It’s been 18 months of hard work and back to the drawing board moments but this week, in collaboration with the Hospital Alcohol Liaison Service, and Public Health we are proud to be launching our MAMA (Maternal Alcohol Management Algorithm) Pathway in our maternity unit.
Women have been receiving mixed messages from various sources regarding alcohol consumption in pregnancy and gaining a true reflection of drinking habits has historically been a challenge as women risk being judged for being honest or indeed are unable to give a true account in view of a lack of awareness into what even constitutes a unit of alcohol.
When devising the pathway we knew we had to change our approach. Asking how many units women were drinking prior to and during pregnancy did not give a true insight into their habits and potential risks and women who had reported to ‘binge drinking’ prior to pregnancy were not offered any support or signposting into services for the duration of their pregnancy and beyond.
TWEAK is a 5 item scale for harmful drinking in pregnancy and is an acronym for the questions below:
- Tolerance – How many drinks does it take to make you feel high?
- Worry – Have close friends or relatives complained about your drinking in the past year?
- Eye Opener – Do you sometimes take a drink in the morning when you wake up?
- Amnesia – Has a friend or family member ever told you about things you said or did whilst drinking that you could not remember?
- Kut Down – Do you sometimes feel the need to cut down on your drinking?
All women are now screened at their first appointment with the midwife using this tool. The screening is then repeated in the 16th week of pregnancy. Screening for harmful drinking will potentially improve pregnancy outcomes by targeting women for interventions to help reduce their alcohol intake during pregnancy. Postnatal follow up will help prevent women resuming harmful habits, enhancing their ability to care for their newborn and prevent future alcohol related damage to the unborn baby in subsequent pregnancies.
Women attending their appointment with the midwife will be given information around the potential risks of alcohol consumption during pregnancy as a standard. This on its own can motivate women to change their habits as an awareness is raised of the potential long term effects of alcohol in pregnancy. Those identified as being at higher risk will, with consent, be referred to the Enhanced Midwifery Service for more specialist support during pregnancy and onward referral into specialist alcohol services for support and treatment as appropriate.
One of the further benefits of the MAMA pathway is that for the first time the results of maternal alcohol screening in pregnancy will be recorded in neonatal notes to enable any potential long-term impact of maternal alcohol consumption during pregnancy to be tracked and considered when seeking diagnosis of FASD in the child in the future. The information will also be shared with the Health Visitor to ensure ongoing support once the woman is discharged from maternity services.
We feel this is groundbreaking work and has the potential to reduce the incidence of FASD in an area of the country which already has a higher than average incidence of hospital admission through alcohol harm. In the run up to the launch of this pathway there have also been 200 members of staff trained in the recognition and management of patients at risk of harmful drinking.
If women are given a clear, consistent message about the risks of alcohol during pregnancy we enable them to make an informed decision about their own health and that of their unborn baby. In view of a lack of evidence around what actually IS a safe amount of alcohol to drink whilst pregnant that message must be No Alcohol = No Risk.