Data sources

National data collection on alcohol in pregnancy: a qualitative study

Why did the AIHW do this research?

As part of the National Indigenous Reform Agreement (NIRA), the Council of Australian Governments (COAG) agreed to the enhancement of perinatal data to capture additional information in relation to antenatal care and alcohol use during pregnancy. Since 2010, the AIHW in partnership with the National Perinatal Data Development Committee (NPDDC) has been progressing work to develop a nationally agreed, uniform method for measuring and recording alcohol use in pregnancy. Having information from all Australian mothers on alcohol usage, such as dose and frequency, will help future planning to improve pregnancy health. It will also help with supporting children who have problems because they were exposed to alcohol before birth.

Murdoch Childrens Research Institute logo

The AIHW commissioned the Murdoch Childrens Research Institute (MCRI) to explore the views of maternity clinicians on asking pregnant women about their alcohol use and the feasibility of using a standardised screening tool such as the AUDIT-C. The study also included pregnant women and sought to explore their views on being asked about alcohol use as part of their maternity care and what they thought about having this information on alcohol dose and frequency of usage reported at a national level.

The study included maternity clinicians at mainstream and Indigenous specific services and sought to capture the opinions of Indigenous and non-Indigenous pregnant women.

Ethics approval

Ethics approval for this study was granted by the Australian Institute of Health and Welfare, and the Human Research Ethics Committees for each participating site.

Who took part in the study?

The MCRI conducted focus groups and interviews at two different hospital maternity care sites, three public hospitals (including one in a disadvantaged area) and one private hospital. Study participants included women from a diverse range of age groups, geographical locations, and cultural, Indigenous and socioeconomic backgrounds, including a socioeconomically disadvantaged area and a rural/regional area. Only English-speaking women were asked to participate. Participating maternity clinicians were mostly midwives, but included Indigenous health workers and general practitioners at some sites.

Overall 48 maternity clinicians and 28 pregnant women participated in discussion groups and interviews at a number of non-Indigenous and Indigenous health services in Victoria and the Northern Territory.

This is a summary of what non-Indigenous women and their midwives told us.

What did we find?

Asking about alcohol

Midwives told us they always ask pregnant women about alcohol, 'normalising' the questions as much as possible and providing a relaxed environment for their patients. Pregnant women did not remember this specifically, but explained the midwife usually asked several health and lifestyle questions at their first appointment (a sort of a 'tick list').

Women often thought the midwife seemed to assume they did not drink. They told us that instead of following a checklist, an open conversation about alcohol with personalised questions would help with a more honest discussion.

This way, women would feel more comfortable talking about their alcohol consumption.

Women also talked about pre-pregnancy drinking habits and that if this was asked about, it could be helpful for the midwife to understand a woman’s general health and lifestyle. Talking about pre-pregnancy drinking habits could be an opportunity for the midwife to explain about the harms from drinking in pregnancy.

Knowledge of harm from alcohol

Overall, midwives told us they did not have any training on how to explain the risks of alcohol use in pregnancy and that there was limited clinical support.

Pregnant women understood that a high level of alcohol use is harmful to the baby, but were less sure about lower levels of drinking.

There were many discussions about the evidence of harm from ‘social drinking’. Pregnant women felt that as long as they had up-to-date information, women should be able to make their own decision about drinking during their pregnancy.

Pregnant women and midwives identified a need for better public awareness of the harms to the baby from drinking.

Is it important to collect this information?

The pregnant women in this study felt it was important to collect information about alcohol in pregnancy nationally because this would help to direct services where needed.

Conclusion

Midwives believed they could successfully include routine questions about alcohol in pregnancy into their clinical practice with appropriate supports and education programs.

Pregnant women felt it was important to ask about alcohol and to report this information at a national level. They suggested personalising these questions to encourage a more open conversation.

What happens next?

What the participants have told us will help the AIHW with the introduction of these questions into clinical care, especially with how to ask questions about alcohol and how to support maternity workers and pregnant women.

For more information

If you are interested in finding out more about this study, contact [email protected]

Acknowledgements

The AIHW acknowledges funding from the Department of Health and thanks the researchers who conducted the study: Evi Muggli, Dr Jean Paul, Associate Professor Cate Nagle, and Professor Jane Halliday. The researchers and AIHW wish to thank all clinic managers and other staff for their generous help with recruitment, organising rooms, and allowing us to interview their staff and clients. We also thank Leisa McCarthy, Clare Morrison and Taryn Charles for their assistance with the discussion groups.

Most of all, we would like to thank all study participants for their time and effort in assisting us with this research.