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Midwives

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Midwives are a pivotal point of medical contact for pregnant women.

It is their responsibility to provide information and advice to their patients and their partners.

It is essential that the advice provided by healthcare professionals is up to date, consistent and evidence-based, in addition to the advice provided on other lifestyle choices such as drugs, smoking and nutrition.

There is no ‘safe’ level of alcohol to drink when pregnant

Guidance from the UK Chief Medical Officers regarding alcohol and pregnancy states:

“If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.”

When you suspect a pregnant woman might be drinking alcohol, early intervention is the most effective way of improving the outcome for both mother and baby. An empathetic, non-judgemental approach encourages a positive response. No matter whether a woman is newly pregnant or nearly full-term, her baby will always benefit when she stops drinking (it is critical for in cases where alcohol withdrawal might be an issue that this is done with supervision). It is also important for mothers-to-be to have the support of the father, close family members and friends. When everyone is informed about the risks, better support can be in place for pregnant women.

Why is it important?

It is believed that the fetus is affected by alcohol in two ways.

  1. Ethanol (alcohol), a teratogenic compound, crosses the placenta and can cause:
  • disruption of cellular energy
  • impairment of cell acquisition/ dysregulation of developmental timing
  • altered regulation of gene expression
  • disrupted cell-to-cell interaction
  • interference with growth factor signalling or other cell signalling pathways
  • cell damage/cell death
  • secondary sources of damage.

  1. Persistent change in fetal behaviour
  • This includes changes in fetal breathing movements even at low levels of alcohol  use
  • Development of the fetal startle reflex is affected, again even at low levels

 

Other adverse outcomes of maternal alcohol consumption include:

  • miscarriage
  • pre-term deliveries
  • stillbirth
  • sudden infant death syndrome (SIDS)/cot death

Recommended action

  • Engage in education related to FASD with all women and their partners.
  • Ask all female patients to discuss their alcohol use (using open-ended questioning and also using tools like the AUDIT-C, TWEAK or T-ACE drinks charts.
  • Identify women at high risk.
  • Advise women about the risks of drinking, including discussion about special occasions and emphasise the positive benefits of cutting out alcohol at any time during their pregnancy.
  • Obtain current promotional materials on FASD and provide them to patients. All pregnant women should be given printed take home info on the risks of alcohol in pregnancy, targeted at hard to reach groups.
  • Refer women who are using alcohol to appropriate specialists.

Ask pregnant women about alcohol use

Ask Pregnant Women About Alcohol Use

Further reading

Resources

Alcohol and Pregnancy - information for midwives

Our midwives’ booklet is widely used in training programmes

Scottish SIGN 156 Guidance

Children and young people exposed prenatally to alcohol

BMA Report on Alcohol in Pregnancy

(2016)

Drymester

Greater Manchester Health and Social Care Partnership has an extensive project focused on alcohol-exposed pregnancies

Be Your Baby’s Hero

Blackpool’s Better Start Programme

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