Home > Creating a better future together. National Maternity Strategy 2016-2026.

Ireland. Department of Health. (2016) Creating a better future together. National Maternity Strategy 2016-2026. Dublin: Department of Health.

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(P.60) 3.7 ALCOHOL

Evidence suggests that high levels of alcohol consumption during pregnancy are associated with miscarriage, low birth-weight and child developmental problems; however the evidence is inconclusive on the risks of light alcohol consumption. Foetal Alcohol Spectrum Disorder (FASD) is a term used to describe the full range of permanent birth defects caused by prenatal exposure to alcohol. FASD is difficult to diagnose as there are many features that need to be present along with a history of prenatal alcohol intake.


Growing up in Ireland has found that Irish women were significantly less likely to report drinking during pregnancy, but, if they did consume alcohol, they were likely to drink more heavily than their UK counterparts. As outlined in Chapter 2, almost 20% of women reported consuming at least one alcoholic drink during pregnancy. A HRB-funded study reported significantly higher rates, where 65-80% of women surveyed in the UK and Ireland drank at some point during their pregnancy. The study reported that 60% of participants drank during the first 3 months of pregnancy – 19% occasional alcohol consumption, 25% low alcohol consumption, 11% moderate alcohol consumption, and 5% heavy alcohol consumption.


As evidenced in the Growing Up in Ireland study, drinking patterns can continue into pregnancy, particularly in the early stages, where pregnancy is not known and/or pregnancy has not been planned. Abstinence from alcohol was less likely among older women with higher levels of education, social class and income; however their pattern of consumption tended to be more moderate than that of younger women with lower levels of income and education. Younger and less educated women were more likely to consume more alcohol earlier in the pregnancy, before reducing their consumption levels in the second and third trimesters. All non-Irish citizenship groups were found to have a lower probability of consuming alcohol than women with Irish citizenship. Only 3.7% of women stopped drinking alcohol during the course of their pregnancy. The health of the mother was also found to influence alcohol consumption. Issues such as stress and depression/anxiety increased the probability of alcohol consumption by 60% and 32% respectively. Conversely, experiencing persistent nausea and vomiting reduced the probability by 27%.


Women are generally asked about their alcohol intake at their first antenatal visit. They are advised to avoid alcohol during pregnancy as there is no safe minimal intake. Women identified as drinking to excess are referred to the social work department for support and advice, and where appropriate, are referred to their GP and other support services. The importance of early identification is essential as ongoing excessive alcohol may have implications for the safety and welfare of the baby and older children. The medical social worker has a key role in co-ordinating support and care for these women and in referring any child welfare and protection services to the Child and Family Agency.


A Pocket Guide Alcohol and Pregnancy is readily available throughout the health services. The guide is a result of collaboration between the HSE, the Public Health Agency in Northern Ireland and the Western and Southern Health and Social Care Trusts, with funding secured through the European Union’s INTERREG IVA programme by the cross border health services partnership, Co-operation and Working Together.


The Department of Health recommends that pregnant women abstain from drinking alcohol. It is intended to bring forward legislation to provide for health warning labelling on alcohol products in relation to consuming alcohol during pregnancy. This is welcomed by the Strategy. While it is recognised that efforts are being made to protect the health and wellbeing of both mothers and their babies from the harms of alcohol, the National Women & Infants Health Programme should further develop a consistent approach to informing women about the risks of alcohol consumption during pregnancy. All maternity units should provide appropriate supports to women to help them reduce alcohol consumption. In addition maternity hospitals/units should facilitate increased awareness of FASD amongst healthcare professionals and strengthen their methods of detecting alcohol abuse and supporting women to reduce their intake.


(P.61) 3.8 DRUGS

Limited information is available on the extent of drug misuse during pregnancy in Ireland. One study in the Coombe Women & Infants University Hospital showed that 4% of women who registered for care, reported using drugs during pregnancy. Of the women who recorded use of drugs, the most common cited drug was methadone, which suggests previous engagement with available services in an attempt to cease the practice. The impact on the baby of the mother’s drug abuse prior to birth, is not always immediately apparent, and sometimes the full harm is not evident until later. The HSE identifies potential negative outcomes of misuse of drugs during pregnancy as increased stress and impulsiveness later in life (cannabis), heart defects and learning difficulties (cocaine) and withdrawal symptoms (opiates) (www.drugs.ie). Women who take drugs are at an increased risk of having babies with low birth weights. There is also risk for the baby associated with the use of infected needles.


Women with drug issues have been found to be a particularly vulnerable group due to a lack of engagement with the maternity services and a tendency to under report the level of their drug use. Extensive support from a medical social worker, both for the mother and for her baby, is necessary to ensure engagement with necessary maternity, neonatal, postnatal and social care services. Three Drug Liaison Midwives are employed by the HSE addiction service, each linked to one of the Dublin Maternity Hospitals. The National Women & Infants Health Programme should examine the need to provide Drug Liaison Midwives and specialist medical social workers in all maternity networks.


The Drug Liaison Midwives provide a link between the maternity service and the drug treatment service. The role of the Drug Liaison Midwife is to case manage pregnant, drug dependent women, providing education and support during their pregnancy. Information is also provided on the possible effects of drug use in pregnancy - a booklet “Substance Misuse in Pregnancy” has been developed. In addition, women are supported to access priority drug treatment and admission to residential inpatient drug treatment centres. One mother and child residential treatment service is available in Dublin, provided by Coolmine Therapeutic Community.


It is important that maternity services work in partnership with drug services and the Child and Family Agency to support parents with substance abuse issues and to identify potential ongoing harm for babies and older children. Involvement with maternity services provides an opportunity for women to reduce their drug dependence and improve their social circumstances.


The Department of Health is working on the development of a new National Drugs Strategy for the period post 2016. The intention over the coming months is to lay the groundwork for a concise and focused policy, placing a clear emphasis on the practical implementation of actions. An examination of the approach to drugs policy and practice in other jurisdictions will also help to identify any additional evidence-based approaches which might be considered in an Irish context.



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