The Swedish experienceAlcohol information - prevention at the Antenatal Clinics
Catharina ZätterströmMidwife, vice president of the Swedish Association for Midwives
A good start
Antenatal Clinics Almost 100 % of pregnant women attend a
clinic during pregnancy Basic programme: 8-9 check-ups starting
from pregnancy week 6-10 The care for the healthy woman with a
normal pregnancy is provided by midwives If complications arise other professionals,
like psycians, social counsellers etc are consulted
What can the midwife do?
Inform about alcohol och risks for the unborn child
Identify harmful consumtion
Motivate to change life style
Informing the pregnant women Started in the beginning of 1980s The main purpose was to inform the women
about the risks and to convey the message no alcohol during pregnancy
Standardized medical record included questions about the woman's alcohol consumtion 3 months before pregnancy, at admission and in pregnancy week 32
3 alternative answers “never, seldom”, “less than once a week” and “more often than once a week”
What happened during the 1990s?
Women who gave birth got older
Increasing alcohol consumption. More women drink heavier and more frequently
Clinical experience and later studies showed that a considerable fractions of pregnant women continued to drink during pregnancy
Midwife Mona Göransson began her studies ”Alcohol consumption during pregnancy: How do we separate myth from reality”
Thesis in 2004
Better ways to identify harmful consumtion
In the beginning of 2000 M. Göransson introduced
AUDIT – the pregnant woman Alcohol Use Disorder Identification Test
TLFB – the unborn child Time Line Follow Back
Audit
Screening alcohol habits before the pregnancy
Introducing a written memo how to handle women with a risky consumption and women with misuse.
2008 All antenatal clinics in Sweden used Audit
TIMELINE FOLLOW BACK
Namn__________________________ Födelsenummer_______________ -_______
GRAV.V DAG 1 DAG 2 DAG 3 DAG 4 DAG 5 DAG 6 DAG 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Time Line Time Line FollowFollowBackBack
The Risk drinking project
Commissioned by the Government
Started in 2004
12 sub projects
Education in Primary Health Care
Strategy Using the general Health Care System as an
arena
Forceful economic support by Government
Close cooperation with the professional associations
Strong focus on education and networking
FocusFocus
Risky consumption Addiction
None or little consumption
Misuse
Problemsbegin
Increasing problemsNo problems
Numbers
Motivate to change life style The Risk drinking project started
training in Motivational Interviewing M.I.
In Stockholm area all midwives are offered a 3-days education in M.I. with 1 follow up-day 3 months later. This is financed by the government.
Similar education is provided all over the country
M.I. Motivational Interviewing
Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
Stages of change Prochaska&Di Clemente
Not ready
Ambivalent
ready
action
maintenance
M.I. Some principles
Show empathy Listen to your patient/client Develop discrepancy
Reduce resistence
Support self-reliance
1999 30% of the pregnant women had been drinking
2003 16%
2006 10%
(Göransson et al, K.I. Inquiries from Stockholm area)
Drinking during pregnancy
Anonymous questionnaireto all pregnant women one week November 2008 5298 respondents Women from pregnancy week 5-42 Women from all over Sweden Ages from 19 years and younger to 40+.
Largest group 30-34 years of age 33% 97% of the women had heard the message
from the midwife “No alcohol during pregnancy”
8% of the women had been drinking alcohol during pregnancy
(M.Holmqvist University of Linköping)
Thank you for listening!
Top Related