Health Promotion - Disease Prevention

Motivational Interviewing Discussing Alcohol Use With a Pregnant Woman Transcript

Speaker 1: In this scenario, a counselor talks with a young woman about her pregnancy and alcohol use using a motivational interviewing approach. The Counselor builds trust and shows empathy by accepting the woman's ambivalence about wanting both things: her group of friends who she drinks with and a healthy baby. By respectfully developing a discrepancy between these two desires and focusing on her desire to be a responsible mother to her baby, the counselor guides her to a decision about her drinking.

Speaker 2: Thank you for coming in to see me today, Nina. I'm looking forward to getting to know you a little bit, and hearing a little bit about you and what brought you in here today.

Nina: My doctor referred me. He said I had to come because I've been a little irresponsible with this pregnancy.

Speaker 2: Okay. He's thinking you were a little irresponsible?

Nina: Yeah. He said that I was drinking too much with it. I haven't been a lot, but he said it was still maybe would screw things up.

Speaker 2: And you're feeling kind of concerned about that?

Nina: Yeah. Yeah. Like, I don't want to screw anything up with this baby, but yeah, I'm just I'm scared I already did.

Speaker 2: Okay, so you're concerned about the consequences. You really care about your baby, and you want to give your baby the best start you can?

Nina: Yeah.

Speaker 2: And you're wondering a little bit about this time that we're going to spend together?

Nina: Yeah, he didn't really tell me what to expect. He just said, "Go see her."

Speaker 2: So here you are today, and you're sharing that you have been drinking alcohol throughout your pregnancy.

Nina: Yeah. I didn't find out I was pregnant till probably two-ish months in, and I had already been drinking then. I've been really trying not to, but you know, weekends come around, and all my friends are kind of partying and stuff, and it's been hard to break that habit.

Speaker 2: So there's this external pressure coming from the people you care about, to sort of stay in the scene?

Nina: A little bit. I think if I talked to them, it would be fine, but it's weird, right? Like, I'm the only one of my friends that's taking this step and having a kid, and they don't really know how to handle that.

Speaker 2: Kind of feels like you're between two worlds. In one world you're preparing to be a mother and bring a baby into this world, and this other world is the world that you've been in for a while, where you're kind of having a good time, and drinking, and your friends are-

Nina: Yeah. Like, I'm still… I'm only in my 20s, and for everyone else, it's like, "Okay, it's party time," and now I kind of have to break out of that.

Speaker 2: Okay. So, this party time world, are you feeling like this is something you want to move out of and move into that mom world, or does it feel like, "I want to hang out there still too"?

Nina: Yeah, there's part of me that still wants to live that out, because I'm not going to have another chance. Like, once this kid comes, it's going to be over. I know I'm going to have to change.

Speaker 2: So for you, you're feeling like once the baby comes, and actually in your arms, then things are going to change, but right now, while you're pregnant, you're thinking, "I can kind of hang out in both worlds a little bit," but part of you may be thinking maybe that's not the case. It's time to go to the mom world, maybe?

Nina: Yeah, probably. And I'm also feeling like it's too late. I already screwed it up.

Speaker 2: Okay, so you've got a lot of concerns about what's happened up until this point, as far as your drinking. What do you know about drinking alcohol throughout pregnancy?

Nina: Well, I know, like, they say not to, but I thought because my friends didn't really care, I thought, "Okay, like maybe it doesn't matter. Maybe it's just what they tell you, just like drinking in general is bad."

Speaker 2: So you were thinking because your friends weren't pressuring you to stop drinking that it must be okay?

Nina: Yeah.

Speaker 2: Then there's this other part of you that was thinking maybe it's not okay?

Nina: Yeah, like I should probably have trusted my gut.

Speaker 2: So, your gut is telling you what? Tell me about that.

Nina: It's telling me that what I'm doing is wrong, and it's probably hurting my kid, and that I'm going to really regret that once I actually get my kid.

Speaker 2: And you really want to do what's best for your babe, and kind of wondering how to move forward from here? Is that where you want to kind of focus in on, or what are your thoughts about giving up drinking altogether?

Nina: I think I could probably do it. It just comes hard when you're, like, in that moment. You're around your friends, and they're drinking, and you don't want to be the mom at that moment. You want to be yourself. You want to be who you were before.

Speaker 2: So you kind of have this identity, dual identity going on. "I want to be that person, yet that person-"

Nina: And so many people, when they have kids, they just vanish from their friends, and I don't want to be that person. I don't want to be that person that just has a kid and they're completely, completely different.

Speaker 2: So embraces this life of the picket fence, and the little house, and having the baby in the stroller-

Nina: Yeah, and suburbs, and yeah.

Speaker 2: So you don't want to be that woman that's just sort of living in this house with a baby carriage, and at the same time, that world's kind of saying it's behind you.

Nina: Yeah. I guess. Like, I don't want to lose my friends because of this, and I don't want to put pressure on them to change, because they're… I mean, they're good people. They're just-

Speaker 2: You care about them.

Nina: Yeah.

Speaker 2: It's just the scene that they're still in, because their life maybe hasn't taken that change that your life has made. So now, you're here, and you're not sure. You want the baby, but you're not sure about the suburbs and the picket fence thing.

Nina: Yeah, I don't want that.

Speaker 2: You don't want that?

Nina: No.

Speaker 2: But you want this baby.

Nina: Yeah.

Speaker 2: And you want to take care of your baby as the baby's growing.

Nina: Like, I want to be responsible for this thing.

Speaker 2: You don't want to let your baby down.

Nina: No.

Speaker 2: And at the same time, it's hard to let go of the past, but on the other hand, you're thinking, "I don't have a choice. I've got to look this way." Is that kind of what it feels like?

Nina: I guess so. I feel like I've already made a choice, and already made some bad choices with this.

Speaker 2: Nina, I'm wondering, what's your hope for the future? When you think about where you are today, what do you hope for when you look ahead?

Nina: Well, I kept the kid because I wanted… It was almost like that push, that sign for me to like move forward and become an adult, because it's scary, right? Like, I still feel like a teenager sometimes, and having that push to be a real person is really… It's a lot of pressure, and I want to raise this kid well. I don't want to let my kid down. I don't want to regret choosing to have this kid, because I think it's the right time, but I don't want to make mistakes that make me realize maybe I'm not ready for this, because sometimes it feels like I'm not ready for this.

Speaker 2: You put your heart there, that the baby is really… It's almost kind of like a sign for you that is saying, "This baby is giving you kind of a new chance at life," or giving you plan B. And you guys both get to decide what plan B's going to look like.

Nina: Yeah. I just guess it's easier said than done, though. It's like great, I can make all these changes, and I can be a completely new person, but it's like at the end of the day, I'm still just who I am.

Speaker 2: Well, this baby's growing in you, and you think of all the opportunities that could come out of this, there's a part of you that says, "I'm still that same girl," that was drinking, and partying, and maybe not living the life you wanted to live?

Nina: Yeah, and I'm just… You know, you can't just one day flick a switch and become a new person.

Speaker 2: Well, this baby feels like this is your second chance. You're wondering, "Do I deserve that second chance," and then this other part of you that says, "Why not? It's here, and I want to go for it."

Nina: Yeah. I guess that voice is just a little more stifled by the other one.

Speaker 2: You've had a lot of people around you that are kind of pulling you down, and it's kind of taking you back to the old life, and baby's a constant reminder that there's this new life ahead.

Nina: Yeah. It's going to be very different when it actually comes.

Speaker 2: When you think about embracing this new life, and taking that different path, turning away from path A and moving into path B, how confident are you that you can take path B and be successful in raising this baby, and letting go of the drinking and the life that you were in path A?

Nina: I think I'm going to have to be successful. I don't have any other choice. I have to take that path.

Speaker 2: Tell me more about that. What makes you say, "I have to take that path"? What makes you feel like you need that?

Nina: Because I need to for my kid. It's going to be all screwed up if I don't.

Speaker 2: This part of you that says, "I don't have an option to make this life better," is wondering, "Do I have the confidence to be able to make that life a reality." What do you think you need to increase your confidence that you can do this?

Nina: I don't know. Like, maybe actually talking to my friends and saying like… Or maybe them actually being able to see this kid, would go, "Of course. Of course, your choice makes sense." Maybe it would give them a wake-up call, too. They actually like see it.

Speaker 2: So you're thinking that once your friends see you with the baby in your arms, that they too will see that there's a different path for them too?

Nina: Or at least they'll… I'll feel less pressure to be who they want me to be.

Speaker 2: Kind of feel like you're pulled between two worlds there.

Nina: A little bit.

Speaker 2: It's not easy to be in that world and also having that constant reminder that this baby's coming, and this baby is saying, "I want this better life," and you want to give the baby the better life too. Who can support you, do you think? When you look around who's in your circle right now, who do you think can support you in moving towards path B?

Nina: Definitely my parents. And I probably need to go and meet some other people who are maybe having kids too, so that I can see, like, how it's done. Because I only have a younger brother, and he's not even close to that, so I don't really have anyone in my life that I know that's had kids recently. So I would like to meet other young moms out there, who are kind of struggling with the same stuff I am.

Speaker 2: And your parents are a support for you and support you from giving up the drinking, the alcohol use? That's something that they would support you with?

Nina: I don't think they realize that I'm doing it, or how much I'm doing it.

Speaker 2: Okay.

Nina: And I know that if they found out, they would be really pissed.

Speaker 2: That would be a concern for them as well as for you now?

Nina: Yep.

Speaker 2: Yeah. Is that something that maybe you and I could meet again about, and talk about having those conversations with the family, maybe having conversations about the folks, your friends that are currently in the lifestyle that you were involved with, and then sort of what it would look like to go down path B? Is that something that you would be open to meeting with me about again?

Nina: I think so, yeah. Like, telling my parents and admitting this to my parents is probably the scariest thing, and having to talk to those friends. Like, right now, I don't want to do that. It puts them in a weird place.

Speaker 2: Kind of feels like your climbing Mount Everest, and-

Nina: Yeah, and it feels like-

Speaker 2: … you don't have equipment.

Nina: It feels like I have to… I don't want to have to lecture them, and I don't want it to be like a lecture.

Speaker 2: You're concerned that they're going to kind of treat you like a child?

Nina: My parents, or my friends?

Speaker 2: Oh, you're talking about-

Nina: Yeah, lecture my-

Speaker 2: … your friends.

Nina: … friends, yeah.

Speaker 2: You're wondering if they're going to kind of be like children, and you're going to be like the parent, saying-

Nina: Yeah, and I don't want to be like that.

Speaker 2: You just want to be like peers talking, and you want them to support you.

Nina: I want to stay friends with them. I don't want them to just-

Speaker 2: You don't want to lose your support group. Yeah, you just want them to support you in being healthy, a healthy mom, raising the babe, and sort of taking path B. You don't want to lose them, just maybe the lifestyle, it sounds like?

Nina: Yeah. Like, if there's a balance between maybe not the paths, but the worlds, if there's a balance between that.

Speaker 2: You kind of want to have the best of both worlds.

Nina: Yeah.

Speaker 2: "I want the friends and the relationship that I get from my friends, and at the same time, I don't want the party scene that goes with that"?

Nina: Yeah. Like, I know I just can't cut off my friends all together.

Speaker 2: Well Nina, you know yourself best, and you know what your world looks like, and what those… You know, the support that your friends give you, and the support that you get from your family, you know that, and I really just want to support you in being able to make those choices and have those conversations, and I want to do whatever I can to support you with that. And I'm just wondering if maybe we can kind of pick this up in a next visit. But before we go there, I'm just wondering, is there some steps that you would be willing to kind of take or consider with regards to your drinking?

Nina: Yeah. Like, I'm so close anyways that I know I need to now, and I just also… Like, have I completely screwed this up? Like, is it already too late?

Speaker 2: You're concerned about the health of your baby. I just would love to share with you, Nina, that every day without alcohol is a good day for your baby, and starting today, to have zero alcohol is a great start, and I'm wondering if that'd be sort of something you'd be open to is no more alcohol at this point.

Nina: I have to.

Speaker 2: Okay. Sounds like this is really important to you. You want to make this happen.

Nina: Yeah.

Speaker 2: Is there anything that I can support you with before we wrap up, as far as giving up alcohol today?

Nina: I don't think so. I think just knowing that it's not too late already is enough kick in the pants to get started.

Speaker 2: You kind of got a reality check today.

Nina: A little bit.

Speaker 2: You did really well talking with me today, and I thank you so much for just sharing your heart.

Speaker 1: Drinking alcohol during pregnancy can harm a developing baby. Supporting a woman to cut down or quit drinking will reduce the harm to the fetus.