Study from Switzerland explores prenatal alcohol consumption from the perspective of 30 couples expecting their first baby. While all couples had internalised the message that drinking in pregnancy is risky, it was not always easy to abstain from alcohol. The findings emphasise that drinking is not an isolated phenomenon, and women need more than advice ‘not to drink’.
In many countries, official medical bodies advise women not to drink alcohol during pregnancy. This is primarily due to the risk of fetal alcohol spectrum disorders, which arise from harm to the embryo or fetus as they are developing. A qualitative study in Switzerland provided the opportunity to uncover why ‘alcohol-exposed’ pregnancies occur, by discussing the uncertainties and difficulties that couples can encounter when adjusting to pregnancy.
The internalisation (and burden) of risk discourses
Original article: Pregnancy as a transition: First-time expectant couples’ experience with alcohol consumption. By Solène Gouilhers and colleagues. Published in Drug and Alcohol Review (2019).
In Switzerland and the United Kingdom (1 2 3), drinking guidelines promote a precautionary ‘abstinence-only’ approach to alcohol in pregnancy. While experts cannot be sure about the level at which drinking becomes significant, they have come to the conclusion that the potential harms of an alcohol-exposed pregnancy are too great for a woman to take the risk of drinking alcohol.
Interviews with 30 pregnant women and their partners in French-speaking Switzerland revealed a consensus that it is best for women not to drink alcohol during pregnancy. Indeed, all women in the study tried to adhere to this principle, and by 21–39 weeks pregnant, most had abstained or significantly cut down their consumption.
Some women who continued to drink alcohol, or drank before they knew they were pregnant, experienced strongly feelings of anxiety, stress, and guilt – an indication that they had internalised the message that alcohol consumption in pregnancy is inherently risky.
In some cases, this prompted women to turn to strict abstinence throughout the rest of their pregnancy. For the wider population of women who are pregnant, however, there may inadvertent consequences associated with the binary representation of risk in drinking guidelines (i.e. ‘drink alcohol and risk immense harm; abstain from alcohol and have zero risk of harm’).
Healthcare guidelines and navigating risk
In 2014, the British Pregnancy Advisory Service (BPAS) reported that well-meaning warnings about the impact of alcohol during pregnancy were leaving some women so distressed that they were considering “ending what would otherwise be a wanted pregnancy”.
Ann Furedi, who was Chief Executive of BPAS at the time, said:
“Women should be reassured that the odd night of heavy drinking before they found out they were pregnant is extremely unlikely to have caused their baby harm. Pregnant women don’t need scare stories but impartial, evidence-based information, and they should be trusted to make the choices that are right for them.”
This call for more, not less, detail about the potential harms of alcohol in pregnancy was echoed in the DECIPHer study in 2018. Dr Rachel Brown and Ms Heather Trickey found that “the lack of nuance in the clear abstinence message [was] not acceptable [among some stakeholders …] and sometimes led to mistrust and to mothers seeking alternative advice from other sources”.
What these two examples show is that a trade-off can occur when guidelines lean into the precautionary approach. Experts may prioritise delivering a clear message, but this can come at the expense of helping women to discern what types or levels of drinking put them and their pregnancy at greater risk based on the evidence base (however limited that currently is).
In the featured study, some women decided to drink occasionally in small amounts, believing that this would not harm the fetus. This is also an important perspective or experience to highlight. These were not women who were drinking unaware of the potential harms. These were not women who had drinking problems. They were women who wanted a healthy pregnancy, who wanted to make decisions for themselves based on their own circumstances, and perhaps saw the norm of alcohol reduction or abstinence as just one of many prescribed behaviours for pregnant women where they had to exercise judgement.
Too narrow a focus?
The research was based on interviews with couples about their (individual and collective) drinking habits before and during pregnancy. The focus of the paper, however, was almost exclusively on the pregnant woman’s alcohol consumption. To some degree, this makes sense. After all, it’s only the woman’s alcohol consumption that can affect the development of the embryo/fetus.
Yet, we know that drinking in pregnancy isn’t an isolated phenomenon. When women drink or do not drink, they do so in a broader context which includes romantic and social relationships, cultural norms, and personal histories.
If women’s partners were expected to be equal participants in a healthy pregnancy, rather than ‘supportive observers’ (at best), this might make it easier for women to reduce or eliminate their risk of alcohol-related harm in pregnancy. This may be especially important when drinking is associated with pleasure, as it was for some women in the study, and where alcohol is part of normal social situations for the couple, such as going out for a meal or attending a party.
This article was published as part of The Pregnancy Edit for September 2021. If you are interested in writing a blog or participating in an interview about alcohol-related harm in pregnancy for the SSA website, please contact Natalie Davies at natalie@addiction-ssa.org.
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