Barrieren in der Thematisierung des Tabak- und Alkoholkonsums Schwangerer in der gynäkologischen Praxis. Eine Fokusgruppenstudie mit Frauenärzten

Abstract

Alcohol drinking and tobacco smoking pose high health risks for the unborn child. Even though routine testing during the course of pregnancy facilitates early intervention, addressing substance use in pregnancy seems to be more difficult. The aim of the study was to identify barriers to addressing pregnant patients' cigarette and alcohol use. 2 focus groups (in total N=10 participants) were conducted with gynaecologists. The transcripts of the discussions were analysed using Mayring's approach of qualitative text analysis. Avoidance of addressing substance abuse directly, the social and educational background of patients influencing the communication in this matter and the physicians' ambivalence about their limits of responsibility were barriers often mentioned by the participants. In view of the several structural and individual barriers among gynaecologists identified in this study, gynaecologists obviously cannot be the only health professionals taking responsibility for coping with substance abuse among pregnant women. Strategies should be designed, e. g., to standardise the identification, counselling and referral process. Physicians should receive more support in improving their competences, and effective low-threshold treatment programmes for the women affected are required.

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

“…It is generally assumed that maternal nicotine and alcohol consumption during pregnancy is underreported [146]. There are many reasons for this [146,147]. The experience of emotional stress is also very common among pregnant women.…”

Tobacco dependence treatment for special populations: challenges and opportunities

“…61 Pregnant women are ambivalent about continuing to smoke, since they are already aware of the risks to their baby and feel guilty about it, but they continue smoking to cope with this physically and emotionally challenging time. 62,63 There are several barriers to the recruitment of pregnant women to smoking cessation programs:…”

„Pft … dann wechsle ich eben den Frauenarzt“

“…Neben strukturellen Problemen (z. B. Zeitmangel) scheint dabei auch Unsicherheit im Umgang mit der Thematik eine Rolle zu spielen [8]. Vorannahmen (ein hoher Bildungsgrad oder religiöse Motive seien mit einer Alkoholabstinenz verbunden), Sorgen bezüglich der Reaktion der Schwangeren und eine mögliche negative Auswirkung auf die bisherige Arzt-Patienten-Beziehung, aber auch Unsicherheit, welche therapeutischen Konsequenzen sich bei einer Alkoholanamnese ergeben würden, wurden als mögliche Barrieren für die Thematisierung von Alkoholkonsum in der Schwangerschaft beschrieben [8].…”

“…Im Rahmen einer Untersuchung äußerten ärztliche KollegInnen die Sorge, dass die Beziehung zur Schwangeren durch das Ansprechen eines möglichen Alkoholkonsums beschädigt werden könnte [8]. Besteht eine tragfähige, vertrauensvolle Beziehung und ist die Art der Ansprache sensibel und unterstützend, so ist diese Sorge in der Regel unbegründet.…”