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There is a strong social norm against consuming alcohol during pregnancy. However, many women do not realise they are pregnant until the sixth week and are not provided with information about the risks of consuming alcohol until they visit a health professional in the second trimester. We conducted semi-structured interviews with 12 midwives and 12 pregnant women from two regions in NSW in 2008-09 to explore attitudes towards alcohol consumption during pregnancy, and the factors that may encourage or inhibit women from following the recommendation to abstain from drinking while pregnant. Both groups noted the social issues around pregnant women consuming alcohol due to perceived social norms and the challenges in not revealing early pregnancy status at social events.

Background: the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages., Objective: to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments., Design: individual semi-structured interviews with midwives and pregnant women., Setting: face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009., Participants: 12 midwives and 12 pregnant women., Findings: midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women)., Key Conclusions: both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised., Implications for Practice: there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery. Methods: This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment. Results: A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues. Conclusions: The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation. Training GPs to deliver effective care for patients who use alcohol or other drugs is an important step in reducing the preventable burden of disease associated with substance use. The training program pilot tested here was found to be capable of increasing GPs' confidence to address substance-related issues and increase their knowledge of current national guidance on low-risk alcohol consumption. A national scale-up of this program, coupled with increased incentives for GPs designed to encourage implementation and ongoing delivery, remains a necessary next-step. [ABSTRACT FROM AUTHOR]