NHMRC alcohol and breastfeeding guideline (2009), clinician application and maternal uptake
Dr Roslyn Giglia, Telethon Kids Institute
Dr Tracy Reibel, Telethon Kids Institute
Despite wanting to breastfeed many Australian women also want to return to drinking alcohol after the birth of their baby. Breastfeeding is the optimal method of feeding an infant to get the best health effects in a child. In Australia drinking alcohol is the cultural norm and alcohol in breastmilk can disrupt the hormones needed to successfully breastfeed. This results in the baby receiving less breastmilk and being hungry and cranky and can often lead the mother to introduce infant formula to help settle her baby. This project will look at what doctors and nurses tell new mothers about drinking alcohol while they are breastfeeding so that they can provide supportive messages which allow a mother to drink and still safely breastfeed.
Background and aims of the project
In 2009 the National Health and Medical Research Council (NHMRC) released the revised 'Australian Guidelines to Reduce Health Risks from Drinking Alcohol'. A national first was the inclusion of an alcohol guideline exclusively for breastfeeding women (4B), and not merely as an add-on to the pregnancy guideline. The guideline recommended 'not drinking as the safest option' however practical advice for safe drinking was included in an effort to acknowledge that lactating women may cease breastfeeding in order to start drinking alcohol. Previous public health campaigns aimed at pregnant women have shown a marked effect on the reduction of alcohol consumption during pregnancy however there has been no associated campaign for the period of breastfeeding despite continued alcohol consumption during this time.
With limited promotion of this guideline it is not known whether practitioners use this guideline in their daily practice and if a resulting decrease in maternal drinking and extended duration of breastfeeding has occurred in Australian women.
This project will use both qualitative and quantitative methods to investigate the awareness and utilisation of the alcohol guideline for breastfeeding women amongst maternal health practitioners and maternal consumers. Obstetricians, general practitioners, midwives, child health nurses and paediatricians will be the primary target group of maternal health practitioners as they most often answer questions relating to breastfeeding in the early days following the birth of a child.
An educational campaign for the maternal health practitioners will be evaluated to see if any changes in their knowledge and behaviour (i.e. utilisation) of guideline 4B resulted from the education campaign. A secondary target group is breastfeeding women. Their knowledge and awareness of guideline 4B and use of educational resources relating to this guideline will be assessed following an education campaign tailored to their level of knowledge, awareness and behaviour regarding alcohol consumption during lactation.
What has happened in 2016?
Data collection was completed and results from 240 maternal health practitioners obtained regarding their use of the Guideline 4b ‘For women who are breastfeeding, not drinking is the safest option’. Child Health Nurses, Midwives and General Practitioners (GPs) were well represented, with a lower response from Paediatricians, and a very limited response from Obstetricians. The rate of response is also reflective of how much each practitioner group is adopting and utilising Guideline 4B. This has been evaluated using the Nursing Practitioner Questionnaire. Child Health Nurses, Midwives and GPs are using this new knowledge sometimes in their daily practice. Paediatricians and Obstetricians still remain to be ‘persuaded’ of its usefulness and inclusion in their practice. Further findings will be released in 2017 as data analysis comes to a close.
Giglia R. Alcohol and breastfeeding and the Australian Breastfeeding Association. Breastfeeding Review. 2016:24:7-11.
Where to from here?
The early results are showing that some maternal practitioner groups are more engaged than others when it comes to maternal health and alcohol consumption. Results will be used to further investigate how the gaps in knowledge of these identified groups can be addressed so that everyone owns the importance of promoting safe alcohol intake during breastfeeding and the prevention alcohol intake during pregnancy.
NHMRC Translating Research into Practice Fellowship
For general inquiries or for more information about the project, please contact Roslyn Giglia.