Transcript `I would have an odd drink but I`m not a drinker. I told her I

Attitudes to smoking and drinking in
pregnancy and their effect on the
delivery of health interventions
Faculty of Public Health Scotland
Dr Debbie Wason
Dr Esther Curnock
NHS Ayrshire & Arran
‘I would have an odd drink but I’m not a
drinker. I told her I didn’t drink and she
didn’t really have anything to say’
Outline
• Background
• Findings
– Behaviour
– Context
– Interventions
• Conclusions
Background
• Negative health impact
– Tobacco
– Alcohol
• Behaviours in pregnancy
• Scottish Government Policy
Specialist Midwife Posts
• Support women to quit smoking in
pregnancy
• Offer support to women with previous
alcohol issues or alcohol use in pregnancy
• Train & support midwives in offering
Alcohol Brief Interventions and tobacco
screening
Findings
Smoking Cessation
Referrals = 674
Contacts = 319
Quit date set = 107
4 week f/u = 63
4 week quits = 57
12 week f/u=
33
12 week
quits = 26
Drinking prior to Pregnancy
• 814 questionnaires
NHS A&A
Harmful drinkers (>35 u/wk)
3%
Hazardous drinkers (14-35 u/wk)
10%
Moderate drinkers
63%
Non-drinkers
24%
Scotland
(women
16-44 yrs)
4%
19%
67%
10%
Who keeps drinking?
•
•
•
•
46 women still drinking at booking
5% of moderate drinkers
10% of hazardous drinkers
10% of harmful drinkers
Or so they say………
Last drink by time to EDD
Context
• What do people mean by ‘drinking’?
• ‘They’ll think only a night binge drinking is the bad thing’
(Midwife)
• ‘Now they tell me you shouldn’t drink at all which is fair
enough. If I’m out for dinner I’ll just have a wee glass of
wine’ (pregnant woman)
Context
• Midwives can be uncomfortable about
discussing drinking alcohol in pregnancy
• ‘And you have to watch what you’re saying because if
that’s the first time you’re meeting these women… You
can’t be too critical’(midwife)
• ‘A lot of girls will admit to using drugs but most of them
don’t admit to taking alcohol. Some of them think it’s
worse’ (midwife)
Context
• Some midwives are ambivalent around the
issue of alcohol.
• ‘One minute the news is saying it’s okay to have one
glass and then we’re saying we’re not really advising
them to take any alcohol at all.’ (Midwife)
• ‘Some are trying to reduce their methadone and their
smoking as well. Which is the one that they really
concentrate on? They’re not going to cut out both
necessarily.’ (midwife)
• ‘I think it’s also raised the issue with midwives
themselves because it’s common practice to smoke, the
drinking is a bit more hidden but it’s so normal that even
as midwives there are many bigger issues.’ (midwife)
Context
• Differences between alcohol and smoking
– Admitting the activity
‘Do you feel that women are more relaxed about admitting to
smoking than drinking?
Yes.
Why do you think that is?
I think it’s (smoking) is more acceptable.’ (midwife)
– Monitoring and detection – the CO Monitor
– Perception of addictive nature
Context
• Unproven harms of alcohol use at low
levels
• ‘But on the alcohol one, it feels a bit like we don’t know.
Nobody’s done research on one unit, once a month, in
the last six months and what, if any, effect that has.’
(pregnant woman)
Interventions
- Timely messages
• Pre-pregnancy
‘They should maybe run pre-conceptional clinics
because what’s happening is people binge drink, then
they find they are pregnant and it’s already into the 12
weeks .... and some past 12 weeks. Those are the
crucial weeks of formation of that child and
sometimes we are shutting the stable door after the
horse’s bolted.’ (midwife)
Interventions
- Pre-booking
• Alcohol is discussed at pre-booking but
many other messages are given then also.
- Later in Pregnancy
• Women could not recall the issue of
alcohol being addressed in later
pregnancy.
Interventions
• Advice needs to be for life not just for
pregnancy
• ‘Last year I stopped myself (smoking) and I fell pregnant.
I had a miscarriage and then I started again. I was gonna
start smoking because I don’t need to stop now. So
when this time came around obviously I thought I should
stop smoking again. It just wasn’t as easy.’ (pregnant
woman)
Conclusion
• Pregnancy can be a great time to address behaviour
change.
• Smoking is more akin to drug misuse than alcohol
consumption.
• For midwives, discussion around alcohol use seems the
most difficult.
• Discussions re. alcohol need to be held at different
stages in pregnancy
Acknowledgements
• Dr Maggie Watts and the Steering Group
for Specialist Midwives
• Angela Cunningham, Head of Midwifery,
NHS Ayrshire and Arran
• The Specialist and Community Midwives
• The pregnant women
• Any questions??
• Contact details:
– [email protected]
– [email protected]