January 5, 2024 • 26 mins
Embark on a transformative journey through the complexities of alcohol use during pregnancy, as we unravel the myriad risks and the vital necessity of abstinence for expectant mothers. Grappling with the nebulousness of self-reported alcohol intake and the deceptive simplicity of a 'unit' of alcohol, we aim to demystify the misconceptions and bring to light the stark realities of alcohol-exposed pregnancies (AEP) and fetal alcohol syndrome disorder (FASD). With a staggering 400+ conditions linked to FASD, this episode is an essential listen for anyone invested in the future health of our children.
Navigating this sensitive topic with the utmost care, we engage with healthcare professionals on the front lines who embody the 'A-S-S-T' framework — a compassionate, judgment-free approach to supporting pregnant women. Through vivid stories, expert insights, and poignant reflections, we invite our listeners to contribute to a crucial conversation that impacts lives profoundly.
Want to know more?
https://eschool.nationalfasd.org.uk/course/alcoholandpregnancy
https://www.rcog.org.uk/media/buohxsmm/pi-alcohol-and-pregnancy.pdf
https://alcoholchange.org.uk/help-and-support/managing-your-drinking/dry-january
Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello, my name is Florence.
Welcome to the ObsPod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, any one
else that's interested, theObsPod is for you.
Episode 162 Alcohol.
(00:55):
Many of us will have indulgedover the Christmas period.
I'm recording this ready for myfirst episode of 2024, bringing
in the new year.
And in maternity, given thatSeptember and October are our
busiest months, a lot of babiesthat are going to be born in
(01:18):
those months are being conceivedaround about now, so there may
be many women that are startingto explore and think about what
they're drinking At this time ofyear.
There's also the campaign DryJanuary or Try Dry.
(01:38):
This is the idea of beingalcohol free for a whole month,
31 days at the beginning of theyear.
It's supported by the charityAlcohol Change UK and you don't
need to have a problem withalcohol to participate.
The idea is that being free ofalcohol for a month will give
(02:06):
you better sleep, better mentalhealth, better physical health,
as well as potentially savingtime and money.
I'm going to put their websitein the programme notes so you
can explore a bit more.
So let's think a little bitabout alcohol in pregnancy.
It's one of the routinequestions that we ask as health
(02:30):
professionals.
When a woman books in inpregnancy, how much does she
drink?
It's also something that you'llbe asked if you attend A&E or
that your GP will regularlyquestion you on.
And I must admit, when I'masked how much do I drink, I
(02:50):
never really know what I shouldbe saying.
Yes, I know what the limits are, what the sort of advice is for
healthy women, how many alcoholunits I should be beneath, but
it's very hard to exactly givean answer about how much alcohol
(03:12):
I drink.
I don't really keep track of it.
I don't think of it as aproblem, I guess.
Do I have a clear idea in mymind about how many days a week
I drink?
I certainly don't drink everyday, but some weeks, if I've
(03:33):
been out socialising, I may havedrunk several days that week
and other weeks I might drinknothing at all.
So when I'm asked to give howmany units on average I drink, I
don't think I could accuratelydo so.
And what about what is a unit?
(03:54):
Well, I loosely think in myhead a unit might be a glass of
wine or a measure of spirits ora pint of beer, but more than
that.
I haven't really thought aboutit in detail.
(04:14):
As with many of my episodes, Ihave had a little look online
about what we should be doing ashealth professionals, and in
pregnancy, as with otherhealthcare interactions, there
is actually a nice little toolalcohol use disorders
(04:34):
identification test, or auditfor short.
It's quite a simple scoringsystem developed by the WHO, the
World Health Organization, andmodified for use in the UK, and
it gives you an idea aboutwhether or not you are likely to
(04:56):
have a problem with alcohol.
At the bottom of that advice,it gives some nice, clear advice
about what is a unit of alcohol, and actually it's a
surprisingly small amount when Ilook at it, and some of the
(05:16):
things that I might have thoughtof as being one unit, or
possibly two units, are morelikely to be three or four.
So it's likely that, even withmy unreliable variable amount of
(05:36):
drinking week on week, that I'malso underestimating how many
units of alcohol I'm drinking,and this makes me wonder, when
we, as health professionals, aska pregnant woman how much she's
drinking and we jot down heranswer, which may be one or two
(05:57):
units, but I've stopped.
Now I got pregnant, or, since Idiscovered I was pregnant, I've
cut down, how accurately are wereally assessing what women are
drinking?
Once we have the answer of whatwomen think they are or aren't
drinking, we then need to beable to have a conversation with
(06:20):
them in a non-judgmental andhelpful way.
We need to have a conversationbecause we need to be clear
about what our advice is, andthe advice is for alcohol
consumption in pregnancy to bezero, for all alcohol to be
(06:43):
avoided, and I think there isconfusion about this, and this
is partially because the advicehas changed over the years.
Until 2016, there was advice toavoid alcohol in the first 12
weeks of pregnancy and then onlyto consume one or two units a
(07:04):
week for the remainder of thepregnancy, and this can result
in confusion, and the changingguidance is now that it's best
not to consume any alcohol atall, and this can be difficult,
(07:26):
and we need to look at our ownunconscious biases, because many
of us that had children Sometime ago, such as myself, may
have drunk small amounts ofalcohol occasionally in
pregnancy and may feel thatthat's okay.
But that isn't the currentguidance.
(07:49):
As is usual when I'm recording apodcast episode, I did a little
bit of background reading andeducating myself to make sure
that I was tip-top up to date.
In this case, I undertook agreat little e-learning course
(08:12):
on the National Organization forFetal Alcohol Syndrome Disorder
website and I'm going to put alink to the course, which is
entitled Alcohol and Pregnancyfor Maternity Teams.
I'm going to put that link inthe show notes and I highly
recommend it.
The course is free if you workfor the NHS and there's a modest
(08:33):
fee if you don't.
What did I learn?
Well, I learned that there wasthis change in guidance and I
did know somewhere in the backof my mind that we should be
encouraging women not to drinkalcohol at all, but I hadn't
thought consciously that theadvice had changed since I'd had
(08:55):
my own children some 20 yearsago.
There definitely is somethingabout how acceptable or not we
find it to drink alcohol inpregnancy.
They talk about alcohol exposedpregnancies, or AEP for short,
and suggest that the prevalenceof this in the UK is 41% the
(09:22):
fourth highest in the world andthat definitely gave me pause
for thought, that we think it'sacceptable to drink some alcohol
during pregnancy.
But of course there may be manyreasons for this.
To have no alcohol intake atall may be easy if you are
(09:45):
planning a pregnancy and you'vemade preparations and you've
consciously thought aboutswitching to alcohol-free
beverages and alcohol is notpart of your life in an
ever-present form.
But this can be much harder ifactually this was an unplanned
pregnancy.
(10:05):
Perhaps you didn't discover youwere pregnant until late on in
pregnancy.
We need to appreciate that somewomen will be drinking through
habit socialization and somewomen will have alcohol
dependency and will need someprofessional support and help to
(10:29):
tackle alcohol use in theirlives.
So why is it so important womenshouldn't drink in pregnancy?
Well, alcohol is what we call ateraetogen, so when something's
teraetogenic, it means that itcauses abnormalities in cell
(10:52):
division and can causedevelopmental problems, so
malformations.
Alcohol crosses the placentaand interferes with the
development of the baby.
The alcohol in a woman'sbloodstream goes straight
through the placenta and intothe baby's bloodstream, and the
(11:14):
baby's liver is not fullydeveloped so it can't filter the
alcohol out of the circulationand the toxic effects of that
properly.
So the alcohol circulates inthe baby's bloodstream which can
harm brain cells and damage thenervous system of the
developing baby through thewhole nine months of pregnancy.
(11:35):
It was a bit of an eye openerwhen I undertook the e-learning
course I mentioned, because Ihad appreciated that alcohol
could contribute to pretermlabour and growth problems of
(11:55):
the baby and I knew about fetalalcohol syndrome, which was
something that we kind oflearned about in the textbooks
when I was training.
There are some specific facialfeatures and neurological
(12:16):
problems.
But what I hadn't appreciatedwas that the alcohol crosses the
placenta and in the e-learningcourse there's a great picture
essentially saying that the babyends up in this kind of
(12:38):
alcoholic reservoir.
So if you imagine your baby notonly getting alcohol through
the placenta but there beingalcohol in the amniotic fluid,
that the baby's then swallowingand essentially bobbing around
in a sea of alcohol because itcan't get rid of it, that
(12:59):
definitely made me feel muchmore negative about the idea of
alcohol consumption in pregnancy, that image and explanation.
The other thing that reallystuck in my mind was that
alcohol is more dangerous inpregnancy than heroin and we
(13:21):
have very negative associationswith illicit drug use, whereas
alcohol, kind of, is a sociallyaccepted thing to have.
So those things definitely gaveme pause for thought and the
reason they've developed thistraining is also because of the
(13:46):
prevalence of fetal alcoholsyndrome disorder is starting to
be looked at and seems to beanywhere between sort of 2 and
3.6%.
So that was the firstprevalence study done in the UK
(14:09):
in 2019 and that's a reallyquite high rate of children
affected in some way by alcoholin pregnancy.
And I think one of the reasonsthat I probably hadn't realised
this is because it says thereare over 400 different
(14:29):
conditions co-occurring withneurodevelopmental issues.
So it's a much more diverseimpact than I had perhaps
realised, and with the typicalfacial features of something
(14:50):
that I consider to be fetalalcohol syndrome disorder.
Those features are only presentin around 10% of people
affected by fetal alcoholsyndrome disorder.
So it definitely gave me pausefor thought and really shifted
(15:13):
in my brain what may or may notbe alcohol related.
I thought to that point thatfetal alcohol syndrome disorder
was incredibly rare.
I'd seen maybe one or two casesin my career and now I'm
thinking if there are 2 to 3.6%of pregnancies affected, then
(15:40):
actually I've probably seen lotsof pregnancies affected and
lots of children affected, but Imay not have realised that
that's what I was seeing.
By no means every alcoholexposed pregnancy will result in
a baby with fetal alcoholsyndrome disorder.
(16:02):
Only about 1 in 13 of alcoholexposed pregnancies will have
some features.
It's really difficult topredict how a baby might be
affected from the amount a womanhas drunk.
It's very variable.
Some babies can be mildlyaffected and others more
(16:28):
severely.
But the good news, just as withsmoking, is that if you cut
down or stop drinking altogether, your baby will start to grow
at the normal rate, so thatstopping drinking at any point
in pregnancy can be beneficialto the health of your baby as
(16:49):
well as your own health, ofcourse.
If we're midwives or doctorsseeing women, then our role is
to assist.
That is A Ask all pregnantwomen about alcohol use.
(17:11):
Don't assume that any pregnantwoman you see is not drinking.
So A Ask.
S Say it's safest to avoidalcohol in each appointment and
that might just feel like yetanother thing to tick off and do
(17:32):
, and it's obviously got to bedone sensitively and in a way
that is part of that hopefullytrusting relationship you're
building with women.
You're seeing S Support thiswith written advice where needed
.
So if a woman is drinking andis having difficulty with
(17:52):
drinking, to back this up withsome written advice and there's
good advice on the website aswell as on the RCOG website.
All in the show notes Iindicate the risks associated
with prenatal alcohol exposureand again, that's included in
(18:14):
the information for pregnantwomen on both those websites S
Stop and record any maternalalcohol history.
So when a woman does tell usshe's drinking and what she's
drinking, it's really importantthat we document this and then
we can tailor her careaccordingly.
(18:35):
And then T Try and help signposting to further support and
referrals.
So try and find out what areyour local alcohol dependency
services, build links with them.
What about your safeguardingteam and your safeguarding
(18:56):
midwives or mental healthsupport teams?
What about thinking morebroadly across your organisation
?
Perhaps you're part of acommunity health trust which may
have alcohol dependencyservices for people that are not
pregnant?
And what about links to primarycare?
(19:19):
What care could a woman accessfor her GP or health visitor?
If you encounter a woman who'salcohol dependent or you as a
woman are alcohol dependent,it's really important not to
(19:40):
hide that from us.
Be open and honest with us,tell us what's happening and how
difficult it is.
I've cared for women in allsorts of really difficult
situations where other membersof the family are heavy drinkers
, or perhaps she's in anenvironment that encourages
heavy drinking at work, or she'sdone incredibly well and being
(20:06):
abstinent for a long periodduring the pregnancy and then a
set of events has triggeredthings, tripped her up and she's
relaxed.
So we need to be understandingand the more women can trust us,
the more we can help them.
(20:27):
We can organise additionalscans to look at the growth of
the baby and, if we're aware ofheavy drinking, specialist fetal
medicine scans to look for anysigns of fetal alcohol spectrum
disorder, so that we arediagnosing things and monitoring
things closely and thereforecan, if necessary, involve our
(20:53):
pediatric colleagues if it lookslike this baby may have been
negatively affected and may havea problem, so that the
pediatricians can assess andsupport that family from birth.
But equally we need to thinkabout the health of the woman
herself.
If you're drinking heavily,you're more likely to get other
(21:17):
complications in pregnancy andbe unwell with complications of
alcohol use, and in somesituations this can be a bit of
a wake up call for a woman, butin other situations.
It's a real struggle for herbeing unwell and being pregnant
(21:41):
and needing to try and cut downor stop drinking, and that's
something that she needs regularvisits, support with from the
whole multidisciplinary team.
There's a great little page onthat website that mentioned
about drinking in pregnancy and,if you have already had some
(22:06):
drinks and you're pregnant, howto cope, how not to panic, how
to talk to your healthcareprofessional and know that
you're not alone and that thereare many reasons why you might
be drinking, and how tellingsomeone telling someone in your
(22:28):
antinatal clinic and tellingyour midwife or telling your
doctor we can start to get youthe right support.
My zesty bit to kick off theyear and round off this episode
is we really need to starthaving these conversations about
(22:49):
alcohol in pregnancy.
We need to know, as healthprofessionals, that the only
safe amount of alcohol inpregnancy is none, but we also
need to acknowledge that thatmay just not be feasible for
some women and we need to starthaving realistic conversations
(23:13):
and educating ourselves so thatwe can educate and point parents
in the right direction to theright resources.
So check out some of the linksin the show notes If you're
(23:33):
pregnant and you're listening tothis and you've had a drink in
pregnancy.
Don't panic, don't worry.
There's some great resources onthe websites I've put in the
show notes.
Talk to your midwife and doctor, try and think about
alternatives and know that everystep you take to cut down and
(23:55):
reduce the amount of alcohol youdrink will be benefiting both
your health and that of yourdeveloping baby.
Thanks for listening.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
(24:19):
review, on whatever platformyou find, your podcasts, as well
as recommending the OBS pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalog
from clinical topics, my careerand journey as an obstetrician
(24:39):
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
(25:02):
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links If you want
to get in touch to suggesttopics for future episodes.
(25:25):
You can find me at the OBS podon Twitter and Instagram, and
you can email me theobspod atgmailcom.
Finally, it's very important tome to keep the OBS pod free and
accessible to as many people aspossible, but it does cost me a
(25:49):
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and, by chance, you do
have a tiny bit to spare, youcan now contribute to keep the
podcast going and keep it freevia my link to buy me a coffee.
(26:09):
Don't feel under any obligation, but if you'd like to
contribute, you now can.
Thank you for listening.
Hello, my name is Florence.
Welcome to the ObsPod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, any one
else that's interested, theObsPod is for you.
Episode 162 Alcohol.
(00:55):
Many of us will have indulgedover the Christmas period.
I'm recording this ready for myfirst episode of 2024, bringing
in the new year.
And in maternity, given thatSeptember and October are our
busiest months, a lot of babiesthat are going to be born in
(01:18):
those months are being conceivedaround about now, so there may
be many women that are startingto explore and think about what
they're drinking At this time ofyear.
There's also the campaign DryJanuary or Try Dry.
(01:38):
This is the idea of beingalcohol free for a whole month,
31 days at the beginning of theyear.
It's supported by the charityAlcohol Change UK and you don't
need to have a problem withalcohol to participate.
The idea is that being free ofalcohol for a month will give
(02:06):
you better sleep, better mentalhealth, better physical health,
as well as potentially savingtime and money.
I'm going to put their websitein the programme notes so you
can explore a bit more.
So let's think a little bitabout alcohol in pregnancy.
It's one of the routinequestions that we ask as health
(02:30):
professionals.
When a woman books in inpregnancy, how much does she
drink?
It's also something that you'llbe asked if you attend A&E or
that your GP will regularlyquestion you on.
And I must admit, when I'masked how much do I drink, I
(02:50):
never really know what I shouldbe saying.
Yes, I know what the limits are, what the sort of advice is for
healthy women, how many alcoholunits I should be beneath, but
it's very hard to exactly givean answer about how much alcohol
(03:12):
I drink.
I don't really keep track of it.
I don't think of it as aproblem, I guess.
Do I have a clear idea in mymind about how many days a week
I drink?
I certainly don't drink everyday, but some weeks, if I've
(03:33):
been out socialising, I may havedrunk several days that week
and other weeks I might drinknothing at all.
So when I'm asked to give howmany units on average I drink, I
don't think I could accuratelydo so.
And what about what is a unit?
(03:54):
Well, I loosely think in myhead a unit might be a glass of
wine or a measure of spirits ora pint of beer, but more than
that.
I haven't really thought aboutit in detail.
(04:14):
As with many of my episodes, Ihave had a little look online
about what we should be doing ashealth professionals, and in
pregnancy, as with otherhealthcare interactions, there
is actually a nice little toolalcohol use disorders
(04:34):
identification test, or auditfor short.
It's quite a simple scoringsystem developed by the WHO, the
World Health Organization, andmodified for use in the UK, and
it gives you an idea aboutwhether or not you are likely to
(04:56):
have a problem with alcohol.
At the bottom of that advice,it gives some nice, clear advice
about what is a unit of alcohol, and actually it's a
surprisingly small amount when Ilook at it, and some of the
(05:16):
things that I might have thoughtof as being one unit, or
possibly two units, are morelikely to be three or four.
So it's likely that, even withmy unreliable variable amount of
(05:36):
drinking week on week, that I'malso underestimating how many
units of alcohol I'm drinking,and this makes me wonder, when
we, as health professionals, aska pregnant woman how much she's
drinking and we jot down heranswer, which may be one or two
(05:57):
units, but I've stopped.
Now I got pregnant, or, since Idiscovered I was pregnant, I've
cut down, how accurately are wereally assessing what women are
drinking?
Once we have the answer of whatwomen think they are or aren't
drinking, we then need to beable to have a conversation with
(06:20):
them in a non-judgmental andhelpful way.
We need to have a conversationbecause we need to be clear
about what our advice is, andthe advice is for alcohol
consumption in pregnancy to bezero, for all alcohol to be
(06:43):
avoided, and I think there isconfusion about this, and this
is partially because the advicehas changed over the years.
Until 2016, there was advice toavoid alcohol in the first 12
weeks of pregnancy and then onlyto consume one or two units a
(07:04):
week for the remainder of thepregnancy, and this can result
in confusion, and the changingguidance is now that it's best
not to consume any alcohol atall, and this can be difficult,
(07:26):
and we need to look at our ownunconscious biases, because many
of us that had children Sometime ago, such as myself, may
have drunk small amounts ofalcohol occasionally in
pregnancy and may feel thatthat's okay.
But that isn't the currentguidance.
(07:49):
As is usual when I'm recording apodcast episode, I did a little
bit of background reading andeducating myself to make sure
that I was tip-top up to date.
In this case, I undertook agreat little e-learning course
(08:12):
on the National Organization forFetal Alcohol Syndrome Disorder
website and I'm going to put alink to the course, which is
entitled Alcohol and Pregnancyfor Maternity Teams.
I'm going to put that link inthe show notes and I highly
recommend it.
The course is free if you workfor the NHS and there's a modest
(08:33):
fee if you don't.
What did I learn?
Well, I learned that there wasthis change in guidance and I
did know somewhere in the backof my mind that we should be
encouraging women not to drinkalcohol at all, but I hadn't
thought consciously that theadvice had changed since I'd had
(08:55):
my own children some 20 yearsago.
There definitely is somethingabout how acceptable or not we
find it to drink alcohol inpregnancy.
They talk about alcohol exposedpregnancies, or AEP for short,
and suggest that the prevalenceof this in the UK is 41% the
(09:22):
fourth highest in the world andthat definitely gave me pause
for thought, that we think it'sacceptable to drink some alcohol
during pregnancy.
But of course there may be manyreasons for this.
To have no alcohol intake atall may be easy if you are
(09:45):
planning a pregnancy and you'vemade preparations and you've
consciously thought aboutswitching to alcohol-free
beverages and alcohol is notpart of your life in an
ever-present form.
But this can be much harder ifactually this was an unplanned
pregnancy.
(10:05):
Perhaps you didn't discover youwere pregnant until late on in
pregnancy.
We need to appreciate that somewomen will be drinking through
habit socialization and somewomen will have alcohol
dependency and will need someprofessional support and help to
(10:29):
tackle alcohol use in theirlives.
So why is it so important womenshouldn't drink in pregnancy?
Well, alcohol is what we call ateraetogen, so when something's
teraetogenic, it means that itcauses abnormalities in cell
(10:52):
division and can causedevelopmental problems, so
malformations.
Alcohol crosses the placentaand interferes with the
development of the baby.
The alcohol in a woman'sbloodstream goes straight
through the placenta and intothe baby's bloodstream, and the
(11:14):
baby's liver is not fullydeveloped so it can't filter the
alcohol out of the circulationand the toxic effects of that
properly.
So the alcohol circulates inthe baby's bloodstream which can
harm brain cells and damage thenervous system of the
developing baby through thewhole nine months of pregnancy.
(11:35):
It was a bit of an eye openerwhen I undertook the e-learning
course I mentioned, because Ihad appreciated that alcohol
could contribute to pretermlabour and growth problems of
(11:55):
the baby and I knew about fetalalcohol syndrome, which was
something that we kind oflearned about in the textbooks
when I was training.
There are some specific facialfeatures and neurological
(12:16):
problems.
But what I hadn't appreciatedwas that the alcohol crosses the
placenta and in the e-learningcourse there's a great picture
essentially saying that the babyends up in this kind of
(12:38):
alcoholic reservoir.
So if you imagine your baby notonly getting alcohol through
the placenta but there beingalcohol in the amniotic fluid,
that the baby's then swallowingand essentially bobbing around
in a sea of alcohol because itcan't get rid of it, that
(12:59):
definitely made me feel muchmore negative about the idea of
alcohol consumption in pregnancy, that image and explanation.
The other thing that reallystuck in my mind was that
alcohol is more dangerous inpregnancy than heroin and we
(13:21):
have very negative associationswith illicit drug use, whereas
alcohol, kind of, is a sociallyaccepted thing to have.
So those things definitely gaveme pause for thought and the
reason they've developed thistraining is also because of the
(13:46):
prevalence of fetal alcoholsyndrome disorder is starting to
be looked at and seems to beanywhere between sort of 2 and
3.6%.
So that was the firstprevalence study done in the UK
(14:09):
in 2019 and that's a reallyquite high rate of children
affected in some way by alcoholin pregnancy.
And I think one of the reasonsthat I probably hadn't realised
this is because it says thereare over 400 different
(14:29):
conditions co-occurring withneurodevelopmental issues.
So it's a much more diverseimpact than I had perhaps
realised, and with the typicalfacial features of something
(14:50):
that I consider to be fetalalcohol syndrome disorder.
Those features are only presentin around 10% of people
affected by fetal alcoholsyndrome disorder.
So it definitely gave me pausefor thought and really shifted
(15:13):
in my brain what may or may notbe alcohol related.
I thought to that point thatfetal alcohol syndrome disorder
was incredibly rare.
I'd seen maybe one or two casesin my career and now I'm
thinking if there are 2 to 3.6%of pregnancies affected, then
(15:40):
actually I've probably seen lotsof pregnancies affected and
lots of children affected, but Imay not have realised that
that's what I was seeing.
By no means every alcoholexposed pregnancy will result in
a baby with fetal alcoholsyndrome disorder.
(16:02):
Only about 1 in 13 of alcoholexposed pregnancies will have
some features.
It's really difficult topredict how a baby might be
affected from the amount a womanhas drunk.
It's very variable.
Some babies can be mildlyaffected and others more
(16:28):
severely.
But the good news, just as withsmoking, is that if you cut
down or stop drinking altogether, your baby will start to grow
at the normal rate, so thatstopping drinking at any point
in pregnancy can be beneficialto the health of your baby as
(16:49):
well as your own health, ofcourse.
If we're midwives or doctorsseeing women, then our role is
to assist.
That is A Ask all pregnantwomen about alcohol use.
(17:11):
Don't assume that any pregnantwoman you see is not drinking.
So A Ask.
S Say it's safest to avoidalcohol in each appointment and
that might just feel like yetanother thing to tick off and do
(17:32):
, and it's obviously got to bedone sensitively and in a way
that is part of that hopefullytrusting relationship you're
building with women.
You're seeing S Support thiswith written advice where needed
.
So if a woman is drinking andis having difficulty with
(17:52):
drinking, to back this up withsome written advice and there's
good advice on the website aswell as on the RCOG website.
All in the show notes Iindicate the risks associated
with prenatal alcohol exposureand again, that's included in
(18:14):
the information for pregnantwomen on both those websites S
Stop and record any maternalalcohol history.
So when a woman does tell usshe's drinking and what she's
drinking, it's really importantthat we document this and then
we can tailor her careaccordingly.
(18:35):
And then T Try and help signposting to further support and
referrals.
So try and find out what areyour local alcohol dependency
services, build links with them.
What about your safeguardingteam and your safeguarding
(18:56):
midwives or mental healthsupport teams?
What about thinking morebroadly across your organisation
?
Perhaps you're part of acommunity health trust which may
have alcohol dependencyservices for people that are not
pregnant?
And what about links to primarycare?
(19:19):
What care could a woman accessfor her GP or health visitor?
If you encounter a woman who'salcohol dependent or you as a
woman are alcohol dependent,it's really important not to
(19:40):
hide that from us.
Be open and honest with us,tell us what's happening and how
difficult it is.
I've cared for women in allsorts of really difficult
situations where other membersof the family are heavy drinkers
, or perhaps she's in anenvironment that encourages
heavy drinking at work, or she'sdone incredibly well and being
(20:06):
abstinent for a long periodduring the pregnancy and then a
set of events has triggeredthings, tripped her up and she's
relaxed.
So we need to be understandingand the more women can trust us,
the more we can help them.
(20:27):
We can organise additionalscans to look at the growth of
the baby and, if we're aware ofheavy drinking, specialist fetal
medicine scans to look for anysigns of fetal alcohol spectrum
disorder, so that we arediagnosing things and monitoring
things closely and thereforecan, if necessary, involve our
(20:53):
pediatric colleagues if it lookslike this baby may have been
negatively affected and may havea problem, so that the
pediatricians can assess andsupport that family from birth.
But equally we need to thinkabout the health of the woman
herself.
If you're drinking heavily,you're more likely to get other
(21:17):
complications in pregnancy andbe unwell with complications of
alcohol use, and in somesituations this can be a bit of
a wake up call for a woman, butin other situations.
It's a real struggle for herbeing unwell and being pregnant
(21:41):
and needing to try and cut downor stop drinking, and that's
something that she needs regularvisits, support with from the
whole multidisciplinary team.
There's a great little page onthat website that mentioned
about drinking in pregnancy and,if you have already had some
(22:06):
drinks and you're pregnant, howto cope, how not to panic, how
to talk to your healthcareprofessional and know that
you're not alone and that thereare many reasons why you might
be drinking, and how tellingsomeone telling someone in your
(22:28):
antinatal clinic and tellingyour midwife or telling your
doctor we can start to get youthe right support.
My zesty bit to kick off theyear and round off this episode
is we really need to starthaving these conversations about
(22:49):
alcohol in pregnancy.
We need to know, as healthprofessionals, that the only
safe amount of alcohol inpregnancy is none, but we also
need to acknowledge that thatmay just not be feasible for
some women and we need to starthaving realistic conversations
(23:13):
and educating ourselves so thatwe can educate and point parents
in the right direction to theright resources.
So check out some of the linksin the show notes If you're
(23:33):
pregnant and you're listening tothis and you've had a drink in
pregnancy.
Don't panic, don't worry.
There's some great resources onthe websites I've put in the
show notes.
Talk to your midwife and doctor, try and think about
alternatives and know that everystep you take to cut down and
(23:55):
reduce the amount of alcohol youdrink will be benefiting both
your health and that of yourdeveloping baby.
Thanks for listening.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
(24:19):
review, on whatever platformyou find, your podcasts, as well
as recommending the OBS pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalog
from clinical topics, my careerand journey as an obstetrician
(24:39):
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
(25:02):
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links If you want
to get in touch to suggesttopics for future episodes.
(25:25):
You can find me at the OBS podon Twitter and Instagram, and
you can email me theobspod atgmailcom.
Finally, it's very important tome to keep the OBS pod free and
accessible to as many people aspossible, but it does cost me a
(25:49):
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and, by chance, you do
have a tiny bit to spare, youcan now contribute to keep the
podcast going and keep it freevia my link to buy me a coffee.
(26:09):
Don't feel under any obligation, but if you'd like to
contribute, you now can.
Thank you for listening.
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