HVs' role in providing alcohol advice to women who are pregnant or planning a pregnancy - IHV

5th January 2024

What is the role of health visitors (HVs) in providing alcohol advice to women who are pregnant or planning a pregnancy?

In support of #DryJanuary, we are delighted to share this Voices blog by Jayne Walker, Lesley Smith, Andrea Hilton, Lolita Alfred, Lisa Scholin and Anand Ahankari from the School of Advanced Practice in the Faculty of Health Sciences at the University of Hull. This blog covers the vital role of health visitors in providing alcohol advice to women who are pregnant or planning a pregnancy.

Jayne Walker MSc, Senior Lecturer | School of Advanced Practice | Faculty of Health Sciences | University of Hull

Pregnancy is a transformative period in a woman’s life and an important time to lay strong foundations for infant health and wellbeing that can last a lifetime. The health and wellbeing of the mother, her unborn baby and wider family are affected by a range of individual and environmental factors that often have cumulative impacts. Having access to personalised support, advice and interventions can make a big difference to outcomes. Health visitors (HVs) and other healthcare professionals can provide a valuable source of advice on various aspects of maternal and fetal health (Smith et al., 2022). One focal area is advising women regarding consuming alcohol when planning a pregnancy.

HVs are experts in maternal and family health (Leonard et al., 2020). Their role extends beyond clinical settings, as they provide personalised care and support to families in their homes. HVs are uniquely positioned to establish trusting relationships with pregnant women, offering guidance that encompasses physical, emotional, and social aspects of pregnancy (Institute of Health Visiting (iHV) 2022).

Alcohol consumption during pregnancy poses serious risks to both the mother and the developing fetus (Chief Medical Officer 2016). The developing fetal brain is particularly vulnerable to the effects of alcohol, and exposure can lead to a range of developmental disorders known as Fetal Alcohol Spectrum Disorders (FASD). FASD can manifest as cognitive deficits, behavioural challenges, and physical abnormalities. The severity of FASD varies – it appears to relate to the pattern of drinking during pregnancy; specifically, the frequency and timing of high levels of alcohol intake – making prevention through education and awareness crucial (Skorka et al., 2020).

The National Institute for Health and Care Excellence (NICE) quality standard Fetal alcohol spectrum disorder (QS204) recommends that:

“Midwives and other healthcare professionals [including health visitors] should give women clear and consistent advice on avoiding alcohol throughout pregnancy, and explain the benefits of this, including preventing fetal alcohol spectrum disorder (FASD) and reducing the risks of low birth weight, preterm birth and the baby being small for gestational age”.

Alcohol treatment services and healthcare professionals should support women who are, or who could be, alcohol dependent not to stop drinking suddenly as this can increase risk to them and to the fetus. They should encourage them to cut down and rapidly refer the woman for a specialist assessment for medically-assisted withdrawal. This reduces the ongoing exposure to the fetus and the risk and severity of future disability (Office for Health Improvement and Disparities 2023).

Building Trust, Providing Support, and Tailoring to Individual needs

HVs are advocates for the health of both pregnant women and their families, and providing alcohol advice is a fundamental aspect of their role (Queen’s Nursing Institute Scotland, 2022). HVs play a key role in providing clear and consistent information to women and their partners about the potential risks associated with drinking during conception and pregnancy, emphasising the importance of abstaining from alcohol to ensure a healthy pregnancy and a positive outcome for the baby.

There is strong evidence that approaches to support behaviour change based on partnership working are more effective (Cowley and Bidmead, 2020). Establishing trust is crucial in supporting the uptake of health promoting advice, and making health changes can be difficult. HVs engage with women in a supportive and non-judgmental manner, recognising the challenges and complexities of individual circumstances. By building strong sustainable relationships with women, HVs create an environment where women feel comfortable discussing their concerns and seeking guidance on behaviours that may be harmful to health, including alcohol consumption.

Pregnancy is a unique experience for each woman, and HVs recognise the importance of tailoring advice to individual needs. Some women may be more receptive to information about the dangers of alcohol, while others may require additional support and resources to overcome potential challenges. HVs utilise their interpersonal skills to work in partnership with families and provide personalised guidance, ensuring that women receive information that is relevant to their specific circumstances.

HVs also collaborate with other healthcare professionals and can connect pregnant women to a wider system of support to meet their individual needs. Working collaboratively with other members of the multi-agency team, HVs contribute to a holistic approach to maternal and fetal wellbeing, reinforcing the importance of abstaining from alcohol during the conception and pregnancy period. HVs also play a critical role in advising women regarding alcohol consumption when considering pregnancy in the interconception period. Through education and personalised support, they contribute to the promotion of healthy pregnancies and the prevention of FASDs (Pei et al., 2019). Sensitive, responsive preconception support from HVs is potentially one of the most important opportunities for HVs to make a difference to maternal and child health outcomes (Walker et al., 2023).

Jayne Walker, Lesley Smith, Andrea Hilton, Lolita Alfred, Lisa Scholin and Anand Ahankari from the School of Advanced Practice in the Faculty of Health Sciences at the University of Hull

References:

CMO UK (2016) Chief Medical Officers’ Low Risk Drinking Guidelines. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf [Accessed 05.12.2023].
Cowley, S. and Bidmead, C., (2020). Relationships and partnership working for public health. Community Public Health in Policy and Practice E-Book: A Sourcebook.
Institute of Health Visiting (2022). Good Practice Points – Reducing alcohol harm: Early intervention and prevention. Available at: https://ihv.org.uk/for-health-visitors/resources-for-members/resource/good-practice-points/generic-gpps/reducing-alcohol-harm-early-intervention-and-prevention/ [Accessed 05.12.2023].
Leonard, R., Linden, M. and Grant, A., (2020). Predictors of family focused practice among health visitors: A mixed methods study. Journal of Advanced Nursing. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14310?casa_token=02Fzx90UmCcAAAAA%3A1eXUkghOYsF2utt8PQsEcrUUS_ZgTDicuxOT1V7sZgvLPOKKrVKdex7jwTOs-Lj0-yWwVx-uHJ8y8o_s [Accessed 05.12.2023].
National Institute for Health and Clinical Excellence (2022) Fetal alcohol spectrum disorder. Quality standard [QS204]. Available at: https://bit.ly/36xkV9W [Accessed 05.12.2023].
Office for Health Improvement and Disparities (2023) Open consultation UK clinical guidelines for alcohol treatment: specific settings and populations. Available at: https://www.gov.uk/government/consultations/uk-clinical-guidelines-for-alcohol-treatment/uk-clinical-guidelines-for-alcohol-treatment-specific-settings-and-populations#pregnancy-and-perinatal-care [Accessed 05.12.2023].
Pei, J., Carlson, E., Tremblay, M. and Poth, C., (2019). Exploring the contributions and suitability of relational and community‐centered fetal alcohol spectrum disorder (FASD) prevention work in First Nation communities. Birth Defects Research. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/bdr2.1480?casa_token=ycCWH_7EY1UAAAAA%3AX3rlPWtldfBIXJoHyLl0ioUqg2_nKO0Ne-qe9lgn2fvQWhLmA1wMYHMtNt1JtLVUeB_I3grAFoujk1xb [Accessed 05.12.2023].
Queen’s Nursing Institute Scotland (2022). FASD is becoming more of a concern for community nurses and midwives. Available at: https://www.qnis.org.uk/blog/fasd-is-becoming-more-of-a-concern-for-community-nurses-and-midwives/ [Accessed 05.12.2023].
Skorka, K., McBryde, C., Copley, J., Meredith, P.J. and Reid, N., (2020). Experiences of children with fetal alcohol spectrum disorder and their families: a critical review. Alcoholism: Clinical and Experimental Research. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.14335 [Accessed 05.12.2023].
Smith, L., Hilton, A., Walker, J., Alfred, L., Ahankari, A. and Schölin, L., (2022). Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers. Dialogues in Health, p.100040.
Walker, J., Smith, L., Alfred, L., Ahankari, A. and Schölin, L., (2023). Promoting an alcohol-free (dry) pregnancy not just for Dry January. Institute of Health Visiting. https://ihv.org.uk/news-and-views/voices/promoting-an-alcohol-free-dry-pregnancy-not-just-for-dry-january/ [Accessed 05.12.2023].