McDermott S, Wareing M, Lavender T, Thomas S
Background for Study
Almost £730 million is spent on coffee each year
An estimated 1.6 billion cups of coffee are
consumed everyday
On average, women consume approximately 1.5
cups of coffee a day
75% of women state that they consume coffee
during their pregnancy
Physiological Effects
Benefits of coffee consumption
Weight Loss
Parkinson’s disease
Hepatic injury, cirrhosis
and hepatocellular
Risks of coffee consumption
Cardiovascular disease
Increased homocysteine
Pancreatic, bladder and
ovarian cancer
Osteoporosis and hip
Mineral deficiencies
Coffee Consumption and Pregnancy
Coffee consumption and the risk of:
 Miscarriage
 Developmental
 Disease in later life
 Delays in conception and general poor pregnancy
Current Coffee Information
Below 200mg a day/ 2 mugs of instant coffee a dayFood Standards Agency, UK
200mg per day throughout pregnancy- Food Safety
Authority of Ireland
Up to 300mg caffeine a day- Antenatal NICE
guidelines, UK
Do not drink more than 4 cups or glasses of caffeinecontaining drinks- Irish Nutrition and Dietetic
Institute, Health Promotion Unit
What are women’s and midwives’
views and opinions on coffee
Pragmatic Paradigm
 Alternative
 Through
to the more dominant paradigms
combining research approaches we are
offered the best opportunity for answering important
research questions
Begin the
Midwives21 in total
Women- 20
in total
and Initial
Framework analysis
Immersing oneself in data (familiarization)
Identifying and developing a thematic framework
Charting and Mapping
Variation in advice on coffee/caffeine consumption
 General
advice is ≤ 2 cups of coffee a day
‘I would probably check what her normal caffeine intake was and then go
from there because if she regularly drinks coffee from... [cafes]... that’s quite
a lot stronger than normal coffee that’s something where she should be
decreasing it quite a lot’ Midwife Rita
‘And I think it’s 6-8 cups of tea and 4-6 cups of coffee was recommended,
yea, but don't know whether that’s changed’ Midwife Jenny
Variation in advice on coffee/caffeine consumption
 Midwives
try to prioritise the advice they give; coffee
consumption is quite low down on the list
‘I don't think it was something I would volunteer to bring up in other
appointments because you only have 15 minutes and as the pregnancy is going
on there are more concerns to talk about such as the upcoming labour or fetal
movements or anything else. So it tends to not be at the forefront’ Midwife Amy
‘I think it’s balancing isn’t it because there’s things like smoking and drug taking
and probably on the hierarchy of things it’s not as high up as other things’
Midwife Fiona
Variation in advice on coffee/caffeine consumption
 Midwives
discussed personal experiences of pregnant
women and coffee
‘I guess, one woman once… was asking about the drinks, probably one of the
only times a woman asked me about her diet was that she said ‘I’ve been
drinking these caffeinated fizzy drinks’ and I said ‘well how many do you
drink?’ and she said ‘oh, a few a day’ and I said ‘well I really don't think you
should have too much of those, you know too much caffeine is bad in
pregnancy’. It happened to be that appointment that it took us a very long time
to find her fetal heart and I was really concerned thinking that maybe,
obviously having heard this research that too much caffeine is bad in
pregnancy and then… taking a long time to find her baby’s heart beat, I was
concerned that some damage had been done. In the end I did find it which was
a huge reassurance’ Midwife Sarah
Variation in advice on coffee/caffeine consumption
 Women
feel that they are overloaded with information
‘I teach antenatal care and women are bombarded with information at
booking and a whole array of leaflets and I’m not quite sure how much is
read or more worryingly how much of it is understood. So I think that
anything that is given should then be backed up, at some stage, with a
conversation’ Midwife Emma
‘But I haven’t read it all…… Because I haven’t got the time’ Catherine
Knowledge about coffee
 Miscarriage
‘raised blood pressure, linked with IUGR and miscarriages. And then
preconception… infertility or less likely to get pregnant’ Midwife Rita
‘it never crossed my mind to tell them, plus, to be fair, when we booked them,
they were about 12 or 13 weeks pregnant. The risk of miscarriage is decreased
towards the end of the first trimester and they were approaching the second.
You’ve thought someone else would have talked to them about it or would have
had information from elsewhere because it’s kind of a bit late, is it by then’
Midwife Anna
Knowledge about coffee
 Need
to decrease amount
‘having problems conceiving I wanted to… increase my chances of getting
pregnant and I just found it really difficult knowing how much caffeine I had in
any one drink. You know, you don’t have it written on the side of the cups in
most cases so I wasn’t sure what was a safe amount to drink’ Samantha
Knowledge about coffee
 Side
effects and general physiological/psychological
‘my knowledge of, I suppose of caffeine is probably limited, you know to the fact
that it’s a stimulant, in varying amounts’ Midwife Emma
‘I’d imagine it’s not good for your heart, the heart rate of the child, I don’t know
really but I think you know the less chemicals you put in your body the better
really. I don’t think it’s necessarily going to harm your baby massively but it
depends on how much you drink, if you’re drinking 10 cups a day perhaps that, to
me, sounds too much’ Sandra
Sources of midwifery information
 Continuing
professional development
‘As soon as something changes and it becomes a big thing in the NICE
guidance we change the way we do things, there has to be really gold standard
research for changing practice otherwise it’s really just traditional care and
advice that we’ve learnt over the years from being a student and we’ve heard it
said over and over again and we repeat the same things over and over again
and it might not be right but if the question hasn’t been asked and hasn’t been
researched and we get guidance from bigger authorities who we take notice of
then we don’t give it, we just carry on with the standard advice’ Midwife Mary
Sources of midwifery information
 Media
‘I ask the students ‘you are giving these out, by doing that, as a midwife, you are
actually endorsing the information that’s inside. Do you know what you’re
giving them?’ because in the bounty packs there’s a lot of advertising. So I
actually get the students to actually look at the information that they’re actually
giving and the other sources from the web and so on and so forth, to get them
thinking of whether it’s evidence based……what I’m asking them to look at and
consider’ Midwife Emma
Sources of midwifery information
 Renew/Review
their information regularly
‘you’ve got your midwives from various ages and generations have been
trained as well saying different things- I think if you had somebody 10 years
older than me and 10 years younger than me, probably we’d be saying 3
different things’ Midwife Patricia
Sources of midwifery information
 Want
more information as they feel information is
‘I should probably know more than I do but I don't. I don't really understand
the why it’s not a good idea- that’s what I don't really understand’
Midwife Claire
Sources of women's information
 Internet
‘We did… a lucky dip [in a pregnancy class] and one week one of the things
was internet sites and we just used to advise the women that anybody can put
anything on the internet…. use a trusted site, but that’s hard [for the women]
to know if it is a trusted site’ Midwife Emily
‘I do like sign-posting women to Tommy’s, because it used to be a Tommy
centre…. and then just any of the pregnancy websites really’ Midwife Anna
Sources of women's information
 ‘Apps’
‘The youth of today, well they love their text messaging, their BBM, their facebook,
twitter…somebody clever could do something for that age group’ Midwife Patricia
‘that first bit of information I actually got from an application, you know an app.
It was pregnancy e, I don’t know if you’ve heard of them but it was an application
that I downloaded….I sort of felt that everything I just read was probably
sufficient, and in the application anyway, the pregnancy e one, everyday it sends
you different things, suggestions and things, and so it reminds you, at least weekly
about diet and caffeine and alcohol’ Lucy
Sources of women's information
 Media
‘And the caffeine, I don’t think it’s advertised enough, if you advertised it a
little bit more they might take it on board’ Midwife Rita
‘campaigns on the television, campaigns in the paper, campaigns on the
radio…. works while they’re campaigning and then 4 to 6 months down the line
they’ve forgotten that campaign’ Midwife Patricia
Sources of women's information
 Forums
‘I think they could be good for communication. I’m not quite sure where they
get all their evidence from, therefore it would make me question it, but I have
looked at MumsNet ‘cause I’m interested in what women know, where they get
their sources of information from and I think it's a good forum’
Midwife Emma
‘Baby centre, that website as well, I used that quite a lot during my pregnancy
for different things. That actually was recommended by my GP…. he said that
it was a really good website’ Midwife Ashley
Sources of women's information
 Women
lack awareness of coffee/caffeine and are
‘You sit in...[the antenatal clinic]... waiting area in antenatal and everybody has
got a massive cup of Costa coffee with them, all heavily pregnant, so obviously
they’re not aware’ Samantha
‘I was surprised that you see your midwife less, you know I think every
pregnancy is different really and you can still be worried about how the baby is
developing regardless of whether it’s your first or second’ Sandra
Desire for more information
 Specific
‘if it was on a leaflet it would have to be visual. And then you’ve got to think of
languages, especially in Manchester, we’ve got a very diverse, multicultural
population’ Midwife Emma
‘Probably it would be to give women a better information leaflet…. what tells
them why they need to avoid…because a lot of the time they don’t understand’
Midwife Rita
Desire for more information
 Media
‘there’s always something new coming out on the TV and in the media isn’t
there. So that will get people talking… and they’ll ask questions at their
booking appointment if they’ve heard something anyway’ Midwife Kirsty
The need and desire for more information
Timing and Presentation of Information
Benefits to the study:
 Influence
care provision or encourage a more holistic
approach to maternal and fetal health
 Encourage the provision of information for expectant
 Improve women’s education on their pregnancy
Future Work
Further analysis
What’s next?
Thank you!
A special thank you to:
Dr Mark Wareing
Professor Dame Tina Lavender
Suzanne Thomas
All the recruitment staff, health care professionals and
midwives of St. Mary’s Hospital
All the women in St. Mary’s who have participated in
this study
Any Questions?

Midwifery Showcase