Midwife discussing pregnancy and alcohol with women (best practice example)
This best practice example shows a midwife 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.
Midwife: Now that we've spoken about nutrition and smoking I'd like to talk to you about alcohol, it's something that I talk to all clients about. Is this something you've thought about and have you made any decisions about alcohol in pregnancy?
Patient: Well I haven't drank since I found out at that I was pregnant. But I'm sort of concerned that I may have already harmed the baby.
Midwife: Hmm why are you concerned?
Patient: Well I didn't know I was pregnant and I went on my friend's hen's night and I just got really drunk. I had no idea that I could be pregnant so I just didn't know. And since then I've been read and I found out that it could cause brain damage for the baby.
Midwife: I understand your concerns and although we can't say what impact that alcohol consumption has had, we do know that the risk is probably very small. So I'd like to talk to you now about your alcohol consumption before pregnancy, if that's ok? Before you were pregnant how often did you drink, was it more than 4 times a week, two to three times a week, a couple of times a month, monthly or less?
Patient: Ah two to three times a week probably, but it was only ever with friends and on weekends.
Midwife: So when you were drinking how many standard drinks did you have? This poster shows you what a standard drink is.
Patient: Maybe one or two.
Midwife: Great, and were there ever times where you had five or more standard drinks in one sitting?
Patient: Oh only ever on those big occasions like my friend's hen's night.
Midwife: And how often would they happen?
Patient: Oh at the moment once every couple of months.
Midwife: Wonderful and you said before that since you found out that you were pregnant you haven't been drinking, is that correct?
Patient: Yeah, ever since the Doctor told me I was pregnant I haven't touched a drink since.
Midwife: That's great, because our alcohol guidelines tell us that it's the safest thing for you and your baby, not to drink in pregnancy.
Patient: But what about that one time, I thought you said that that was ok.
Midwife: Yes I understand your concern but this is a very common thing for women to come to me in pregnancy and talk about. We do know that the effects of that one night are probably very small. So the important thing from now on is to focus on the rest of your pregnancy, that you're happy and healthy, and you look towards a pregnancy without alcohol. The other important thing is that you think about your health and your baby's health. How do you feel about these things?
Patient: I guess I'm not sure what to say in those situations, where everybody else is drinking. I'm not ready to tell anybody about the pregnancy yet though either.
Midwife: Yes it can be difficult when everyone around you is drinking. But perhaps you could tell one person who is close to you about your situation and you can discuss what to say together. Also when you do decide to tell people that you're pregnant you can you tell them that you're looking forward to having the healthiest baby possible and that you've got all the information from your health care providers about what the best thing to do is.
Patient: Yeah ok thanks.
Midwife: No worries I'll also give you some information on drinking alcohol in pregnancy and why it's important to stay away and it tells you some tips on what to do in those social situations. And of course if you need to talk to me at any time in the future you can come back and have another visit.
Patient: Thank you.
Midwife: No worries.
Midwife: 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 questions allow the woman the opportunity to talk about her knowledge and feelings. Rather than tell the woman the health consequences of alcohol consumption, this approach, known as 'Motivational interviewing' aims to find out the patient's level of knowledge and provide 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 mention this as an issue" and "sometimes women receive mixed messages about alcohol and pregnancy. This helps the woman realise that they're not alone and that it is normal for a health professional to talk about alcohol.
End of transcript
This video is a best practice example of discussing pregnancy and alcohol with women.
In this video, a midwife starts a conversation about pregnancy and alcohol with a patient. The patient is pregnant for the first time.
The woman had a session of binge drinking before she was aware of the pregnancy. She is worried she may have harmed the baby.
In this scenario the Midwife uses the 5As approach (ask, assess, advise, assist and arrange) to guide the conversation. Each of these areas highlighted in the video.