Midwives’ views on alcohol guidelines: A qualitative study of barriers and facilitators to implementation in UK antenatal care

Objective: Midwives play an important role in health promotion and prevention of alcohol-related harm, but previous research has suggested that although most midwives report advising on abstinence, evidence exist that women are informed that “some” alcohol is not harmful. The aim of this qualitative study was to explore midwives’ views on implementation of the 2016 Chief Medical Officers’ alcohol guidelines in antenatal care in the UK. Methods: Focus groups and individual interviews with 22 midwives working in maternity and educational settings in the UK were conducted either in person or over telephone. Data were subjected to thematic analysis. Results: Conflict between guidelines from different sources and lack of knowledge of the abstinence advice issued in the Guidelines were barriers to discussing abstinence. Communication with women and building relationships were key facilitators supporting alcohol discussions. How alcohol was addressed appeared to vary across the UK with no uniform approach. Building a trusted relationship was believed to be the way in which women can disclose alcohol use, though the first antenatal contact was not always viewed as the best time to discuss what was considered a personal matter. Conclusion: Despite the release of new guidance in 2016, there was little recognition and awareness of these among midwives. Midwives were by default guided by other national clinical sources or guidelines. Future research should explore how practice-based interventions can address systemic and interpersonal factors to support health professionals to implement the Guidelines, and ensure that women are provided support to change unhealthy behaviours.