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PROMOTING HEALTHY LIFESTYLES

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Anna Seaman

on 9 July 2018

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Transcript of PROMOTING HEALTHY LIFESTYLES

What do we know?
PROMOTING HEALTHY LIFESTYLES: ALCOHOL
'Not drinking alcohol is the safest approach'
(drinkaware 2016)

WHAT'S IN A UNIT?


1.3.9.1 Pregnant women and women planning a pregnancy should be advised to
avoid drinking alcohol in the first 3 months
of pregnancy if possible because it may be associated with an increased risk of miscarriage. [ NICE 2008]

1.3.9.2 If women choose to drink alcohol during pregnancy they should be advised to drink
no more than 1 to 2 UK units once or twice a week.
Although there is uncertainty regarding a safe level of alcohol consumption in pregnancy, at this low level there is no evidence of harm to the unborn baby. [ NICE 2008]


(drinkaware 2016)
REFERENCES
Alcohol Concern. (2016). Alcohol statistics. [online] Available at: https://www.alcoholconcern.org.uk/alcohol-statistics [Accessed 11 Mar. 2018].

British Medical Association (2007, revised 2016). Alcohol and pregnancy: Preventing and managing fetal alcohol spectrum disorders [online] Available at: https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/alcohol/alcohol-and-pregnancy [Accessed 11 Mar. 2018].

Bulman, M. (2017). Spending on drug and alcohol treatment slashed by £105m in four years. [online] The Independent. Available at: http://www.independent.co.uk/news/uk/home-news/spending-on-drug-and-alcohol-treatment-slashed-by-105m-in-four-years-a7912531.html [Accessed 12 Mar. 2018].

Curtis, L. and Burns, A. (2017). Unit Costs of Health and Social Care 2017. [online] Personal Social Services Research Unit (PSSRU). Available at: https://www.pssru.ac.uk/pub/uc/uc2017/services.pdf [Accessed 11 Mar. 2018].

Drink Aware (2016) Alcohol and Pregnancy [online] Available from: https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/fertility-and-pregnancy/alcohol-and-pregnancy/?gclid=EAIaIQobChMIluOKic_D2QIVz7ftCh0YvAKbEAAYAiAAEgIuEvD_BwE [Accessed 26/02/18]

Drink Aware (2016) What is an alcohol unit? [online] Available from: https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/what-is-an-alcohol-unit/ [Accessed 26/02/18]

Dunkley J (2000) Health Promotion in Midwifery Practice. Alcohol use p.135. London: Bailliere Tindall.

FASD Network UK. (n.d.). What is FASD?. [online] Available at: http://www.fasdnetwork.org/what-is-fasd.html [Accessed 11 Mar. 2018].

FASD Prevention (2014) Girls, Women, Alcohol, and Pregnancy. FASD Awareness Campaigns: Creating Effective Messages [online] https://fasdprevention.wordpress.com/2014/07/14/fasd-awareness-campaigns-creating-effective-messages/ [Accessed 14/03/18]

Frank D, DeBenedetti AF, Volk RJ et al (2008) E ectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic Groups. Journal of General Internal Medicine 23(6): 781-787

Kersting A. and Wagner B. (2012). Complicated grief after perinatal loss.
Dialogues in Clinical Neuroscience
. 14(2), pp187-194

Mamluk L, Edwards HB, Savovic J, et al. (2017) Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open. Published online 11/09/17 [Accessed 12/03/18]

NHS choices (2017) How does alcohol affect my unborn baby? [online] Accessed from: https://www.nhs.uk/conditions/pregnancy-and-baby/alcohol-medicines-drugs-pregnant/#how-does-alcohol-affect-my-unborn-baby [Accessed on 10/02/18]

NHS England (2017) - Statistics on Alcohol, England, 2017 [online] Available at: http://digital.nhs.uk/catalogue/PUB23940 [Accessed 11/03/2018].

NHS England, (2017). NHS Maternity Statistics, England 2016-17. [online] Available at: https://digital.nhs.uk/catalogue/PUB30137 [Accessed 11 Mar. 2018].

NHSGGC.org.uk (2017) No alcohol, no alcohol harm warning to mums-to-be. Available from: http://www.nhsggc.org.uk/about-us/media-centre/news/2017/09/no-alcohol-no-alcohol-harm-warning-to-mums-to-be/ [Accessed 02/03/18]

NHS.uk/oneyou [online] Drinking. Available from: https://www.nhs.uk/oneyou/drinking#ET4uwIpR3DdfjaMC.97 [Accessed 02/03/18]

NICE (2008) Antenatal care for uncomplicated pregnancies. [online] Available from: https://www.nice.org.uk/guidance/cg62/chapter/1-Guidance#lifestyle-considerations [Accessed 26/02/18] Section: 1.3.9

NOFAS-UK (2011) Foetal alcohol spectrum disorder (FASD): Information for pregnant women [online] Available from: http://www.nofas-uk.org/documents/2011.331%20NOFAS%20Factsheet%20PregnantFinal.pdf [Accessed 12/03/18]

No thanks I'm pregnant campaign [online] Available from: http://www.alcoholandpregnancy.org.uk/index.html [Accessed 02/03/18]

Our Chance (2016) [online] Our chance for a safety pregnancy. Available from: http://ourchance.org.uk/video/can-i-drink-the-facts/ [Accessed 02/03/18]

Our Chance (2016) [online] Video 'Can I drink? The Facts'. Available from: http://ourchance.org.uk/video/can-i-drink-the-facts/ [Accessed 08/03/18]

Peadon E. et al. (2009). Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698825/ [Accessed 11 Mar. 2018].

Public Health England (2018). Alcohol: applying All Our Health - GOV.UK. [online] Available at: https://www.gov.uk/government/publications/alcohol-applying-all-our-health/alcohol-applying-all-our-health [Accessed 11 Mar. 2018].

RCOG (2015) Alcohol and pregnancy [online] Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf [Accessed 26/02/18]

Tommy’s (2017) What is foetal alcohol syndrome? [online] Accessed from: https://www.tommys.org/pregnancy-information/im-pregnant/drinking-alcohol-pregnancy [Accessed on 10/02/18]

Tommys (2017) Study finds British women most likely to drink alcohol in pregnancy [online] Available from: https://www.tommys.org/pregnancy-information/im-pregnant/pregnancy-news-and-blogs/study-finds-british-women-most-likely-drink-alcohol-pregnancy [Accessed 27/02/18

Vall O., Salat-Battle J. and Garcia-Algar O. (2015) Alcohol Consumption during pregnancy and adverse neurodevelopmental outcomes.
Journal of Epidemiology and Communiy Health
, 69(10), pp 927-929
A 2017 study found that British mums are among the most likely in the world to drink alcohol during pregnancy, harming their baby as a result.

Britain came
seventh out of 195
countries for the proportion of children with FAS.

That means four times more children in the UK suffer
alcohol-related birth defects than the global average
What's being done about it?
1 in 13 women who consume alcohol in pregnancy will
go on to have a child with fetal alcohol syndrome (FAS).
Tommys (2017)
short term benefits of reducing alcohol
consumption in pregnant women
Long term benefits of reducing alcohol
consumption in pregnant women
'Many women perceive alcohol to be a positive part
of their social lives and as such, it is unrealistic
to expect them to stop drinking without providing
appropriate education, advice and support.'
(Dunkley j, 2000)
(alcoholandpregnancy.org.uk)
ourchance.org.uk (2016)
nhsggc.org.uk (2017)
www.nhs.uk/oneyou
WHY DO WOMEN
DRINK ALCOHOL
WHEN PREGNANT?
1. women are unaware they are pregnant
2. women are unaware of the extent of damage alcohol can cause the fetus
3. women underestimate the harms alcohol consumption can cause because they know
other women who drank during pregnancy
and their children appear healthy
4. alcohol use is the norm in their social
group and abstaining may be difficult
5. women may be using alcohol as a coping mechanism (violence, depression, poverty, isolation)
6. addiction
http://ourchance.org.uk/video/can-i-drink-the-facts/
Dr Linda de caestecker, NHSGGC director of public health
'If you had one drink before you know you were pregnant
the risk will be small. But it's also just kidding yourself
on to believe that drinking wine with dinner most
nights doesn't really count. The message is that the only
way to guarantee your baby not being exposed to alcohol
harm to avoid alcohol completely.
'
‘Drinking alcohol during pregnancy can affect the way your baby develops and grows in the uterus (womb), your baby’s health at birth, and your child’s long-term health.’
(RCOG 2015)
1.3.9.3 Women should be informed that getting drunk or binge drinking during pregnancy (defined as more than 5 standard drinks or 7.5 UK units on a single occasion) may be harmful to the unborn baby. [NICE 2008]
Alcohol won't pass through the mother's placenta to the fetus...


• Prevents alcohol related damage to the fetus’ brain and spinal cord cells

• Reduces the risk of miscarriage

• Reduces the risk of premature labour

• Reduces the risk of stillbirth

• Reduces risks to the growing fetus in utero...

(RCOG 2015)
• Prevents the child from suffering from fetal alcohol spectrum disorder (FASD) which describes the range of alcohol effects (RCOG 2015)

• Prevents fetal alcohol syndrome (FAS) (RCOG 2015)

• Reduces the likeliness of the child having physical disability, emotional or psychiatric problems that may be life-long (RCOG 2015)

• ‘Makes the child less prone to illness in infancy and in childhood, and also as an adult’ (RCOG 2015)

• The fetus’ liver (which develops in the later stage of pregnancy) won’t be affected negatively (NHS choices 2017)




IMPLICATIONS ON HEALTH CARE SERVICES
A few figures about general alcohol consumption in the UK:
595,000 dependent drinkers
in the UK; 100,000 currently accessing treatment;
[NHS England, 2017]
[Alcohol Concern UK, 2016]
[Public Health England, 2018]
A MAJOR PUBLIC HEALTH CONCERN
Reduced miscarriage and still birth rates results in
fewer cases of long term psychological and emotional distress for parents and families

(Kersting and Wagner, 2012)

reducing Damage from alcohol to
mother and child can
benefit the whole family


long term benefits of no alcohol consumption in pregnancy for the whole family...
ARE NEW GUIDELINES &
CAMPAIGNS CHALLENGING NICE?
RCOG (2015) there is no ‘safe’ level of alcohol
to drink when you are pregnant
BJM (2017) time to change guidelines indicating apparently ‘safe’ levels of alcohol during pregnancy?
'At any stage of pregnancy, a woman can benefit
her baby by avoiding alcohol' (NOFAS-UK 2011)
‘Drinking heavily in pregnancy can: affect the way your baby grows in the uterus by causing the placenta not to work as well as it should – this is known as fetal growth restriction' (RCOG 2015)
Fetal alcohol
spectrum disorder
(FASD)

preventable birth defects caused by a woman drinking alcohol
at any time during pregnancy
spectrum of different presentations with each ranging between mild and severe:

Vision impairment - Sleep problems - heart defects - liver problems - poor immune system memory problems - speech and language delays - hyperactivity - inappropriate social behaviour - lifetime emotional and psychiatric problems
fetal alcohol syndrome (FAS)
Poor neurological development
abnormal growth
characteristic facial features
Improving the health and wellbeing of mother and baby leads to less strain on NHS resources in the future

What does fasd cost the uk per year?
[FASD UK Professionals]
FASD affects 7,000 babies born each year.
It is estimated that £2.9 millions per individual are necessary to raise a child with FASD across their lifespan.
(FASD PREVENTION 2014)
(2008)
Major life impacts on child and family
prevention is key!
(Vall, Salat-Batlle and Garcia-Algar, 2015)
(British Medical Association, 2016)
Implications of lowering alcohol consumption rates in pregnant women on public health care services
Reduced workload
on Midwives long term
Increased training of Midwifery workforce
Reduction of financial strain on current
health care services
- Cost to implement improvements, ex. training, literature
- Increased workload on Midwives
short term
To summarise :

Why are alcohol consumption rates in the UK during pregnancy so high....?

- Lack of research to provide clear concise information to women

- Conflicting advice from leading bodies

-Lack of informed knowledge around subject of alcohol in pregnancy for both women and Midwives

-Lack of Government based initiatives- currently focused on antisocial behaviour and alcohol based violence

-Reduction in funding in NHS to raise awareness/ provide support/ provide services- to mothers and babies affected by alcohol

To remember:

-Drinking alcohol whilst pregnant carries a potential risk to the fetus,
So. No Alcohol = No Risk


THANK YOU
for listening

Any questions?
https://www.bma.org.uk/-/.../fetal-alcohol-spectrum-disorders-report-feb2016.pdf
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263658/2901502_PHOF_Improving_Outcomes_PT1A_v1_1.pdf
Emotional Benefits to workforce.
https://www.gov.uk/.../Staff_wellbeing__service_delivery_and_health_outcomes.pdf
A NEED FOR CHANGE...
IN A COMPLEX CONTEXT
“The Government’s cuts to public health budgets are incredibly short-sighted and will hit some of the most vulnerable in our society. Prevention ought to be at the heart of the Government’s health strategy but instead they are reducing services that are there to keep people well and out of hospital”.
Julie Cooper, MP
Shadow Minister for Community Health
2017
1.1 million hospital admissions
related to alcohol consumption in 2016 - 339,000 of which directly caused by alcohol;

Alcohol harms estimated to cost the NHS £3.5 billions annually;
Alcohol-related crime
is estimated to cost
between £8-13 billions
per year in the UK;

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/210100/NMR_final.pdf
More working years are lost due to alcohol than the 10 most frequent cancer types combined. In 2015, an estimated
167,000 working years were lost due to alcohol.

1.
2.
3.
4.
AIMS & OBJECTIVES
TO EXPLORE WHY DRINKING ALCOHOL DURING
PREGNANCY HAS RELEVANCE TO MIDWIFERY
HEALTH IMPROVEMENT INITATIVES




CONSIDER THE SHORT & LONG TERM BENEFITS OF IMPROVING
HEALTH AND WELL-BEING OF WOMEN AND HER
SIGNIFICANT FAMILY MEMBERS
CONSIDER THE IMPLICATIONS OF IMROVING HEALTH
AND WELLBEING ON THE DELIVERY OF
HEALTH CARE SERVICES
MIDWIFES
ROLE
Full transcript