that advising women to abstain has no impact on their behaviour.

Weaker barriers were midwives’ level of confidence/self-efficacy in discussing alcohol, prioritising other tasks and the extent to which they found it rewarding to share the information.

Midwives were most likely to advise women to abstain from alcohol if the desire and intention was there and if they saw it as integral to their job.

The report concludes:

An implementation intervention to support midwives delivery of alcohol advice at each antenatal appointment and not just at booking could lead to improved outcomes for women and infants. Reducing risky drinking has benefits which extend beyond pregnancy, including during breastfeeding and subsequent pregnancies and throughout the lifecourse to prevent chronic disease. Pregnancy presents an ideal opportunity to change behaviour, and midwives are in a key position to engage with women to facilitate this change.

You can read a brief summary of the report’s findings from one of the report’s authors, Dr Lisa Schölin, on Twitter.