Approximately one third of participants’ accounts reflected a keen desire to form their own opinions about what constituted a safe level of alcohol consumption during
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pregnancy; for these women, individual choice was of a high importance in their decisions around health behaviours. These women looked for a clear reasoning behind the health messages to abstain and instead received conflicting messages. This influenced them as they did not see their low level drinking as putting the health of their unborn child at risk. Instead they sought to take control over their own bodies by making their own decisions (see quote from Yvette on page 143 and further discussion in Chapter 6 and 7 of pleasure and the feminisation of wine) based on lay knowledge (for a broader discussion of the finding of the importance of lay knowledge see Section 4.4). Viewing the message to abstain as being too simplistic and being a policy which assumes that ‘one size fits all’ was a factor across three of the women’s accounts. This ‘one size fits all’ approach to health promotion appears to be based on stereotypes of gendered behaviour (Coles et al., 2010). Yvette argued that this one size fits all guidance is not realistic, attainable or achievable. In her view it is not useful as she explained:
But it just seems so much of the national health is just that one policy fits all and that is just not realistic for the way people are... I think information about alcohol during pregnancy and during breastfeeding is pretty rubbish, because again it’s like one policy fits all and now they just say to people don’t drink anything
Yvette, 35-44, Edinburgh Yvette clearly objected to being coerced into a particular behaviour, for her this was being told she had to abstain from alcohol during pregnancy. She evidently felt the message was one size fits all and therefore was not appropriate to her. Across their accounts it was apparent that some women, Yvette included, are asking for a less patronising approach to these health recommendations. The findings revealed how women want sufficient information on the subject to enable them to make up their own minds, within the context of their own lives. This is indicative of the argument of Davison et al. (1992) that simplistic or patronising information that glosses over complexities is likely to be rejected to be people. For these women the one size fits all policies failed to recognise the individual differences. It was clear that some participants resisted the one size fits nature of the new guidance; women wanted recognition that all women are different and have a different relationship with
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alcohol. The women therefore resisted the recommendation because it was not aimed at them, they aligned with the belief that health is the responsibility of the individual (Waterson, 2000b) revealing the importance of being able to make their own choices. It is therefore important that recommendations are in place to help individuals to make up their own minds and recognise the different definitions of risk; women are therefore seeking credible information on the risk and an attention to individual differences. The one size fits all and inconsistent messages which women felt were aimed at ‘other’ women were deemed not suitable. It was clear that independent choice was strongly linked to a sense of empowerment and responsibility. It is important to consider how exercising choice in defining one’s own health risks which Waterson (2000b) argues has been ignored.
I think now they're kind of not willing mothers to make these decisions for themselves, so they're kind of making them for them in a way erm (pause) but then I think it probably is quite a good thing
Paige, 28, Edinburgh Paige indicated an idea that this one size fits all was flawed as specific advice should be set for different women, depending on their drinking habits. As these participants interpret their drinking as positive, they do not feel targeted by the recommendations. The recommendations, thus do not speak to them. The problem may therefore lie within the nature of the communication by which the recommendation is given. Women potentially see it as ‘policing’ and controlling their lives (Ettorre, 1997) and there is a perception that women are thus being told what to do. It is therefore evident that there still exists what Waterson (2000b, p.172) describes as a ‘stumbling block’ in the way in which health promotion guidance is presented. The recommendation for abstinence is seen to be a policy which is one size fits all; however it therefore does not incorporate difference, some women therefore see the promotion of abstinence as unwelcome (Waterson, 2000b) as they interpret these messages to not be aimed at them, and their health behaviours are therefore challenging the medical power by resisting the guidance.
In this approach, the messages given to women to abstain from alcohol during pregnancy reveal the control that is apparent over women’s relationship to alcohol
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(Ettorre, 1997). Being told what to do, opposes the idea that women should be able to make their own choices. This lack of choice is in opposition to the ‘your baby, your way’ type of advice or the health model of choice. This conflict and how it mirrors the internal conflict that women face of doing things for themselves versus doing things in the interest of their baby is important, especially that increasing medicalisation of motherhood sees the women being reduced to the ‘maternal environment’ (Rothman, 2000, p.112) for the foetus. This highlights the on-going power struggles within the pregnant body (Jones and Chandler, 2007). Some of the women were clearly unsure about these messages, as they resisted being told what to do on an individual level, yet they recognised that for some other women it was important to be told what health choices to make.
Othering
In general, there is an awareness that women should avoid alcohol during pregnancy, or at least cut down. However it is apparent that some women do ‘other’ themselves to this advice feeling that it is aimed at ‘other’ women, who perhaps have poor relationships with alcohol. Some women reported drinking alcohol at very low levels and therefore did not report drinking alcohol during pregnancy at a level at which there is evidence of harm. Holloway et al. (2008) argues that ignorance towards recommended drinking levels could be indicative of a lack of concern about the health consequences of drinking. However the women, who consumed alcohol in this study, did so in awareness of the conflicting medical discourses around women’s alcohol consumption during pregnancy. They clearly felt that the recommendation for abstinence simply wasn’t aimed at them, or other ‘light’ drinkers. The women who chose to consume alcohol were not ignorant of the advice, they were still clear that it was important that they reduce their alcohol consumption during pregnancy, aware that heavy drinking is probably harmful. Sometimes their knowledge was incomplete, or unclear because of the conflicting and inconsistent discourses, but they were still aware that some guidance did exist.
A generalised feeling was asserted that the advice to abstain is only applicable to ‘drunks’, binge drinkers or heavy drinkers. Therefore, the women who only drink at low levels, felt that the advice is not aimed at them and they do not feel obliged to follow it. These women are not drinking large amounts; instead their consumption
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remains at levels which adhere to what the recommendation around alcohol consumption during pregnancy was previously. It is important that attention is given to the role of othering within self governance and lay health choices. In several cases women within the study insisted that because they interpreted their drinking as ‘normal’ it was consequently not harmful. Their opinion was that the recommendation was therefore not targeted at them but instead at ‘other’ women, as Skyla demonstrates:
The reason that was given to us was by the health people, advised against drinking in the first trimester really, and keeping it very limited after that. I think this time they are saying not to avoid it all together, but I got through one pregnancy with a little bit of wine, err my feeling is that is aimed at people who are excessive drinkers
Skyla, 42, Inverness This extract offers an appropriate example of how women interpreted the government recommendation for abstinence to be targeted at other women who drank excessively during their pregnancies, therefore consequently feeling they were exempt from following it. Skyla distinguishes herself as not an ‘excessive drinker’ and because of this does not feel the advice is aimed at her; again she reflects the importance of her own lay experience, although being advised to abstain, she reflects upon her behaviour from previous pregnancies where she drank and does therefore not see a reason to change her behaviour for her current pregnancy. Although aware that the advice is now to abstain from alcohol, she maintains that this is aimed only at ‘excessive drinkers’. Skyla reported generally restraining from alcohol consumption during pregnancy (except “a little bit of wine”) because of the perceived unknown risk that drinking a large amount may pose to the health of her unborn child. Her narrative was greatly informed by the notion of risk because of previous miscarriages and ectopic pregnancies. It was these traumatic experiences which resulted in her wanting to look after her body and fearing the potential risks that consuming alcohol might bring; despite this she was certain that a small amount of wine would not be harmful. By demonstrating self control over their alcohol consumption during pregnancy, women including Skyla protect their moral identities (Rolfe et al., 2009) and prevent a stigmatised identity. They therefore protect their
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moral status as a ‘good’ mother and prevent themselves from being perceived as bad or irresponsible mothers.
This othering may exist because the women interviewed didn’t feel there was a reason behind the change to the recommendation for abstinence (see Section 4.3.2) as these messages are aimed at ‘other’ types of women who drink heavily during pregnancy. This is also influenced through the type of alcohol drank, for example there was less perceived harm from drinking red wine, compared to say cider, vodka, whisky or other spirits consumed more by ‘real’ alcoholics in the public’s mind. There is also a class implication of this with wine perceived more middle class and therefore safe (see Section chapter 7 for a further discussion around the importance of the type of alcohol).
Women who believed that they were sensible with their alcohol consumption, perceived themselves and other women who drink at low levels to not be the target audience for the advice to abstain. Yvette recognises the difference in what drinking means for other women by maintaining it is the ‘other’ mother who is irresponsible because they “don’t think about” their alcohol consumption. As Yvette highlights:
I mean basically I drank practically nothing through my pregnancy, which certainly didn’t do any harm. So I suppose that’s the way I looked at it, when you’re having a big family celebration and a glass or half a glass of champagne you don’t want to feel guilty about something like that...I suppose the problem is that if some people don’t think about it and I suppose moderate drinking for some is totally drinking than moderate drinking for others
Yvette, 35-44, Edinburgh In this instance, Yvette, does not see herself as the target audience for the abstinence guideline. Instead she feels that the advice to abstain is aimed at women who are moderate or heavy drinkers. This is no surprise as it is often a certain group of women who are often vilified in the media for their alcohol consumption. For example; young women have also been targeted for binge drinking and the associated unprotected sex leading to unwanted pregnancy (Naimi et al., 2003, Foster and Marriott, 2006, Kanny et al., 2013, Mallard et al., 2013). Yvette
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recognises the difficulty in constructing policy which addresses these health messages, when drinking levels and the definition of ‘moderate drinking’ is highly individualised.
Yvette, therefore, uses the process of othering as defined by Plant et al. (2002, p.332) to ‘project the unacceptable face of women’s drinking onto other (frequently younger) women, leaving their own identities unspoiled’ by reassuring herself that the messages for abstinence are not meant for her. This has strong links to the literature on ‘good’ mothering (May, 2008, Duncan, 2005, Kirkman, 2008, Lawler, 2000, Letherby, 1999, Lupton and Fenwick, 2001, Miller, 2005, Oakley, 1979, Radcliffe, 2011a, Rothman, 2000) as women resist being criticised for their health decisions by comparing their choice to those of other women. Some women expressed that they were aware their choices were different to others and were individualised choices, different to their friends or family. Women that therefore continued to drink during pregnancy showed awareness that by deciding to drink during pregnancy they were resisting these normalised ideas of how a pregnant woman should behave (i.e. to not drink). There was therefore an element of tension evident as women noted that their choices may be different to expectations of them and the perceived implications that this may have for them as women, to be a ‘good’ mother. It is also evident that individualization, which emphasizes personal responsibility for life outcomes, is dominant in late modern societies. Many people appear to have accepted that they should make themselves aware of risks and therefore act in accordance with the experts’ risk (Lupton, 1999a). Rhea felt that the message for abstinence had been instated because of concerns over ‘other’ women, who are uneducated about alcohol and consequently who drink too much.
It was just that, erm, I think there were concerns about women knowing what one or two units was and women drinking too much
Rhea, 35, Edinburgh Emphasis is placed here by Rhea on women who were uneducated and did not understand units or what is safe to drink. There is a link here to class in that these women who drink must be uneducated and that is why the guidance had to be changed. Paige also demonstrated the theme of othering. Even as a midwife herself, she communicated her belief that the recommendation to abstain is not aimed at
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women similar to her but to other women whose idea of what drinking is not the same as hers. There is the assumption therefore that these messages of abstinence are only aimed at very heavy drinkers or alcoholics.
So my idea of drinking one glass of wine can be someone else’s idea of a bottle of wine or whatever, so I think it was very much that you can have a little bit in moderation but it wasn’t really recommended
Paige, 28, Edinburgh The midwife in this situation assumes that Paige’s understanding of what is meant by moderation is also similar to hers, and that she will in general only drink a very small amount of alcohol. Picking up again on the lexical choice use of ‘little bit’ and ‘moderation’, and ‘wasn’t really recommended’ reinforces the different perceptions around alcohol consumption that exist. Paige does not refer to the midwife expanding on what moderation during pregnancy means, or what “a little bit” is understood to represent. Instead these are presumed common understandings that women share, this utilises the work of Geertz (1983) and understandings of ‘common sense’ in that there is no such things as ‘common sense’ instead that it is a learnt idea. A “relatively organized body of considered thought, rather than just what anyone clothed and in his right mind knows” (Geertz, 1983, p.75). The midwife’s idea of common sense may therefore be different to that of Paige. Unless you have a firm discussion with women about how much they are drinking advice could therefore be misleading, and could potentially lead to women adopting their own decision and believing that they are ‘above’ the recommendations. Added to this there is also the continual problem of misunderstanding what a unit is (Kerr and Stockwell, 2012) (see Chapter 2 for a further discussion of the problem with a unit as a measurement). The unofficial advice is championed through the importance that women give to lay health beliefs and others’ experiences. Women therefore felt that they are given the advice, yet left alone to make their own decisions about what line of action is best for them to follow. It is however problematic that women receive these inconsistent messages as it draws on the themes of responsibility and othering. The midwife therefore gives Paige official and unofficial advice and assumes that Paige will drink responsibly.
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In talking of their alcohol consumption during pregnancy, it was apparent that some women had to justify their drinking as being safe, and responsible. This created what Rolfe et al. (2009, p.332) describe as a ‘balancing act’ as women compare themselves to other women. Controlled forms of drinking are acceptable, contrasted against other women’s drinking practices which are more disorderly. As a midwife, this quote also demonstrates the lack of trust that some health care professionals have in the messages that they themselves are expected to give out. Paige resists these overarching messages that are being given to women which she feels have no medical grounding, as she reveals an understanding that women’s ideas of drinking are varied, and that what is recommended is not always followed. Paige knew her drinking was limited; however she is aware that for some women, one glass of wine might be a much larger amount of alcohol. This has strong links to how alcohol measurements are understood which is important given the increased consumption of alcohol in private spaces such as the home as evidenced through increases of off- sales of alcohol (for a further discussion of drinking in the home during pregnancy see Section 5.3). Jennifer also had a strong sense that it was ‘other’ women who drank during pregnancy by positioning her own relationship with alcohol in opposition to these women seeing it as a personal, individual decision and that this behaviour was often linked to dependency:
I just, I just never ever felt the need to (drink alcohol), like I didn’t depend on it
Jennifer, 20, Edinburgh Jennifer hints that she found little pleasure in drinking, and it is evident that didn’t drink since she did not feel like she needed to; it was something that she could go