Page 19 - Zero for nine: Reducing alcohol use during pregnancy via health counselling and Internet-based computer-tailored feedback

General Introduction
Advice on alcohol use during pregnancy 1
In order to develop an intervention with information helping pregnant women to reduce their prenatal alcohol use, it is important to know about the current situation with regard to alcohol advice. Consequently important questions are what alcohol advice do pregnant women currently receive, from who do they receive this advice and how is this advice experienced, both by the provider and the receiver of this advice? Reviewing the literature on alcohol advice during pregnancy clarifies the gaps in knowledge on this issue, some of which are targeted in this dissertation.
Research has shown that the absence of alcohol abstinence advice from health professionals presents an environmental risk factor of prenatal alcohol use (Jones, et al., 2011; Kesmodel & Schioler Kesmodel, 2002; Raymond, et al., 2009). Both pregnant women and health professionals have reported flaws in health professionals’ alcohol advice. International studies revealed that many pregnant women are dissatisfied with their health professionals’ alcohol advice (Jones, et al., 2011; Kesmodel & Schioler Kesmodel, 2002; Raymond, et al., 2009), they often do not recall being actively engaged by the midwife in a discussion about alcohol consumption (Jones, et al., 2011) and when they receive alcohol advice, they describe this advice as being confusing, unclear or lacking sufficient detail (Jones, et al., 2011; Kesmodel & Schioler Kesmodel, 2002; Raymond, et al., 2009). Pregnant women’s negative experiences with health professionals’ alcohol advice are supported by research showing the difficulties of midwives with providing alcohol advice (Kesmodel & Kesmodel, 2011). Midwives find it difficult to screen for prenatal alcohol use (Holmqvist & Nilsen, 2010), they believe they lack detailed knowledge about the risks of alcohol use in pregnancy and lack skills to deliver advice without distressing women who have already used alcohol in pregnancy (Kesmodel & Kesmodel, 2011).
Although, international studies have shown that midwives experience difficulties with providing alcohol advice (Holmqvist & Nilsen, 2010; Jones, et al., 2011; Kesmodel & Kesmodel, 2011), there is no research
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