Attitudes to smoking and drinking in pregnancy and their effect on the delivery of health interventions Faculty of Public Health Scotland

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Attitudes to smoking and drinking in pregnancy
and their effect on the delivery of health
interventionsFaculty of Public Health Scotland

• Dr Debbie Wason
• Dr Esther Curnock
• NHS Ayrshire Arran

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• I would have an odd drink but Im not a drinker.
  I told her I didnt drink and she didnt really
  have anything to say

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Outline

• Background
• Findings
• Behaviour
• Context
• Interventions
• Conclusions

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Background

• Negative health impact
• Tobacco
• Alcohol
• Behaviours in pregnancy
• Scottish Government Policy

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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

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• Findings

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Smoking Cessation
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Drinking prior to Pregnancy

• 814 questionnaires

NHS AA Scotland (women 16-44 yrs)
Harmful drinkers (gt35 u/wk) 3 4
Hazardous drinkers (14-35 u/wk) 10 19
Moderate drinkers 63 67
Non-drinkers 24 10
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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

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Last drink by time to EDD
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Context

• What do people mean by drinking?
• Theyll think only a night binge drinking is the
  bad thing (Midwife)
• Now they tell me you shouldnt drink at all
  which is fair enough. If Im out for dinner Ill
  just have a wee glass of wine (pregnant woman)

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Context

• Midwives can be uncomfortable about discussing
  drinking alcohol in pregnancy
• And you have to watch what youre saying because
  if thats the first time youre meeting these
  women You cant be too critical(midwife)
• A lot of girls will admit to using drugs but
  most of them dont admit to taking alcohol. Some
  of them think its worse (midwife)

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Context

• Some midwives are ambivalent around the issue of
  alcohol.
• One minute the news is saying its okay to have
  one glass and then were saying were not really
  advising them to take any alcohol at all.
  (Midwife)

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• Some are trying to reduce their methadone and
  their smoking as well. Which is the one that they
  really concentrate on? Theyre not going to cut
  out both necessarily. (midwife)
• I think its also raised the issue with midwives
  themselves because its common practice to smoke,
  the drinking is a bit more hidden but its so
  normal that even as midwives there are many
  bigger issues. (midwife)

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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 its (smoking) is more acceptable.
  (midwife)
• Monitoring and detection the CO Monitor
• Perception of addictive nature

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Context

• Unproven harms of alcohol use at low levels
• But on the alcohol one, it feels a bit like we
  dont know. Nobodys done research on one unit,
  once a month, in the last six months and what, if
  any, effect that has. (pregnant woman)

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Interventions

• Timely messages
• Pre-pregnancy
• They should maybe run pre-conceptional clinics
  because whats happening is people binge drink,
  then they find they are pregnant and its 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 horses bolted. (midwife)

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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.

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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 dont
  need to stop now. So when this time came around
  obviously I thought I should stop smoking again.
  It just wasnt as easy. (pregnant woman)

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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

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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

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• Any questions??
• Contact details
• esthercurnock_at_nhs.net
• Deborah.wason_at_aapct.scot.nhs.uk