The Swedish experienceAlcohol information - prevention at the Antenatal Clinics

Catharina ZätterströmMidwife, vice president of the Swedish Association for Midwives

A good start

Antenatal Clinics Almost 100 % of pregnant women attend a

clinic during pregnancy Basic programme: 8-9 check-ups starting

from pregnancy week 6-10 The care for the healthy woman with a

normal pregnancy is provided by midwives If complications arise other professionals,

like psycians, social counsellers etc are consulted

What can the midwife do?

Inform about alcohol och risks for the unborn child

Identify harmful consumtion

Motivate to change life style

Informing the pregnant women Started in the beginning of 1980s The main purpose was to inform the women

about the risks and to convey the message no alcohol during pregnancy

Standardized medical record included questions about the woman's alcohol consumtion 3 months before pregnancy, at admission and in pregnancy week 32

3 alternative answers “never, seldom”, “less than once a week” and “more often than once a week”

What happened during the 1990s?

Women who gave birth got older

Increasing alcohol consumption. More women drink heavier and more frequently

Clinical experience and later studies showed that a considerable fractions of pregnant women continued to drink during pregnancy

Midwife Mona Göransson began her studies ”Alcohol consumption during pregnancy: How do we separate myth from reality”

Thesis in 2004

Better ways to identify harmful consumtion

In the beginning of 2000 M. Göransson introduced

AUDIT – the pregnant woman Alcohol Use Disorder Identification Test

TLFB – the unborn child Time Line Follow Back

Audit

Screening alcohol habits before the pregnancy

Introducing a written memo how to handle women with a risky consumption and women with misuse.

2008 All antenatal clinics in Sweden used Audit

TIMELINE FOLLOW BACK

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Time Line Time Line FollowFollowBackBack

The Risk drinking project

Commissioned by the Government

Started in 2004

12 sub projects

Education in Primary Health Care

Strategy Using the general Health Care System as an

arena

Forceful economic support by Government

Close cooperation with the professional associations

Strong focus on education and networking

FocusFocus

Risky consumption Addiction

None or little consumption

Misuse

Problemsbegin

Increasing problemsNo problems

Numbers

Motivate to change life style The Risk drinking project started

training in Motivational Interviewing M.I.

In Stockholm area all midwives are offered a 3-days education in M.I. with 1 follow up-day 3 months later. This is financed by the government.

Similar education is provided all over the country

M.I. Motivational Interviewing

Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Stages of change Prochaska&Di Clemente

Not ready

Ambivalent

ready

action

maintenance

M.I. Some principles

Show empathy Listen to your patient/client Develop discrepancy

Reduce resistence

Support self-reliance

1999 30% of the pregnant women had been drinking

2003 16%

2006 10%

(Göransson et al, K.I. Inquiries from Stockholm area)

Drinking during pregnancy

Anonymous questionnaireto all pregnant women one week November 2008 5298 respondents Women from pregnancy week 5-42 Women from all over Sweden Ages from 19 years and younger to 40+.

Largest group 30-34 years of age 33% 97% of the women had heard the message

from the midwife “No alcohol during pregnancy”

8% of the women had been drinking alcohol during pregnancy

(M.Holmqvist University of Linköping)

Thank you for listening!