1. The Swedish experience Alcohol information - prevention at the Antenatal Clinics Catharina Zätterström Midwife, vice president of the Swedish Association for Midwives

2. A good start

3. 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

4. What can the midwife do?  Inform about alcohol och risks for the unborn child  Identify harmful consumtion  Motivate to change life style

5. 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”

6. 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

7. 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

8. 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

10. The Risk drinking project  Commissioned by the Government  Started in 2004  12 sub projects  Education in Primary Health Care

11. 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

12. Focus Risky consumption Addiction None or little consumption Misuse Problems begin Increasing problems No problems NumbersNumbers

13. 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

14. M.I. Motivational Interviewing  Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

15. Stages of change Prochaska&Di Clemente Not ready Ambivalent ready action maintenance

16. M.I. Some principles  Show empathy  Listen to your patient/client  Develop discrepancy  Reduce resistence  Support self-reliance

17.  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

18. Anonymous questionnaire to 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)

19. Thank you for listening!