Il vissuto di ostetriche in merito alla prevenzione del consumo di alcol in gravidanza: una ricerca qualitativa

BACKGROUND: Numerous studies show that a substantial number of women continue to consume some alcohol during pregnancy, regardless of social status. The effects of excessive gestational alcohol consumption on the fetus are well documented, in particular FAS and FASD, but at present there is no accepted ‘safe’ level for alcohol intake during pregnancy. The only certainty is that FASD and FAS is preventable if a woman abstains from drinking during the periconception period and during pregnancy. Most countries recommend abstention from all kind of alcohol. Midwives are the reference professionals of the women’s health care and they have to give correct information to all pregnant women they consult. A dutch study (2011) analyzed the experiences of midwives about their practice to talk about alcohol to pregnant women and their partners. The midwives reported to lack good screening skills and sufficient knowledge about the mechanism and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. AIM: This study aimed to explore the experiences of the Milan midwives and what kind of counseling they do with pregnant women and their partners, about alcohol use for a good prevention of FAS and FASD. METHODS: A qualitative design was used to capture the experiences of midwives. The semi-structured interview is the translated version of the interview in the study “A qualitative investigation of alcohol use advice during pregnancy: Experiences of Dutch midwives, pregnant women and their partners” (NY Van Der Wulp 2011), based on the I-Change Model 2.1. RESULTS: The data saturation was reached with 11 interviews. The data analysis and triangulation found 77 meaning labels, 17 categories and 6 themes. DISCUSSION: Seven midwives of the sample show a sufficient knowledge about the consequences and about the epidemiology of alcohol use in pregnancy. Only two of them recommend to pregnant woman the complete abstinence from alcohol use. Three of them would speak only with women during counseling, but the sample agrees on customization assistance. They generally find some difficulties in counseling when they have to communicate in anomalous situations. In fact, the sample agrees on education for improve communication skills on this particular topic. Four midwives feel lack of competence and auto-efficacy. The sample also agrees on prevention based on complete information. To improve the knowledge and the information to give to pregnant women, they recommend proposals for the future intended both to midwives themselves and women. CONCLUSIONS: The alcohol use in pregnancy is a taboo-topic for midwives and their équipes. To optimally prevent FASD and FAS they need education on epidemiology, consequences and how to treat women who use alcohol in pregnancy and women who simply have to be informed. IMPLICATIONS FOR PRACTICE: The Midwives Council of Milan – Lodi – Monza Brianza manages the Belly Friendly Initiative. The project aims to prevent alcohol use during pregnancy, providing accreditation to all locals in Milan that join the initiative, promoting non-alcoholic drinks on their menu, intended to pregnant women. The Council aims to provide a screening tool online version that women can auto-administer. At the moment the best tool seems to be TWEAK test.