Article Summary: Midwives’ knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

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Pregnant women agree that health care professionals have great influence in providing advice for a safe and healthy pregnancy. Midwives play a significant role in advising pregnant women on the dangers of alcohol consumption during pregnancy and therefore must be knowledgeable and confident in order to appropriately deliver the abstinence message. This article aims to identify midwives’ knowledge, attitudes, and quality of practice in addressing alcohol use and pregnancy.

 Current knowledge, attitudes, & practice

  • Most (but not all) midwives consistently asked women during their first visit how much and how often they drank alcohol
  • Some midwives did not talk about how alcohol can affect the fetus, because they did not want to stress the mother
  • Even though they were knowledgeable on the effects of alcohol during pregnancy, midwives were not very confident when explaining this information to pregnant women, and often avoided discussing the topic
  • Most midwives believe that pregnant women or women planning to become pregnant should not consume alcohol at all

Barriers to practice

Midwives found that barriers to putting their knowledge into practice and advising women on the harms of alcohol consumption during pregnancy include:

  • Limited time spent with the mother
  • The sensitivity of the mother and fear of her reaction to the conversation
  • Stigma around alcohol consumption during pregnancy
  • Not enough resources to address the issue if it was found that a mother does drink alcohol while pregnant
  • Even though midwives know there is a risk to drinking alcohol while pregnant, they may not know how much is considered harmful, and what the specific effects may be


  • Making sure midwives know why alcohol is harmful
  • Training them on how to have these conversations with their patients
  • Increasing the amount of time spent with at-risk women
  • More resources such as online and written materials to give to patients

 Take home message:

Only about 2/3 of midwives report discussing alcohol and pregnancy with their patients, showing a gap in knowledge and education. Even in cases where they are generally knowledgeable on the topic, they tend to avoid the conversation because of a lack of confidence in properly delivering the message to pregnant women. If midwives are given proper support and education to help their patients, as well as more involvement in early stages of screening and care before pregnancy, they would be better prepared to help women have an alcohol-free pregnancy.

For more information:

Authors: Janet M Payne, Rochelle E Watkins, Heather M Jones, Tracey Reibel, Raewyn Mutch, Amanda Wilkins, Julie Whitlock, Carol Bower

Journal: BMC Pregnancy & Childbirth

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