Help for the midwives

Midwives are in a prime position to help support pregnant women to stop or cut down on alcohol and other drug use and to improve outcomes for themselves and their children.

A new South Australian initiative will examine the role midwives can play in promoting key public health messages and supporting abstinence during pregnancy.

The program has facilitated a collaboration between experts at Flinders University, the University of Adelaide and the Northern Adelaide Local Health Network (NALHN) with funding from the Australian Government Department of Health and Aged Care.

In a new research protocol published in Addiction Science and Clinical Practice (BMC), researchers outline how they will investigate the pivotal role midwives play in engaging with pregnant women during regular hospital antenatal clinic checks and suggest improved systems for identifying and supporting the reduction of any alcohol and other drug use during pregnancy.

“Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing babies,” says the first author of the study, Dr Matthew Stevens, from The University of Adelaide.

“Despite recommendations for abstinence during pregnancy, some women need additional advice and in some cases further support in order to discontinue use, making screening and early intervention an important strategy for reducing risk.”

Professor Annette Briley.

NALHN and Flinders University Professor of Women’s Health and Midwifery Research, Dr Annette Briley says the study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent.

“We have outlined a protocol which focuses on a multi-stage approach in implementation.

“With periods of abstinence promoted during pregnancy, this time presents an ideal opportunity to discuss lifestyle practices and seek help to make change to healthier lifestyle choices.”

Health warnings from government agencies and advice from midwives about refraining from using alcohol, tobacco and illicit drug use during pregnancy are already a potential catalyst for healthier choices for the mother and her child.

The new project commenced with changes in recent years of the availability and habits of alcohol, tobacco and other drug use, including the rise of vapes as a substitute for tobacco.

“We’ve seen a large shift in the availability and attitudes towards both licit substances like alcohol and tobacco, and illicit substances like cannabis in recent years and we wanted to find out how midwives discussed these issues with the women booking for antenatal care,” adds Dr Stevens.

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“Despite strong public health campaigns around cessation of alcohol and tobacco use in pregnancy, some women struggle to discontinue use. It may also be the case that some women are unlikely to disclose recreational drug use in pregnancy. Therefore midwives are in an ideal position to help women make the change.”

But while midwives are well placed to initiate referral for support to quit smoking, substance use and alcohol intake, researchers are asking “are they aware of current trends and do they feel confident to discuss these issues with women and support them through pregnancy?”

“A prize example is vaping, with conflicting advice in the media about its impact on the persons health, but also the unborn child,” adds Professor Briley.

“We hope this program will evaluate current practices and provide midwives and other health professionals working with pregnant women with the knowledge and skills to support them to stop using substances, alcohol or smoking in pregnancy to improve both their and their baby’s health.”

So far, the research team has completed phase one – a retrospective case note review which helped to understand the current practices around screening and intervention within the services.

The team has also conducted a ‘Training Needs Analysis’ of the midwifery staff at those services to understand attitudes, beliefs and commitments to care for pregnant women who use alcohol and other drugs.

Researchers will now focus on providing training around identifying and responding to alcohol and other drug use and assess and monitor changes over time.

The protocol, Improving the quality of antenatal screening and early intervention for alcohol and other drug use: protocol for a multi-stage approach to systems reform (2024) by Matthew WR Stevens, Megan Cooper, Lynette Cusack, Robert L Ali and Annette L Briley has been published in Addiction Science and Clinical Practice (BMC). DOI: 10.1186/s13722-023-00434-6


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