Background : Alcohol exposure during pregnancy can have negative maternal and infant outcomes. Due to a lack of clear evidence of a ‘safe’ threshold for alcohol consumption during pregnancy, the UK Chief Medical Officers (CMOs) revised their guidance in 2016 to advise pregnant women to abstain completely from alcohol. Furthermore, primary prevention in antenatal care, through screening and brief intervention, has been set as a priority by the World Health Organization (WHO). Midwives are key to achieving these aims, but little is known about the extent to which UK midwives are aware of, and implement, the CMO guidelines. Moreover, there is a lack of knowledge about barriers to implementing the guidelines.

Conclusions: This study shows that awareness specifically of the CMO guidelines was lacking amongst midwives. It is worth noting that these guidelines were introduced before a change was made to the National Institute for Health and Care Excellence (NICE) guidelines and for a period of about three years these two guidelines, containing different advice, were available concurrently. However, the advice that was provided was in line with the CMO guidelines by most midwives during the booking appointment, but not routinely at later appointments. There is no standardised approach to addressing alcohol consumption during antenatal appointments meaning that assessment and recording of alcohol consumption is inconsistent across the UK and within each country. Midwives accept the guidelines in principle and believe that it is important for women to be supported to make informed choices. Use of the TDF helped factors that influenced midwives’ alcohol-related practices. Findings suggest that interventions aimed to improve midwives’ knowledge, skills and clinical confidence to deliver alcohol advice appropriate for the level of risk of the woman’s drinking may facilitate midwives’ practices.