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

Drinking prior to Pregnancy

• 814 questionnaires

NHS A&A

Scotland (women

16-44 yrs)Harmful drinkers (>35 u/wk) 3% 4%Hazardous drinkers (14-35 u/wk) 10% 19%Moderate drinkers 63% 67%Non-drinkers 24% 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:– esthercurnock@nhs.net– Deborah.wason@aapct.scot.nhs.uk