Combined Modules 1-7

Learning objectives

1. Discuss the changing patterns of alcohol use of American women.

2. Review unintended pregnancy rates in the U.S. 

3. Discuss the potential impact of alcohol use on reproductive health and unintended pregnancies.

Supplemental readings

• Bray BC, Dziak JJ, Lanza ST. Age trends in alcohol use behavior patterns among U.S. adults ages 18–65. Drug and Alcohol Dependence. 2019;205:107689 .

• Denny CH, Acero CS, Naimi TS, Kim SY.  Consumption of alcohol beverages and binge drinking among pregnant women aged 18–44 years - United States, 2015–2017. Morbidity and Mortality Weekly Report. 2019;68(16):365–368. 

• Kanny D, Naimi TS, Liu Y, Lu H, Brewer RD. Annual total binge drinks consumed by U.S. adults, 2015. American Journal of Preventive Medicine. 2018;54(4):486-496. 

• White A, Castle IJ, Chen CM, Shirley M, Roach D, Hingson R. Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012. Alcoholism: Clinical and Experimental Research. 2015;39(9):1712-1726 .

Discussion questions

• Discuss how changing patterns of alcohol use in the U.S., and particularly among women, can potentially influence pregnancy outcomes.

  • What trends have contributed to this change?

  • How can preventive health messages be delivered effectively to this group?

Downloads

Presentation

Presenter: Marilyn Pierce-Bulger, MN, FNP, CNM                                     Length: 20 minutes

This webinar describes a known clinical set of outcomes associated with prenatal alcohol exposure. Recognition challenges are discussed.

Access at www.npwh.org/courses/home/details/825. Registration may be necessary.

Learning objectives

1. Review the current prevalence of FASDs.

2. Describe the continuum and potential impact of the effects of prenatal alcohol exposure (PAE) on a child’s functional and behavioral presentation.

3. Identify challenges related to the early recognition of FASDs.

Suggested supplemental reading

• Bertrand J. Fetal alcohol spectrum disorders are clearly brain-based. Developmental Medicine & Child Neurology. 2016;58(8):794-795.

Suggested handouts

• Impacts from prenatal substance exposure

• Research summaries – impacts of alcohol on child development

Suggested videos

• What is FASD?                                                                                     Length: 1:16 minutes
  Marilyn Pierce-Bulger, CNM, gives a brief overview of fetal alcohol spectrum disorders.

• FASDs: Beyond Physical Effects                                                   Length: 2:55 minutes
  Fetal alcohol syndrome is one of the most well-known indicators of damage caused by drinking alcohol during pregnancy, but most of the effects are not visible. Marilyn Pierce-Bulger, CNM, discusses some of the less obvious signs and effects of prenatal alcohol exposure.

• Drinking While Pregnant: What Happens to the Baby        Length: 3:56 minutes
  This video discusses the effects of alcohol on a baby in the early stages of pregnancy and throughout development.

Downloads

Presentation

Presenter: Marilyn Pierce-Bulger, MN, FNP, CNM                                     Length: 22 minutes

Effectively addressing alcohol use as part of preconception care can include several types of interventions. Three types of brief interventions to prevent alcohol-exposed pregnancies are discussed in this webinar.

Access at www.npwh.org/courses/home/details/830. Registration may be necessary.

Learning objectives

• Review how to determine risk for alcohol-exposed pregnancies.

• Discuss practical responses to alcohol screening.

Suggested supplemental reading

• Chiodo LM, Cosmian C, Pereira K, Kent N, Sokol RJ, Hannigan JH. Prenatal alcohol screening during pregnancy by midwives and nurses. Alcoholism: Clinical and Experimental Research. 2019;43(8):1747-1758.

• CHOICES Overview

• One Key Question

• Kelsey B, Edwards A, Pierce-Bulger M. Nurses and midwives: Partnering to prevent FASDs. Women’s Healthcare: A Clinical Journal for Nurse Practitioners. 2020;8(3):25-27 .

• Shogren MD, Harsell C, Heitkamp T. Screening women for at-risk alcohol use: An introduction to screening, brief intervention, and referral to treatment (SBIRT) in women's health. Journal of Midwifery & Women's Health. 2017;62(6):746-754.

Suggested handouts

• US AUDIT with instructions & scoring

• Screening tool comparison chart

Suggested activities or assignments

• The media can skew our understanding of federal guidelines (www.cdc.gov/ncbddd/fasd/alcohol-use.html) and other research for preventing FASDs. Discuss the following blog posts 1) bit.ly/2iCacSd; 2) bit.ly/1nMoVa9; 3) bit.ly/2ySw7c1. Generate ideas on how to respond appropriately to clients seen in clinic who refer to these opinions regarding alcohol use during pregnancy. 

• Peer-to-peer brief intervention role play – 15 minutes to set up and complete 

• Find a partner. Read both the scenarios and decide who will be the client and who will be the clinician for each one. 

  • Scenario # 1: At a routine well-woman visit you ask a sexually active, reproductive age client the one key question – Would you like to become pregnant in the next year? She answers no. She is not using contraception. She has 2-3 beers about one weekend a month and her audit score overall indicates low risk alcohol use. 

  • Scenario # 2: At a routine well-woman visit you ask a sexually active, reproductive age client the one key question – Would you like to become pregnant in the next year? She answers yes. She is not using contraception. She has 2-3 beers about one weekend a month and her audit score overall indicates low risk alcohol use.

  • Decide which of you will be the client first and which will be the clinician. 

    • Clinician: Using the components of a brief intervention from SBIRT role play how you would approach the conversation with the client about the risk for an alcohol-exposed pregnancy.

    • Take no more than 5 minutes and then switch roles and repeat the role play using the other client scenario again taking no more than 5 minutes. 

  • Take 3 minutes to process with each other how it felt to use the brief intervention approach both from the clinician and client perspective. 

Downloads

Presentation

Presenter: Kathleen Tavenner Mitchell, MHS, LCADC                                      Length: 24 minutes

It is easy to assume a woman who has a child living with an FASD fits a certain profile. This webinar discusses reasons why women may drink alcohol during pregnancy and how nurses can play a compassionate role in preventing FASD.

Access at www.npwh.org/courses/home/details/833. Registration may be necessary.

Learning objective

1. Discuss the role of the nurse in preventing FASD by supporting women with substance use disorders.

Suggested supplemental reading

• ACNM Ethics Committee. Code of ethics with explanatory statements. Silver Spring, MD: American College of Nurse-Midwives; 2015. 

• American College of Obstetricians and Gynecologists. Alcohol abuse and other substance use disorders: Ethical issues in obstetric and gynecologic practice. August 2015.

• Keyes KM, Hatzenbuehler ML, McLaughlin KA, et al. Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology. 2010;172(12):1364-1372.

• Seiler NK. Alcohol and pregnancy: CDC's health advice and legal rights of pregnant women. Public Health Reports. 2016;131(4):623-627.

Suggested activities or assignments

• Stigma can be perpetuated due to cultural factors and inadequate information. Using CDC’s feature on FASD at www.cdc.gov/ncbddd/fasd/FASD-Awareness.html, discuss how our own assumptions potentially impact our methods to address difficult topics, like alcohol use and pregnancy, in clinical care. How has universal screening reduced perceived stigma and bias for other health issues (e.g., malnutrition, domestic violence, depression)?

• Small group changing stigmatizing language activity 

  • Gather in small groups of 3 to 4 students. Choose one of the following statements. 

    • Statement # 1: FASDs are caused when a mother drinks alcohol during pregnancy. 

    • Statement # 2: FASDs are completely preventable if a developing baby is not exposed to alcohol before birth.

    • Statement # 3: Many women are drinking alcohol and not using adequate contraception. This may put them at risk for an alcohol-exposed pregnancy. 

  • Discuss ways in which the statement might be stigmatizing. Alter the statement in a way that you believe makes it less stigmatizing. 

  • As a group present to the entire class the original statement, in what ways you thought it might be stigmatizing and how you changed the statement.