Rebecca has been referred by her GP because she is a 36-year-old in her first pregnancy. She and her partner are busy professionals. Rebecca has no significant past or family history and is in good health at 18 weeks gestation. She admits to often feeling stressed and says she has cut down on alcohol since the pregnancy was confirmed at 10 weeks, but is still having a glass of wine daily to help her wind down. Following history taking, review of test results and physical examination, you determine that Rebecca’s pregnancy is progressing well.

Rebecca’s dilemma

Drinking alcohol helps Rebecca relax. She is not sure she can give up without help. She’s received mixed messages about the risks of having the occasional glass of wine now she’s pregnant. She feels reluctant to raise this with you, and hopes that you will raise alcohol consumption as part of the routine consultation.

Your dilemma

You need to have a conversation with Rebecca about her drinking, but don’t want to offend or alarm her. You’re not sure how to approach this. You need to assess her level of risk and provide her with the appropriate advice, support or referral. This will all take time, and you already have a full waiting room.

Rebecca’s story is not uncommon

In Australia, one-in-four pregnant women consume alcohol after knowledge of their pregnancy.¹ Surprising to some is the fact that older, more educated and better-off women are those more likely to continue to drink during pregnancy.

Rebecca is consuming alcohol at a level that increases her risk of miscarriage and stillbirth, and puts her baby at risk of premature birth, low birthweight and fetal alcohol spectrum disorder (FASD) conditions.

Australian Alcohol Guidelines and level of risk

The National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol state that for women who are pregnant, planning pregnancy or breastfeeding, not drinking alcohol is the safest option.²

Alcohol is a teratogen and heavy or binge drinking can cause damage to the developing fetus. It is not currently known if there is an amount of alcohol that can be consumed without damage to the fetus, hence, the recommendation to not drink.

Women Want to Know – alcohol and pregnancy

You can solve dilemmas such as the ones outlined here by:

• having the conversation about alcohol consumption that women want
• providing clear advice about alcohol, based
• on the Australian Alcohol Guidelines
• offering support and referral if needed

RANZCOG eLearning course

This course provides you with the information and skills to confidently tackle the above dilemmas. Completion of the comprehensive course attracts CPD points, but more importantly, you will be able to help women to achieve alcohol-free pregnancies by delivering clear and evidenced-based advice about the risks of alcohol during pregnancy.

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016: detailed findings. 2017. Available from www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed.
2. National Health and Medical Research Council. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. 2009. Available from www.nhmrc.gov.au/health-topics/alcohol-guidelines.