General Practitioners and other health professionals ought not be embarrassed to discuss alcohol use with their patients – whether pregnant women or otherwise.
When treating a pregnant woman there are many issues that need discussing that could be considered sensitive: drug and alcohol, including tobacco use, is just one area. Others include previous or current sexually transmitted infections – and sometimes even previous pregnancies that may not be known to a patient’s current partner. All these issues are important to raise for a healthy safe pregnancy.
The overwhelming majority of pregnant women want to do the best for their baby and will cease drinking alcohol if advised to by their health professional. So the onus is on health professionals to be aware of the guidelines and to be specific. Saying “You probably shouldn’t drink too much when pregnant” can be unhelpful as what one person thinks of as ‘too much’ may not be what another does. Likewise, assuming a woman simply knows the guidelines can also be an error: information may have been received from a friend, relative or partner that is neither accurate nor current and may even reflect the advisor’s interest, rather than the patient’s. Women report feeling much more supported in abstaining when their partner does too, so it’s good to have the discussion with them together. If the pressure to drink alcohol can be anticipated, sometimes it can be easier to forgo certain social events such as after-work drinks.
As many as half the women who present with a positive pregnancy test have not actively planned to become pregnant and have been drinking alcohol as part of their normal lives. It is important to cease drinking alcohol from the time pregnancy is confirmed and discuss with their GP the previous alcohol consumption. In the vast majority of instances there will have been no problem, but occasionally a GP may refer the patient to an antenatal drug and alcohol counsellor to determine if further medical steps are required.
One way for this to be minimised is for the alcohol use of all patients to be noted, not just those considering becoming pregnant. This way a potential problem can be identified before rather than after the fact. Most GP software programs have fields to enter in alcohol use, along with smoking status and other variables, and often will prompt when these fields are left blank. Asking about current alcohol intake at the same time as smoking, height, weight, allergies and recent pap smear eliminates the issue of being seen to target someone’s drinking. High level drinking can be identified at a much less emotionally fraught time and can present a good opportunity to implement alcohol reduction strategies.
One method I have found that works well is to replace alcohol with a non-harmful pleasurable activity. Often people have received the advice to replace drinking with a ‘healthy’ alternative such as going for a jog – which is terrific if you can do it, but can compound a sense of failure if a person does not. Choosing to have a bubble bath or indulge in a DVD after work can develop patterns that alcohol is not the only way to turn off and relax.
Dr Barri Phatarfod is the Australian Medical Association representative on the Working Group for Women Want to Know, a campaign that encourages health professionals to discuss alcohol and pregnancy with women who are pregnant or planning pregnancy. To find out more about the campaign and to order resources for health professionals, visit www.alcohol.gov.au
You can watch Dr Barri Phatarfod initiate a conversation about pregnancy and alcohol with a woman who is pregnant with her second child in the video clip below: