GP discussing pregnancy and alcohol with women (best practice example)
This best practice example shows a general practitioner (GP) using the 5As approach (ask, assess, advise, assist and arrange) to talk about pregnancy and alcohol with a pregnant woman. This video is a part of the Women Want To Know initiative.
GP: Ok so look we've covered smoking and nutrition and I'd now like to talk about something that I discuss with all my pregnant patients and that's alcohol. How much would you say you'd drink?
Patient: Well I drank a bit before I found out I was pregnant, but just wine with dinner.
GP: Ok and has that changed since you found out you're pregnant?
Patient: Not really but I've never been a big drinker.
GP: Ok. So just so I've got a better idea of what your drinking patterns are like, how often would you say you drink?
Patient: Three or four nights a week, wine with dinner.
GP: And how much do you have? What I'm going to do is I'm going to show you here a chart of what a standard drink is.
Patient: Well I usually drink wine so I guess about a bottle between us.
GP: Between you and your husband? Ok would you share it equally, would one of you drink more?
Patient: Yeah no I drink have less than my husband, I don't really want to drink much at the moment but I just find it helps me relax.
GP: Ok. What have you heard about alcohol and pregnancy?
Patient: Everything in moderation? I know I've heard that you're not supposed to go and get wasted and I'm definitely not doing that. It's just a glass or two with dinner. And I drank during my pregnancy with Tim so I'm not overly worried about it.
GP: Look moderation is good for most things, but when you're pregnant, it's safest not to have any alcohol at all.
Patient: No alcohol at all? But I drank when I was pregnant with Tim and he's fine.
GP: Look I'm sure he is, but when you were pregnant with Tim was four years ago. The Guidelines have since changed there's actually no safe level of alcohol when you're pregnant. And also every pregnancy is different so what might have been ok in your first pregnancy may not be so ok now.
Patient: Are you saying I've hurt my baby? Because I've been drinking as I normally would. If it's so bad, then why hasn't someone told me sooner?
GP: I'm not saying that you've hurt your baby and no-one is suggesting that and I'm really sorry that no one has been clear with you beforehand. But the important thing is that now that you're aware, that you stop drinking any alcohol, that you look after your health, that you maintain your nutrition, reduce your stress and relax. All the decisions that you make from now on are going to be really important for your health and the health of your baby.
Patient: Well that's going to be really hard because a glass of wine it helps me relax.
GP: You've mentioned relaxing a few times, umm is there something that is causing you to feel not relaxed?
Patient: Well, it would be great if my husband helped more, umm came home earlier and helped put Tim to bed. Maybe if he gave up drinking too.
GP: Do you think that's something he'd be willing to do?
Patient: I don't know umm but we can chat about it. So what do I say to those people who say that a glass of wine on occasion is no big deal?
GP: Is it going to be hard for you to be around those people?
Patient: Yes because my friends they just say 'doctors tell you that to make you feel guilty.' I don't know what to say to that.
GP: Look I can understand, in those situations it's probably best just to say that there are new guidelines, you want to do what's healthiest for your baby and you want to give your baby and yourself the best start. How does that sound?
Patient: Yeah that sounds ok, I can try it.
GP: Ok good. Now, look I'm going to give you some information that will explain the reasoning behind these new guidelines and also some tips that might make you feel more confident about stopping drinking. Don't forget that any time you can come back and discuss it perhaps bring your husband as well and we can go through all of this together.
Patient: Yeah that might be helpful, I will think about that.
GP: It's important to open with a question like 'What do you know about, or how do you feel about drinking alcohol in pregnancy?' These open ended questions allow the woman the opportunity to talk about her knowledge and feelings. It also allows the health professional to know where to guide the conversation in terms of advice. Rather than tell the woman the health consequences of alcohol consumption, this approach, known as Motivational Interviewing aims to find out the patients level of knowledge and provide the relevant information. There is no assumption that if she just 'had the correct information she would change.' So it's good to make some general statements such as 'A lot of women receive mixed messages about alcohol and pregnancy'. This helps the woman realise that their not alone and that it's completely normal for a health professional to bring up alcohol.
End of transcript
This video is a best practice example of discussing pregnancy and alcohol with women.
In this video, a GP starts a conversation about pregnancy and alcohol with a patient. The patient is pregnant with her second child.
The woman drank alcohol in her first pregnancy. She is unclear on the guidelines for drinking alcohol while pregnant.
The GP uses the 5As approach (ask, assess, advise, assist and arrange) to guide the conversation. Each of these areas is highlighted in the video.