Women, Alcohol, Pregnancy & FASD

Supporting Community Nurses and Midwives

The recent QNIS survey revealed that most of the  community nurses and midwives who made time to respond– despite the stresses of the pandemic and its aftermath – are keen to know more about preconception health and do more within their practices: https://www.qnis.org.uk/blog/your-views-and-experiences

More specifically, they expressed interest in training (whether first-time or additional) on FASD and how it affects both children under 5 years and adults.  They want advice and guidance on providing better care for women with alcohol-related problems, and to join the dots between FASD care and trauma-informed care.

This is not a comment on the care already being provided. Remember, practitioners are already seeing and caring for children, young people and adults with prenatal alcohol exposure. However, it’s usually undiagnosed and therefore, neither understood nor responded to properly.  Increasing access to training, improving on core knowledge, and upgrading the ‘toolkit’ available to community nurses and midwives will only make them more effective and give them more job satisfaction.

I wrote about stigma in Blog 5.   The stigma surrounding women who drink alcohol has meant, remarkably, that an increasing number of pregnant women are more likely to admit to drug abuse than consuming alcohol.  The example I used in Blog 5 was about a little boy with FASD whose mother had died the year earlier from an alcohol-related problem and who was being cared for by his grandparents.  For the grandfather, his daughter dying from illicit drug use would have been considered more “respectable” than an alcohol-related death.

But what about the more in-depth, personal aspects of ongoing training and development that go beyond the facts?  Those personal dimensions are what makes each of us unique.  It’s not just the attitudes of the parents, families or the public toward alcohol, pregnancy and FASD that we need to examine.  It’s also our own attitudes and especially our unconscious biases.

When I trained as a nurse (back in the day) the assumption and attitude was that ‘the doctor is always right’.  I remember, as a student nurse, asking one of the doctors on a gastrointestinal surgery ward why he was prescribing Valium for a patient.  I wasn’t challenging him in any way. I genuinely wanted to understand why he was doing it – even then I must have been most interested in psychiatric nursing.  I can still see the expression of outrage on his face.  I clearly remember thinking “Oh dear, Moira, you’ve done it again!”

Thankfully, times have changed for the better. Yet, honestly, I still get into trouble just for asking questions sometimes!  So, what has this got to do with FASD?  For me, the connection is how we ask patients sensitive questions and how we respond to their answers. After all, patients/clients are very aware of not only the words we use, but also the facial expressions and body language that accompany them.  Working as a psychotherapist, I have learned you can guard against judgmental language, but your vocal tone, body language and facial expressions will give you away every time.

It is rare that health professionals are given the opportunity to learn from others about our communication style, the impact we have, and how that is perceived.  Including such feedback sessions is essential in any training programme.

Another important part of any health professional’s job is our ability to listen very carefully to the patient’s stories and to accurately understand their tone, body language and facial expressions.  I can hear you now reacting with “Well, I already do that”, but is that always true?  What about the times when the phone is ringing; when we are late for another clinic; or we didn’t sleep well the night before?  Believe me, I’ve been there.

This is not about judgement. It’s about being self-aware and being kinder to ourselves, as well as compassionate toward the people with whom we work.  In counselling, the majority of clients are not interested in the theoretical model used by the therapist. They want to be heard, accepted, and understood.  If they feel those hallmarks of respect and trust are present, then they feel safe enough to disclose concerns and share their lived experience candidly. If done well, then they will also begin to hear, accept and understand themselves.

I still recall the words of a woman with a long history of trauma saying: “The only place I can hear my own voice is in your therapy room”.   I felt both sad for her, yet also pleased she was able to hear her own voice and make progress in better understanding her own life.

Isn’t it true that, even as health professionals, we, too want to feel heard, accepted and understood?  This is especially true when we are feeling scared and vulnerable.  Whatever our own background, skills and expertise, those three results are key. How much more so for an anxious patient experiencing her first pregnancy and worried about any drinking before the pregnancy was confirmed?

Moving a little deeper, on a personal level, consider our own ability to be self-aware.  Many health professionals have a history of trauma in their backgrounds. This ranges from parental divorce to family members experiencing mental health problems and, yes, sometimes our own struggles with alcohol and/or drugs.

Hearing some of our patient’s stories can trigger memories from our own lives, which, in turn, can trigger secondary trauma within us.  Ongoing learning and support from one another can be very helpful.  I know these secondary traumatising events can feel worse if we are exposed to the significant, real, unmet needs of our patients. Unfortunately, at this point in time, services and support for people with FASD (and their families) are few and far between throughout Scotland.

I spoke earlier of the importance of listening carefully and truly hearing the people we are trying to help.  The degree of distress a listening health professional experiences is related to the patient/client’s expectations that we can help.  With FASD services, the pressure this situation places on the community nurse or midwife is clear. “Oh, where do I (and they) go from here?” is a common reaction. Training in how to map the complete picture, identify priorities and make a realistic plan, can reduce the sense of being overwhelmed and powerless.

What needs to be included in any alcohol or FASD-related training? What do we need to do to ensure we are responding well to what community nurses and midwives want?  In turn, they need to ensure they are responding well to what their patients/clients want.

Some aspects are obvious, from recording a drinking history to exploring, where appropriate, what may be causing the woman to self-medicate with alcohol.  The first steps are having the space and time to ask sensitive questions.  To reach a meaningful level of understanding and identify FASD-related issues at different ages and stages of life. This can be an even more powerful tool when used in preconception care – prevention is still a better goal than ‘after the fact’ services for a lifelong disorder for which there is no cure. Both are needed, of course.

But why don’t we go further and deeper to learn more about the ‘tool’ we rely on most – ourselves! That can make all the difference in our practice and in the lives of the people who come to us for help and support.

****

This ends Moira’s series of six blogs. Please look for, read and comment on Prof Plant’s full report to be published by QNIS/HPBL during the summer of 2022. You can find it by visiting the Healthier Pregnancies, Better Lives section of the QNIS website or by following @HPBL_Scot.

You can read the other blogs here:

1. What is a Unit of Alcohol?
2. Who is most likely to drink during pregnancy?
3. FASD Across the Lifespan:  Physical Problems
4. FASD Across the Lifespan: Behavioural Problems
5. Stigmatisation Must Be Challenged
6. Training Community Nurses – You’re already here