Need to respect individual differences

In relation to the previous theme, the theme of individual differences emerged inductively from the data. Women acknowledged how alcohol can vary in its effects on different people and were aware of individual differences between women.

“And its one of those things where everybody’s different so you don’t know whether a little bit will affect you or have no effect whatsoever.” (Interview 9, no children)

The recognition of individual differences was often associated with advocating drinking behaviour that felt comfortable for each individual.

“I think you have to do what you feel is right for you.” (Interview 13, two children)

Facilitators to drinking in pregnancy

An unexpected theme which emerged inductively from the data was the benefits of drinking. Women described drinking as being beneficial with regard to stress relief and relaxation and that the positive effects of alcohol outweighed the possible risks.

“I just know that it gives me just that total relaxation feeling… which I guess could outweigh the fact that you’re having alcohol.” (Interview 6, one child)

“I also think it helps when you’re really stressed out, emotionally up and down… as you are during pregnancy, occasionally have a glass of wine.” (Interview 2, two children)

Influence of confusing or unclear advice on drinking in pregnancy

In anticipation that women would find current information unclear, we looked for this theme. The advice on drinking during pregnancy was described as being confusing, unclear or lacking sufficient detail.

“Some books say you should avoid it all together and others say it’s OK to perhaps have one glass. So even in the pregnancy books you get a confusing message.” (Interview 1, two children)

Concern was expressed about the conflicting advice.

“It’s very difficult to feel very reassured with any of the advice because everything conflicts so much. So… it has been very difficult.” (Interview 13, two children)

There was a call for the advice given from health professionals, government and other sources to become clearer and more consistent, in line with advice and information regarding smoking.

“I think midwives should be a lot more clear about it. The info given to women in the big pack of info, when you go to your first visit, maybe that should be a little more clear.” (Interview 20, no children)

“I mean they are very clear on smoking but not drinking.” (Interview 10, no children)

More specifically, the term ‘units’ used to describe measures of alcohol in government guidelines and by health professionals was regarded as being misunderstood or confusing.

“Especially if you’re drinking at home, it can be difficult to estimate how much a unit actually is.” (Interview 9, no children)

Clear advice was deemed to be particularly important for pregnant women who were less knowledgeable.

“They need to sort it out really, I mean I know what’s right and wrong, but if somebody else isn’t that well educated and things like that, then the media is what they listen to, then they’re going to listen to that kind of thing.” (Interview 7, no children)

Attitudes towards available advice: Advice lacks reasons, evidence or sufficient detail

Given that a recent systematic review [5] had found no consistent evidence for adverse outcomes from light drinking during pregnancy, this theme was explored deductively. Existing advice and information was felt to lack legitimate justification, supporting research evidence or adequate detail. They suggested a need to deal with these shortcomings and provide more detailed information for pregnant women.

“And the first time you are pregnant you do get a pregnancy book which goes into diet and I think it mentions it in there but I don’t think there is enough said about why you shouldn’t drink.” (Interview 11, one child)

Often pregnant women were asked about their alcohol consumption in consultations with health professionals but not given advice. In addition, where advice about alcohol was given by midwives and GPs, this was not considered to be sufficiently informative.

“So there’s not really much in the literature that you get from the midwife. They just tell you not to drink and they don’t tell you why.” (Interview 11, one child)