Research Article| Volume 32, ISSUE 1, P3-5, February 2019

Benefits of caseload midwifery to prevent fetal alcohol spectrum disorder: A discussion paper



      Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy.


      This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach.


      Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care.


      Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        Guidelines for the identification and management of substance use and substance use disorders in pregnancy.
        • National Health and Medical Research Council (NHMRC)
        Australian guidelines to reduce risks from drinking alcohol.
        Australia Co, Canberra2009
        • O’leary C.M.
        • Bower C.
        Guidelines for pregnancy: what’s an acceptable risk, and how is the evidence (finally) shaping up?.
        Drug Alcohol Rev. 2012; 31: 170-183
        • Colvin L.
        • Payne J.
        • Parsons D.
        • Kurinczuk J.J.
        • Bower C.
        Alcohol consumption during pregnancy in nonindigenous west Australian women.
        Alcohol Clin Exp Res. 2007; 31: 276-284
        • Cameron C.M.
        • Davey T.M.
        • Kendall E.
        • Wilson A.
        • McClure R.J.
        Changes in alcohol consumption in pregnant Australian women between 2007 and 2011.
        Med J Aust. 2013; 199: 355-357
        • Davis K.M.
        • Gagnier K.R.
        • Moore T.E.
        • Todorow M.
        Cognitive aspects of fetal alcohol spectrum disorder.
        Wiley Interdiscip Rev Cogn Sci. 2013; 4: 81-92
        • Streissguth A.P.
        • Bookstein F.L.
        • Barr H.M.
        • Sampson P.D.
        • O’Malley K.
        • Young J.K.
        Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects.
        J Dev Behav Pediatr. 2004; 25: 228-238
        • May P.A.
        • Baete A.
        • Russo J.
        • et al.
        Prevalence and characteristics of fetal alcohol spectrum disorders.
        Pediatrics. 2014; 134: 855-866
        • Lange S.
        • Probst C.
        • Gmel G.
        • Rehm J.
        • Burd L.
        • Popova S.
        Global prevalence of fetal alcohol spectrum disorder: a systematic review and meta-analysis.
        JAMA Pediatr. 2017; 171: 948-956
        • Fitzpatrick J.P.
        • Latimer J.
        • Olson H.C.
        • et al.
        Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities.
        Res Dev Disabil. 2017; 65: 114-126
        • Popova S.
        • Lange S.
        • Burd L.
        • Rehm J.
        The burden and economic impact of fetal alcohol spectrum disorder in Canada.
        Canad CfAaMHPHA, Canada2015
        • Jones S.C.
        • Telenta J.
        What influences Australian women to not drink alcohol during pregnancy?.
        Aust J Prim Health. 2012; 18: 68-73
        • Crawford-Williams F.
        • Steen M.
        • Esterman A.
        • Fielder A.
        • Mikocka-Walus A.
        If you can have one glass of wine now and then, why are you denying that to a woman with no evidence: knowledge and practices of health professionals concerning alcohol consumption during pregnancy.
        Women Birth. 2015; 28: 329-335
        • Payne J.M.
        • Watkins R.E.
        • Jones H.M.
        • et al.
        Midwives’ knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder.
        BMC Pregnancy Childbirth. 2014; 14: 377
        • Payne J.
        • Elliott E.
        • D’Antoine H.
        • et al.
        Health professionals’ knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy.
        Aust N Z J Public Health. 2005; 29: 558-564
        • Meurk C.S.
        • Broom A.
        • Adams J.
        • Hall W.
        • Lucke J.
        Factors influencing women’s decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication.
        BMC Pregnancy Childbirth. 2014; 14: 246
        • Poole N.
        • Schmidt R.A.
        • Green C.
        • Hemsing N.
        Prevention of fetal alcohol spectrum disorder: current Canadian efforts and analysis of gaps.
        Subst Abuse Res Treat. 2016; 10: 1
        • Commonwealth of Australia
        Improving maternity services in Australia. The report of the maternity services review.
        Ageing DoHa, Canberra2009
        • Commonwealth of Australia
        National maternity services plan.
        Health Do, Canberra2011
        • McLachlan H.
        • Forster D.
        • Davey M.
        • et al.
        Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial.
        BJOG Int J Obstet Gynaecol. 2012; 119: 1483-1492
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        The Cochrane Library, 2016
        • Tracy S.K.
        • Hartz D.L.
        • Tracy M.B.
        • et al.
        Caseload midwifery care versus standard maternity care for women of any risk: [email protected], a randomised controlled trial.
        Lancet. 2013; 382: 1723-1732
        • Dawson K.
        • McLachlan H.
        • Newton M.
        • Forster D.
        Implementing caseload midwifery: exploring the views of maternity managers in Australia—a national cross-sectional survey.
        Women Birth. 2016; 29: 214-222
        • Australian Government Department of Health and Ageing
        Clinical practice guildeines: antenatal care—module 1.
        Commonwealth of Australia, Canberra, ACT2012
        • Anderson A.E.
        • Hure A.J.
        • Kay-Lambkin F.J.
        • Loxton D.J.
        Women’s perceptions of information about alcohol use during pregnancy: a qualitative study.
        BMC Public Health. 2014; 14: 1048
        • Wampold B.E.
        How important are the common factors in psychotherapy? An update.
        World Psychiatry. 2015; 14: 270-277
        • Williams K.
        • Lago L.
        • Lainchbury A.
        • Eagar K.
        Mothers’ views of caseload midwifery and the value of continuity of care at an Australian regional hospital.
        Midwifery. 2010; 26: 615-621
        • Allen J.
        • Kildea S.
        • Stapleton H.
        How optimal caseload midwifery can modify predictors for preterm birth in young women: integrated findings from a mixed methods study.
        Midwifery. 2016; 41: 30-38
        • Beake S.
        • Acosta L.
        • Cooke P.
        • McCourt C.
        Caseload midwifery in a multi-ethnic community: the women’s experiences.
        Midwifery. 2013; 29: 996-1002
        • Josif C.M.
        • Barclay L.
        • Kruske S.
        • Kildea S.
        ‘No more strangers’: investigating the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling aboriginal women in northern Australia.
        Midwifery. 2014; 30: 317-323
        • Gao Y.
        • Gold L.
        • Josif C.
        • et al.
        A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory Australia.
        Midwifery. 2014; 30: 447-455
        • Bakhireva L.N.
        • Wilsnack S.C.
        • Kristjanson A.
        • et al.
        Paternal drinking, intimate relationship quality, and alcohol consumption in pregnant Ukrainian women.
        J Stud Alcohol Drugs. 2011; 72: 536-544
        • Skagerstrom J.
        • Chang G.
        • Nilsen P.
        Predictors of drinking during pregnancy: a systematic review.
        J Women’s Health (2002). 2011; 20: 901-913