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an alcohol-abusing woman's encounter with the health care system. This case history begins with the birth of a child with fetal alcohol syndrome.
These case histories are presented to provide the reader with the real-life context in which significant fetal alcohol exposure often occurs. The reader will note that there are many similarities in the maternal histories presented. Some of these similarities include the following: alcohol abuse is usual in the family of birth of women who drink during pregnancy; early experimentation with alcohol is common; first pregnancy often occurs at a very young age; FAS and other levels of alcohol-related damage usually occur in later pregnancies and in the later years of childbearing; child neglect is frequent; unstable domestic relations are common, particularly when a spouse who abuses alcohol is involved; there is a general lack of stable employment and occupational commitment; and low education and unstable living conditions are frequent. Commonly, there is intervention by others with the children after birth to protect them from chaotic home environments.
The reader will also notice many differences among these cases. It cannot easily be said that there is only one pattern that leads to the birth of FAS children. Some of the differences illustrated in the cases are in the quantity, frequency, and timing of the drinking that occurs. That is, there are a number of heavy-drinking patterns, from bingeing to chronic consumption, that can produce FAS. Various levels of medical and health problems are experienced by the mothers, very frequently in some and surprisingly absent in others, given the high level of drinking. Frequent contacts with criminal justice and social service agencies occur, but some women, particularly isolated drinkers, tend to escape this problem. Finally, family relationships are highly variable, although frequently not very stable. Many of the consequences of drinking relate to the level of community support and to the social interaction, both within a community and between the community and the pregnant woman who drinks.
Therefore, despite the commonalities outlined above, there is no one pattern or life-style associated with alcohol abuse or with having a baby with FAS. While we must be aware of the common risk factors and patterns of maternal drinking that can lead to FAS and other possible alcohol-related effects, we must also be aware that any of a variety of patterns of alcohol abuseparticularly over an extended period of time in older women of childbearing agecan damage a fetus.
Sally was 35 years old. She had been pregnant three times and had borne two boys and a girl. Her second child was diagnosed with FAS while she was pregnant with the third child. This third child has since been diagnosed with FAS as well. Sally had a relatively unremarkable youth, but was 16 years old at the