Until now, a doctor wouldn’t usually ask a woman having a routine pap smear how many drinks she enjoyed that week. But new national guidelines recommend that alcohol consumption become a regular topic of conversation between female patients of child-bearing age and their physicians. “We’re not here to moralize or be pejorative,” says Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, and a co-author of the report. “This is a question of awareness and harm reduction.”
The guidelines, published in the August edition of the Journal of Obstetrics and Gynaecology of Canada, recommend that doctors ask women who are or could become pregnant about their drinking habits, and record that information in their charts. Previous guidelines focused on diagnosing cases of fetal alcohol spectrum disorder, which affects as many as three in every 1,000 births, and results in neurological and behavioural problems.
Given that half of pregnancies are unintended, and that most Canadian women imbibe, comfortable dialogue is critical, say experts. Unfortunately, many physicians admit that they don’t broach the subject for fear of shaming their patients. That’s why the guidelines offer doctors suggestions on how to ask about alcohol consumption in a “supportive” and “motivational” way.
The guidelines also aim to alleviate the anxiety women experience after learning they’re pregnant—and realize they’ve had a few drinks. “We’re fairly comfortable saying there’s no need to terminate, and chances are there hasn’t been an effect,” explains Senikas. In fact, the guidelines take into account that some studies show “low level” alcohol consumption doesn’t have a negative impact. The trouble is defining how much is too much. “The most prudent choice,” says Senikas, “is to abstain.”