'No alcohol, no risk'

AIMS Journal, 2012, Vol 24 No 4

Gill Boden reports on the FASD information for midwives

This 26-minute film has just been released by NOFAS-UK, the National Organisation for Foetal Alcohol Syndrome UK. It examines the risks of drinking alcohol in pregnancy and follows a birth mother with a child with suspected fetal alcohol spectrum disorder (FASD), a midwife and a pregnant woman who is drinking low levels of alcohol. The focus of the film is the message that the only safe advice is to abstain from alcohol at all stages in pregnancy.

The three women and, through them, the viewers are shown some quite shocking footage of children with deformed features and very challenging behaviours, all of whom have been removed from their presumably alcoholic mothers and fostered. There is no information on the levels of alcohol during pregnancy that would result in such damage, but it is very clearly stated that the standard advice, that 'one or two units once or twice a week' should cause no harm, is based on no evidence at all. The only evidence offered of the effect of alcohol in pregnancy is ultrasound scanning showing the foetus reacting to, presumably low, levels of alcohol in the blood of the mother, but it was explained that these visible reactions can't be interpreted.

There is an irony here in that the logical conclusion that 'FASD is a direct result of prenatal alcohol exposure and can be completely eliminated if pregnant women do not drink alcohol' could equally well be applied to diagnostic ultrasound. The toxic effects of ultrasound exposure, for example low birth weight, which are direct effects of high levels of ultrasound, could be completely eliminated if pregnant women did not submit themselves to routine screening.

All three women were convinced that women need more information about the effects of alcohol and that a policy of advising no drinking is best. While this may be the case, what is not explored in the film is the repercussions of such a policy in a society where social drinking by women is prevalent and many women do not plan their pregnancies, or do not know immediately when they conceive. It is also the case that European societies have relied on fermentation to keep liquids free from bacteria for thousands of years and women and children have regularly consumed weak beer for probably centuries.

I feel that what is missing is a consideration firstly of how drinking habits and strength of drinks have changed, and secondly what support women who are heavy drinkers need and get. Finally, while the language of the film is about education, what is not made explicit is the kind of sanctions that society might impose on women who for whatever reason, don't or can't take the advice. It was stated that 30 children are taken into care in the UK every day and the largest single group within this is children suffering from FASD. We know that in the US women are being imprisoned for drinking 'too much' while pregnant. I believe we need far more research into the effects of low and moderate levels of alcohol in pregnancy so that we know what will damage babies. We need to challenge the punitive treatment of pregnant women: women whose behaviour may damage themselves and their babies need help and support, not punishment.

To view the film online, go to www.nofas-uk.org section 'Alcohol in pregnancy - training for midwives'. There is also a fact sheet for parents, carers and professionals containing information on fetal alcohol spectrum disorder.