The Royal College of Midwives has warned of ‘mixed messaging’ after a study revealed that midwives are giving different advice around alcohol consumption during pregnancy.
One in five (19%) midwives surveyed as part of the research, funded by the Institute of Alcohol Studies, incorrectly reported that the chief medical officers’ (CMO) 2016 guidelines advised a limit of 1-2 units once or twice per week.
The CMO began advising pregnant women to abstain completely from alcohol in 2016, but one in four (42%) of midwives surveyed said they were not aware of the actual content CMO guidelines update.
The National Institute for Health and Care Excellence (NICE) guidance were only updated to reflect the CMO guidelines in December 2018, which the survey indicated may account for incorrect identification of the CMO guidance content among midwives.
Commenting on the findings, RCM professional policy advisor Clare Livingstone warned that the CMO and NICE are ‘out of step, resulting in mixed messaging’.
She went onto ask for a ‘standardised approach to alcohol screening and advice’, as the survey suggested that there is no such thing during antenatal appointments.
The study revealed that nearly all midwives (97%) ‘always’ or ‘usually’ advised all women to abstain from alcohol during pregnancy at the first appointment – but the proportion who did so at later appointments dropped to 38%.
Most midwives (69%) reported having fewer than four hours of alcohol training pre-qualification and 19% had received none. After qualifying, a third (33%) of midwives had not received any alcohol-related training and only a quarter (25%) were offered this within annual training updates.
Ms Livingstone continued: ‘Effective communication of official guidance and appropriate training is essential in ensuring that health professionals are giving consistent advice to women on such an important issue as alcohol abstinence in pregnancy.’
Lead author of the study Lisa Schölin said: ‘Our findings that 42% midwives were not aware of the CMO guidelines suggests that the government did not effectively communicate the introduction of these updated recommendations.
‘The CMO guidelines were introduced almost three years before the NICE guidelines were updated in line with them, meaning that during that time both guidelines were live, and no coherent message was given from all sources midwives may refer to.
‘We also found that approaches varied greatly across the UK and whilst adaptation and tailoring is important, more needs to be done to standardise approaches to assessment and recording of alcohol consumption and associated care pathways. That would allow us to better compare and understand the impact of services across the UK.’