European Journal of Midwifer, 2023

Opening Pandora’s box: A meta-ethnography about alcohol use in pregnancy from midwives’ and other healthcare providers’ perspectives


Alcohol consumption has increased in recent years, including among women of childbearing age. A woman’s alcohol intake during pregnancy is linked to complications and injuries in the newborn, and the risk of the child being harmed by the mother’s alcohol use increases in proportion to the amount of alcohol she consumes. This meta-ethnography aims to explore midwives’ and other healthcare providers’ experiences of screening pregnant women for alcohol use in pregnancy and counselling them on the subject.

A systematic literature search in CINAHL, Maternity & Infant Care, MEDLINE, and Scopus was conducted in August 2021 and updated in January 2023. The CASP checklist was used to assess the included articles and meta-ethnography was used to synthesize the data.

Fourteen qualitative studies were included. In the synthesis, we use the metaphor of Pandora’s box to deepen our understanding of the topic. We found that some healthcare providers tiptoe around the box, not wanting to face the consequences and responsibilities of asking women about their alcohol use. Others refuse or are reluctant to open the box because they lack knowledge about screening and counselling. Some eventually open the box, understanding the importance of establishing a trusting relationship to address alcohol use and seeing the need for knowledge and screening tools.

Healthcare education has the important task of ensuring that healthcare personnel have sufficient evidence-based knowledge about alcohol use in pregnancy. In the future, a health-promoting, tailored approach offering women in pre-pregnancy and early pregnancy sufficient evidence-based information should be implemented.


Bente Dahl, Aud Johannessen and Terese Bondas

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