I recall a presentation by Health Education Associates a few
years back (c. 1990?) where a study was presented that
indicated drug use and alcohol use affected 15% of our
maternal populations--across all class boundaries. (Cites
anyone?) This is something that I have pondered over the
years and which I think deserves more
discussion/awareness.

I work in a population primarily of college educated, upper
middle class (and above) where *everybody knows* there is
no need to carefully question women prenatally. I recall that
the above mentioned study found that superficial questioning
(e.g., "Do you drink alcohol?") is not effective -- many women
who consume significant amounts of alcohol may believe
they don't, since they may perceive beer or wine as
innocuous or may have the sense that a "few" drinks per day
are within "normal" limits. If it is true that 15% of my
population is using drugs or alcohol I can assure you that
that 15% is going unscreened. For this population, ordering a
tox screen would likely cause a ruckus!

One of my patients told me she had her first baby at a
hospital in Dublin where the maternity ward was sponsored
by the Guinness brewery. Moms were provided with free
beer.  Anyone practicing in Dublin? Is this still the case?
(Has beer beat out the free abm? :-D ) I once had a physician
question my advice to a patient that 4 oz of wine per day was
"ok" (I never told her that -- thank heavens I documented the
data I shared with her!)  The physician figured even 4 oz per
day was not ok for bf mom; others have no opinion/guidelines
at all.

I will follow with interest the postings from those of you who
work in hospital settings where there is more awareness.
Also, I would welcome discussion in this forum of the
significance of drug use across our populations.

Margery Wilson, IBCLC
probably an ostrich on this topic