A qua lit a t ive study exp lor ing m idw ives’

a t t it udes and pract ices of adv ising p regnant w om en about a lcohol

Dr Lisa SchölinResearch FellowUniversity of Edinburgh

Visiting Research FellowPublic Health InstituteLiverpool John Moores University

Presenter d iscosureLisa SchölinThe p re s e nte r ha ve nothing to d is c los e .

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Acknow ledgem entsDr Lorna Porc e lla to, Liv e rp ool J ohn Moore s Univ e rs ity

Prof Ka re n Hug he s , Pub lic He a lth W a le s

Prof Ma rk Be llis , Pub lic He a lth W a le s

Prof C ha rli Eriks s on, Öre b ro Unv ie rs ity

This re s e a rc h w a s c a rrie d out a s a PhD p roje c t a t Pub lic He a lth Ins titute a t Live rp ool J ohn Moore s Unive rs ity

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UK 4 1.3%

Popova et al. (2017)

Any a lcohol use dur ing p regnancy

Prevent ion in an tenata l care￮ De s p ite a b s tine nc e p olic y , s om e m id w iv e s s till a d v is e

w om e n tha t the y c a n d rink s om e a lc ohol￮ Re a s ons b e ing la c k of e v id e nc e or m a king

e xc e p tions for d rinking a t s p e c ia l oc c a s ions ( C ra w ford - W illia m s e t a l., 20 15 ; Ke s m od e l & Ke s m od e l, 20 11; v a n d e r W ulp e t a l., 20 13)

￮ Re s e a rc h from e a s t Eng la nd s ug g e s te d not a ll m id w iv e s routine ly a s ke d a b out a lc ohol ( 6 0 %) or p rov id e inform a tion a b out a lc ohol a nd p re g na nc y ( 29%) ( W ins tone a nd V e rity , 20 15 )

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W HO ( 20 14 ) g uid e line s outline tha t:

o All w om e n s hould b e a s ke d a b out the ir d rinkingo W om e n w ho a re s till

d rinking s hould b e p rov id e d inte rv e ntion or

re fe rre d to s p e c ia lis t s e rv ic e s

The a im of the study was to exp lore percept ions and p rac t ices of p rovid ing a lcohol advice to p regnant wom en am ong front line m idwives in Eng land and Sweden.

Methods￮ Interviews w ith 16 m idwives

p rac t ic ing in Liverpool (n=7) and Örebro (n=9)

￮ Swed ish m idwives a ll based in GPs, Eng lish m idwives were com m unity or hosp ita l- based m idwives

￮ Age range: 32- 62 years ￮ Years of experience: 1.5- 38 years￮ Them atic ana lysis (Braun and

Cla rk, 2006) and them atic network m ap

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Pregnant w om en ’s lifest y les/p rom ot ing a hea lt hy lifest y le

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￮ Mos t w om e n s top d rinking ; s om e Eng lis h m id w iv e s q ue s tione d c lie nts ’ hone s ty

￮ Pa rtne rs ra re ly c ha ng e the ir d rinking ha b its – c a n b e ha rd to e ng a g e

￮ W om e n’s d rinking in g e ne ra l w a s s e e n a s a p ub lic he a lth c onc e rn

I a c tua lly think tha t p e op le d rink inc re d ib le a m ounts . And it is s hoc king s om e tim e s w he n y ou

he a r how y oung w om e n d rink. The y a re w a s te d ( Sw e d is h m id w ife 8 )

In general I think alcohol is just a massive issue for this country and this region in general […] massive public health

issue isn’t it (English midwife 1)

Ante na ta l pra c tic e s8

o Ab s tine nc e p re fe rre d a s the a d vic e to g ive to w om e no Diffe re nc e in inte rp re ta tion of ris k a t d rinking s m a ll le ve lso Routine q ue s tions us e d in b oth c ountrie s – d iffe re nc e in how

form a lis e d the y w e re

W e ll w e know tha t the ris ks a re b ut w e d on’t know w ha t le ve l w ould b e a t ris k, s o I w ould g ive the

inform a tion, I think tha t w e s hould a ll b e s ing ing from the s a m e hy m n s he e t (Eng lis h m id w ife 7)

Midw ifery role￮ Dis c us s ing a lc ohol is p a rt of the role – MI us e ful s kill

￮ Re la tions hip a nd trus t im p orta nt c om p one nts

￮ Id e ntifie d p rob le m to a d v is e w om e n w ho d ra nk b e fore know ing a b out the p re g na nc y – g uid a nc e re q ue s te d

I w ould re a lly like to know w ha t a d vic e c ould b e g ive n to s om e b od y s a y w ho’ve d one it for a b out e ig ht w e e ks . And m a y b e he a vily . So I d on’t know w ha t the im p lic a tions of tha t a re . So I s hould b e

a b le to g ive he r tha t a d vic e , y ou know , w ha t w e d o ( Eng lis h m id w ife 1) 9

I ne ve r s a y tha t it’s not d a ng e rous . I d on’t think I ha ve

e ve r s a id tha t, b ut y ou a re ve ry

te m p te d . Be c a us e y ou w a nt to d o g ood ( Sw e d is h m id w ife 7)

Discussion￮ C ultura l d iffe re nc e s in ris k p e rc e p tion s e e m to b e p a rt of

b oth g e ne ra l p ub lic ’s a ttitud e s a nd p ra c tic ing m id w iv e s ’ (Sc hölin e t a l., 20 17)

￮ Mid w iv e s s up p ort a b s tine nc e a s a m e s s a g e – p ra c tic a l g uid a nc e for s up p orting ina d v e rte nt e xp os ure ne e d e d

￮ W om e n w a nt a nd d o s e e k re a s s ura nc e – e q uip p ing m id w iv e s to g iv e g ood a d v ic e is im p orta nt

￮ Me d ia fra m ing m a y b oth s up p ort a nd ha m p e r a b s tine nc e g uid e line s (Mc C a llum & Holla nd , 20 17) –c om m unic a ting the c om p le xity of the e v id e nc e is d iffic ult, c le a r c om m unic a tion in a nte na ta l c a re is ke y

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Communication of new drinking guidelines – how to negotiate ‘no alcohol is best’ and ‘if you drank before you

knew it’s probably fine’

Conflicting/other sources of information

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Schölin, L., Hughes, K., Bellis, MA., Eriksson, C., Porcellato, L. (2018) “I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol, Drugs: Education, Prevention and Policy, DOI: 10.1080/09687637.2018.1478949

References￮ Bra un, V ., & C la rke , V . ( 20 0 6 ) . Us ing the m a tic a na ly s is in ps y c holog y . Qua lita tive Re s e a rc h in Ps y c holog y , 3( 2) , 77– 10 1.

￮ C ra w ford - W illia m s , F., Ste e n, M., Es te rm a n, A., Fie ld e r, A., & Mikoc ka - W a lus , A. ( 20 15 ) . “If y ou c a n ha ve one g la s s of w ine now a nd the n, w hy a re y ou d e ny ing tha t to a w om a n w ith no e v id e nc e ”: Know le d g e a nd pra c tic e s of he a lth profe s s iona ls c onc e rning a lc ohol c ons um ption d uring pre g na nc y . W om e n a nd Birth : J ourna l of the Aus tra lia n C olle g e of Mid w ive s , 28 ( 4 ) , 329– 335 .

￮ Ke s m od e l, U. S ., & Ke s m od e l, P. S . ( 20 11) . Alc ohol in Pre g na nc y : Attitud e s , Know le d g e , a nd Inform a tion Pra c tic e Am ong Mid w ive s in De nm a rk 20 0 0 to 20 0 9. Alc oholis m : C lin ic a l a nd Expe rim e nta l Re s e a rc h, 35 ( 12) , 2226– 2230 .

￮ Popova , S ., La ng e , S ., Probs t, C ., G m e l, G ., & Re hm , J . ( 20 17) . Es tim a tion of na tiona l,re g iona l, a nd g loba l pre va le nc e of a lc ohol us e d uring pre g na nc y a nd fe ta l a lc ohol s y nd rom e : a s y s te m a tic re v ie w a nd m e ta - a na ly s is . The La nc e t G loba l He a lth .

￮ Sa llis , J . F., Ow e n, N., & Fis he r, E. B. ( 20 0 8 ) . Ec olog ic a l Mod e ls of He a lth Be ha vior. In K. G la nz, B. K. Rim e r, & K. V is w a na th( Ed s .) , He a lth Be ha vior a nd He a lth Ed uc a tion - The ory , re s e a rc h a nd pra c tic e ( 4 th e d .) . Sa n Fra ns is c o: C a lifornia : J ohn W ile y a nd Sons .

￮ Sc hölin , L; Hug he s , K; Be llis , MA; Eriks s on, C ; Porc e lla to, L. ( 20 17) Exploring pra c tic e s a nd pe rc e ptions of a lc ohol us e d uring pre g na nc y in Eng la nd a nd Sw e d e n throug h a c ros s - c ultura l le ns , Europe a n J ourna l of Public He a lth , c kx20 8

￮ va n d e r W ulp, N. Y., Hoving , C ., & d e V rie s , H. ( 20 13) . A q ua lita tive inve s tig a tion of a lc ohol us e a d vic e d uring pre g na nc y : e xpe rie nc e s of Dutc h m id w ive s , pre g na nt w om e n a nd the ir pa rtne rs . Mid w ife ry , 29( 11) , e 8 9—98

￮ W HO. ( 20 14 ) . G uid e line s for the id e ntific a tion a nd m a na g e m e n t of s ubs ta nc e us e a nd s ubs ta nc e us e d is ord e rs in pre g na nc y . G e ne va : W orld He a lth Org a niza tion

￮ W ins tone , A. M., & V e rity , C . ( 20 15 ) . Ante na ta l a lc ohol e xpos ure : An Ea s t Ang lia n s tud y of m id w ive s ’ know le d g e a nd pra c tic e . Britis h J ourna l of Mid w ife ry , 23( 3) , 18 0– 18 6

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