Alcoholism is an addiction that can affect both men and women. In the United States there is an estimation of “more than 10 million alcoholics” (Huether & McCance, 2017). About one-third of the alcoholics are women (Perry & Hockenberry, 2018). When a woman is an alcoholic not only does put her health at risk but potationally endangers the life of her baby if she were to get pregnant. Alcohol exposure to a potential fetus is not only a problem during the pregnancy, but also before pregnancy. Prenatal alcohol exposure has the potential to cause health problems to a fetus through “epigenetics alteration” (Huether & McCance, 2017).
Epigenetic alterations occur to the maternal DNA are then passed on to the future offspring of the alcohol drinker. Alcohol exposure before and during pregnancy further increases the risk for detrimental health problems for the infant. Since there is no known amount of alcohol, type of alcohol, or a timeframe within the pregnancy that consuming alcoholic beverages is a safe, all alcohol consumption is contraindicated when a woman is pregnant (Perry & Hockenberry, 2018).
This is why it is of great importance that women who consume alcohol should avoid getting pregnant, and if they do become pregnant, they should completely be abstinent from alcohol. This is exactly what the Healthy People 2020 objective MICH-11.1 is trying to achieve, because maternal alcohol consumption during pregnancy puts the fetus health at great risk for developing a disability or dying.
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These alcohol related disabilities that a child can acquire during their time in the womb will continue to affect the child for the rest of their life. This objective is aimed at improving maternal and newborn health through increasing the rate of maternal alcohol abstinence during their pregnancy. Abstaining from alcohol during pregnancy is important, because it will provide health benefits for both the mother and the developing fetus.
Since heavy alcohol consumption before and during pregnancy causes so much harm to a fetus the Centers for Disease Control and Prevention recommends that a woman who drinks alcohol is having sexual intercourse with men, she should use a form of contraception. The usage of effective contraception is important especially if a women drinks because it dramatically reduces her chances of conceiving. Early in a pregnancy it may be difficult for women to know they have conceived (CDC, 2018).
If a woman is unaware of her pregnancy, she may continue to consume alcohol, which will in turn exposure her fetus to the dangers of maternal alcohol consumption. But why is alcohol consumption during pregnancy so dangerous? Excessive maternal alcohol consumption during pregnancy affects the mother’s nutrition causing deficiencies in many important vitamins needed for a healthy pregnancy. On of these vitamins that is affected in alcoholic pregnant women is folic acid (Huether & McCance, 2017).
Adequate levels of folic acid are required during pregnancy because it reduces development of neural tube defects (Perry & Hockenberry, 2018). Deficiency in folic acid has also bee linked to the development of fetal alcohol syndrome (Huether & McCance,2017). Fetal alcohol syndrome is one of the many conditions that can affect a fetus of an alcoholic mother. These conditions can potentially affect the fetus behavior, intelligence, and physical. These conditions fall under the “umbrella term” of “Fetal Alcohol Spectrum Disorders which is also known as “FASD” (Ramaglia, 2013). Another danger of maternal alcohol consumption is that that mother can have a miscarriage or her fetus can be born as a stillborn baby (CDD, 2018).
According to the Healthy People 2020 website the baseline of pregnant women who are abstinent from alcohol during their pregnancy is 89.4%, but their target goal is 98.3% (Healthy People, 2020). California is one of the states that has been able to meet the national target (Healthy People, 2020). Other states can also be able to meet national target goal if they use appropriate interventions that increase alcohol abstinence such as “SBIRT,” during the prenatal care of a pregnant women (O’Brien, 2013).
SBIRT is made up of the following, Screening, Brief Intervention and Referral to Treatment (O’Brien, 2013). This intervention is useful because through screening healthcare provides can identify and assess pregnant women who have a risk of consuming alcohol during their pregnancy. Once a pregnant woman is identified as a potential alcohol consumer during pregnancy there is an appropriate “brief intervention” to help with their risk of alcohol consumption.
During the brief intervention the healthcare provider interviews the patient and give the patient feedback and their medical advice (SAMHSA-HRSA, 2018). If the pregnant woman is identified as a substance abuser of alcohol, she is referred to receive specialized treatment to help with alcohol cessation (O’Brien, 2013). Using a screening tool such as SBIRT model would be the best way to increase abstinence of alcohol during pregnancy.
During my obstetrics rotation I did not get to care for any patient’s who consumed alcohol during their pregnancy, but I do have a life experience related to a person (whose name I will omit due to privacy) who was affected by their mother’s alcohol consumption during pregnancy. This person was one of my ex-coworkers at a retail job, where I worked at as a head cashier a few years ago. This person was one of the cashiers I would supervise, and she was hired at my job through a program that helps people with disabilities obtain job opportunities.
I learned that this cashier’s disability was caused by her mother’s alcohol consumption during pregnancy. This cashier displayed multiple of the disabilities mentioned under the fetal alcohol spectrum disorder. Some of the disabilities this cashier has were difficulty with learning and remembering, she had behavioral problems, and also had physical problems. The cashier had difficultly learning and remembering things that were required for the job as a cashier. Some of the behavioral problems the cashier displayed were attention problems, hyperactivity, and would not socially interact well with customers and coworkers.
This cashier would sometimes threaten other coworkers by telling them “I am going to kill you.” Physical problems the cashier has is very poor eyesight, was very underweight (90 lbs.), short, and had speech problems. The cashier also has problems with her joints especially her back; which made it difficult to work at this retail store which requires cashiers to be able to lift a minimum of 50 lbs. Due to her disabilities the cashier was not able to get a California driver’s license, and so she relied on her mother to drive her to work, and from work back home.
At times the mother would call the store where the cashier worked telling her, “catch a ride from a coworker after work because I’m drunk.” The cashier also learned some of these behaviors from the mother, such as drinking excessive alcohol. With only 19 years of age the cashier would drink alcohol and come “hungover” to work some days. As a head cashier I would give advice to the cashier to get some help with her drinking, and I would explain that drinking alcohol at such a young age could really further affect her health. Having to work with this cashier inspired me to research further the topic of increasing alcohol abstinence during pregnancy.
Learning how to increase maternal alcohol abstinence is of great importance for an aspiring obstetrical nurse like myself. My goal is first become an obstetrical nurse and then go to further my education in women’s health, and become a certified nurse midwife; due to my fascination for caring for women and their babies. As an obstetrical nurse I have many roles that empower me to appropriately care for women and their baby’s health.
In my collaborator nursing role, I can team up with other members of the healthcare team in screening and assessing women who are at risk for drinking or abusing alcohol during their pregnancy through the usage of a screening tool such as SBRIT. If a mother is screened and assessed as a alcohol abuser I can collaborate with the healthcare team to find them resources to help treat their alcohol problem. Through the usage of SBIRT I can take appropriate interventions to promote a healthy pregnancy and baby. The women identified through SBIRT as a risk for alcohol consumption should be educated.
In my nursing role as an educator, I teach at risk mothers about the importance of being abstinent from alcohol throughout their pregnancy, and the dangers alcohol has on her and the baby’s health if it abstinened from. Dangers such as miscarriages, stillborn births, and fetal alcohol related disabilities. By educating pregnant women during preconception or prenatal care about alcohol abstinence I am also advocating for the fetus’ health and future; since the fetus is vulnerable and cannot advocate for themselves. In my nursing role of an educator I could also empower women by providing them with information about birth contraceptives.
Educating them about using appropriate birth contraceptives if they are not planning to become pregnant is recommended by the Centers for Disease Control and Prevention because women who drink have an increased risk of unplanned pregnancies and prevent their fetus form having the risk of developing many of the alcohol induced health issues that to pertain to fetal alcohol spectrum disorders.
Through the usage of SBIRT and patient education on contraceptives and alcohol cessation during preconception or prenatal care the Healthy People 2020 goal of alcohol abstinence during pregnancy can be achieved.
Achieving the national target goal of 98.3% in the United States in regards to alcohol abstinence during pregnancy would dramatically improve maternal and infant health.
