These are some examples of concerns that many health providers have when talking to women about their use of alcohol. Following each question is a list of some of the possible responses.

Concern: Will women become upset with me, if I start asking "personal questions" about their alcohol use?

Responses:

• Reassure the woman that the alcohol screening procedures are a part of the routine for all clients.
• Women who become irritable with alcohol screening questions often have personal or family problems associated with alcohol use.

Concern: Who should be advised to become totally abstinent?

Responses:

• Pregnant women.
• Women who are trying to become pregnant. Damage to the fetus can occur prior to pregnancy recognition.
• Women who are not using effective contraception. The chances of an unplanned pregnancy for someone who is drinking are quite high, so it is best to advise women to use effective contraception if continuing to drink.
• Women who are breastfeeding. Alcohol can be passed to the infant in breast milk. Some research shows that infants exposed to alcohol tainted breast milk actually prefer the taste when given a choice between it and regular breast milk.

Concern: What do I do if a woman states that she would like to cut down or stop drinking, but does not believe she can?

Responses:

• Talk to her about trying to stop drinking during her pregnancy for the health of her baby, provide brief intervention.
• Ask her if she would like to get help for her drinking.
• If she agrees to seek help, make an appointment for her at a local alcohol treatment program while she is still in your office.

Concern: What if the woman says she does not want to cut down or stop drinking when I am conducting a brief intervention with her?

Responses:

• It is your choice to reduce or abstain from alcohol but there is risk to your baby if you continue to drink.

Concern: What if a woman is worried that it is too late to stop drinking because the harm has already been done to her baby.

Responses:

• It is never too late to stop drinking and the sooner you stop drinking, the better the outcome for the baby.

Concern: What if a woman says that her best friend drank throughout pregnancy and her child is fine.

Responses:

• Women metabolize alcohol at different rates based upon their genetic makeup so that one woman may be able to drink more than another woman with fewer ill effects to the fetus, but at this point, we have no reliable way of testing for this so there are no guarantees that your baby will have no ill effects. The best advice that we have to date is not to drink during pregnancy.

Concern: What should I tell my friends when they offer me a drink?

Responses:

• I am pregnant and there is no safe level of drinking during pregnancy.

Concern: I don't really want to stop drinking.

Responses:

• I understand your reluctance to stop, how about trying to stop for the next week and we will meet again and discuss your progress. It may not be as hard as you think to make a change.

Concern: What should I do if I get the urge to drink?

Responses:

• Remember the coping steps we went over when we talked about risky situations.
• Try practicing those steps until we meet again.
• If you do have a drink, don't be discouraged. Start each day anew and tell yourself that you will not drink today. Take it day by day.
• If you have the urge to drink and you do not drink, reward yourself for a job well done.

Concern: Do you think I should have an abortion if my baby is already damaged?

Responses:

• While having an abortion is a personal choice, it is important to stop now to minimize any potential problems to your baby. If you are worried, you can have the baby followed by a pediatrician to make sure that everything is okay.

Fetal alcohol spectrum disorders are the leading cause of developmental problems but they can be prevented through the use of standardized screening tools and brief intervention for alcohol reduction or cessation. It was the goal of this training to encourage the use of these techniques by all health practitioners who provide services to women of childbearing age and to pregnant women in particular. 13