NICE listens to RCM view on recording of alcohol consumption

By Lia Brigante, RCM Policy & Practice Advisor Midwives NHS NICE - The National Institute for Health and Care Excellence Pregnancy Alcohol and pregnancy

The RCM secured an important victory last week around the recording of alcohol consumption, which could have put the important relationship between pregnant women and their midwife in jeopardy. RCM Policy & Practice Advisor Lia Brigante explains more.

Last week, the proposal from NICE to transfer the record of woman’s consumption of alcohol in pregnancy to her child’s medical record was dropped following pressure from the RCM and other campaigners.

The RCM’s strong opposition, as a registered stakeholder for NICE consultations relating to maternity care, alongside that of other charities such as BPAS, Birthrights and AIMS, brought about a change in NICE’s quality standard. When the standard draft was published in 2020, it suggested that women should be asked about their alcohol consumption throughout pregnancy and that recording of alcohol intake, including low-level consumption, should be transferred to the child’s health record. The RCM successfully called for this recommendation to be dropped and for careful consideration to the process by which women’s consent is obtained for any transfer of confidential medical information onto the child’s record.

The rationale for the NICE proposal was to aid  diagnosis of fetal alcohol spectrum disorder (FASD), which can be difficult to identify at an early stage. As there is no known safe level of alcohol consumption during pregnancy, the RCM already advocates for midwives to advise women that the safest approach is to avoid alcohol during pregnancy. It is also important for midwives to counsel women to support them to make informed decisions, based on the best available evidence. There is no conclusive evidence of any causal relationship between low- to mid-level alcohol consumption and FASD.

The approach of recording low alcohol consumption is not supported by the evidence and mandatory screening at every antenatal appointment was a measure repeatedly rejected by the UK Screening Committee. We also believe that this approach could cause women to be stigmatised, or cause self-stigmatisation, and that recording low level alcohol consumption could disrupt or prevent the development of a relationship of trust between a woman and her midwife. Women that are in most need of help, could be deterred to confide in their midwife and disclose consumption and seek help. Midwives are best placed to make assessments concerning what information to document during antenatal appointments and, given the demands on their time, they should maintain the autonomy to tailor their advice and support according to women’s needs.

We are pleased that NICE has listened to our view, and we welcome the publication of this reviewed quality standard. Midwives need to have enough time to provide personalised, high quality care, including the provision of public health advice. The ongoing Responses to Alcohol and Pregnancy Policy [RAPP] study is exploring the impact of the proposed introduction of mandatory alcohol screening from the perspective of midwives based in the UK. Information about the study can be accessed through the RCM Research Hub.

It is important to remember that pregnancy offers a unique window of opportunity for public health advice, as it is often the first time healthy women engage with healthcare services. Enough resources need to be allocated to specialist services, including specialist midwife roles for substance misuse, and training and development for midwives. Midwives are key to enhancing the public health and well-being of society at large by supporting the very best start in life.