No, new study does NOT show tiny amounts of alcohol in pregnancy affect baby’s face

Close Up Of Pregnant Woman Drinking Red Wine

We have a terrible problem in contemporary scientific research. Or it would be more accurate to say we have two terrible problems.

First, a great deal of published research is junk, generally because of spurious statistical analysis.

Second, the media credulously publishes any press release, the more irresponsible the better.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It doesn’t matter what the paper showed because the results are NOT statistically significant.[/pullquote]

Consider this story in STATNews, usually a reliable outlet for medical news. Entitled Babies’ face scans detect exposure to low amounts of alcohol in utero, it is remarkably injudicious. Why? Because by the authors’ own admission, their results AREN’T statistically significant.

Here’s a simple explanation of statistical significance:

When a statistic is significant, it simply means that you are very sure that the statistic is reliable.

So when results aren’t statistically significant, it means that the results are NOT reliable. In other words, the paper does NOT show what it claims to show.

STATNews reported:

…[C]an a small amount of drinking by an expectant mother show itself on her child’s face?

To answer that question, researchers in Australia analyzed three-dimensional images of over 400 children’s faces and heads around their first birthday. An algorithm … looked for any substantial deviations from a standardized template made from all of the children’s scans. The children’s mothers also answered surveys about their alcohol intake several times before giving birth — data that researchers used to separate them out into groups based on when and how much they drank…

So far, so good.

3-D facial scanning picked up some differences … It also picked up on one otherwise difficult-to-measure change called mid-facial hypoplasia, in which the center of the face develops more slowly than the eyes, forehead, and lower jaw. Perhaps most notably, there seemed to be slight differences in the mid-face and at the tip of nose even in the children of women who had only had a little to drink and only in the first trimester of their pregnancy. (However, almost no overall changes were statistically significant.)

The fact that the overall results weren’t statistically significant is not a minor issue that merits only a comment in parentheses. It is the most important thing about the study. In truth, the authors’ data shows that tiny amounts of alcohol do NOT affect a baby’s face. The people at STATNews should never have repeated the claim and certainly not titled their article based based on the erroneous claim.

No matter how they sliced and diced the data (by level of drinking or by trimester), the results are not statistically significant.


It’s notoriously difficult to get negative results published. Perhaps this is why the authors kept slicing and dicing. They came up with this:


The authors looked at whether the results sliced on the basis of how a mother FELT after drinking. Did she feel the effects of alcohol as usual or more quickly than usual? When the mother reported feeling the effects of alcohol as usual, there was still no difference in facial structure based on alcohol exposure. But when the mothers reported feeling the effects of alcohol more quickly than usual, two out of nine variables were statistically significant.

In what way is the mothers’ perception of alcohol effects relevant? I can’t think of any plausible reason to analyze the data that way besides p-hacking, aka data dredging.

What is p-hacking?

Data dredging (also data fishing, data snooping, and p-hacking) is the use of data mining to uncover patterns in data that can be presented as statistically significant, without first devising a specific hypothesis as to the underlying causality.

The process of data dredging involves automatically testing huge numbers of hypotheses about a single data set by exhaustively searching — perhaps for combinations of variables that might show a correlation, and perhaps for groups of cases or observations that show differences in their mean or in their breakdown by some other variable.

P-hacking occurs in a desperate effort to find something, anything, that is statistically significant in the data. If you engage in p-hacking you will almost always find something that is statistically significant because tests of statistical significance produce some false positives by definition.

When large numbers of tests are performed, some produce false results … hence 5% of randomly chosen hypotheses turn out to be significant at the 5% level, 1% turn out to be significant at the 1% significance level, and so on, by chance alone.

P-hacking leads to testing hypotheses suggested by the data and that is invalid:

If one looks long enough and in enough different places, eventually data can be found to support any hypothesis. Yet, these positive data do not by themselves constitute evidence that the hypothesis is correct. The negative test data that were thrown out are just as important, because they give one an idea of how common the positive results are compared to chance. Running an experiment, seeing a pattern in the data, proposing a hypothesis from that pattern, then using the same experimental data as evidence for the new hypothesis is extremely suspect, because data from all other experiments, completed or potential, has essentially been “thrown out” by choosing to look only at the experiments that suggested the new hypothesis in the first place.

When interviewing the mothers, the authors presumably asked a variety of questions. Then they apparently exhaustively searched for combinations of variables that might show statistical significance. When they found a few variables that were statistically significant if they sliced the data based on mothers’ perception of alcohol effect, they created a new hypothesis — even small amounts of alcohol affect the facial structure of children so long as the mothers feel the effects of alcohol sooner than they expected —- and use the data that generated the new hypothesis to “prove” the new hypothesis.

In other words, instead of acknowledging these few results, though statistically significant, are meaningless, the authors blithely ignore what they are required to take into account and brazenly conclude:

The results of this study suggest that even low levels of alcohol consumption can influence craniofacial development of the fetus and confirm that the first trimester is a critical period.

The truth is that their results confirm the EXACT OPPOSITE; there is no evidence that alcohol ingestion had any impact on facial structure no matter how desperately the authors wish to claim it.

The folks at STATNews should have understood that and should have debunked the paper, not compounded the problem of junk science by repeating the spurious claims.

81 Responses to “No, new study does NOT show tiny amounts of alcohol in pregnancy affect baby’s face”

  1. carovee
    June 6, 2017 at 5:12 pm #

    I wonder if the original authors even tried to come up with a mechanism of action? I don’t know much about the biological processes of drinking and I know nothing about the rate at which alcohol in the blood stream is passed through the placenta vs metabolized and eliminated by the mom’s liver. If a woman feels the effects more quickly does that mean the alcohol isn’t metabolized as effectively? Is that even a thing?

    I had such a craving for red wine in my first trimester. I wish I’d given in. I’m so glad I didn’t give up chocolate or coffee.

  2. Gæst
    June 6, 2017 at 3:11 pm #

    Ha. Well, I drank a tiny amount of alcohol during my pregnancy (half a glass of champagne at a wedding in my second trimester, and a shot of vodka four days before they were born), and my kids are the cutest kids in the whole family, while I have an asymmetrical and lumpy face and my mother never drank at all.

  3. June 6, 2017 at 1:53 pm #

    Let’s think about this for a second:

    My son will most likely have a slightly upturned tip of his nose at 12 months because he was one right now.

    Which reason is more likely to be the cause:
    1)The less than one ounce of alcohol I drank at a wedding in the middle of the second trimester with Spawn
    2) My twin, my brother and assorted first-cousins on my mom’s side of the family have a slightly upturned tip of the nose.

    Yeah. That’s what I thought, too.

    When you use a composite of all the kids in the study, you fail to control for the fact that some parents are giving genes for deep-set eyes, a non existent chin or an upturned nose to their offspring.

  4. fishcake
    June 6, 2017 at 12:47 pm #

    OT: Woman gave birth to premature twins at a homebirth attended by 3 midwives in Oregon. One died about 4 hours after birth. No one called 911 at any point, but family called medical examiner’s office directly to report the death. ME who responded just happened to learn that there was a second baby, still alive. The parents do believe in faith-healing, so this explains (but doesn’t excuse) some of their behavior. But what about the midwives? Another article I read said 60 people were at the house celebrating the births. Neither these 60 people nor the 3 midwives thought to call 911.

    • Heidi
      June 6, 2017 at 12:57 pm #

      What the . . .!? I can’t believe a midwife would attend a premature birth! But not to call 911 immediately is even more mind-boggling. That is an obvious hit over the head HIGH RISK birth that needs medical attention. And twins?! I know there are a few that will do twin births but again, that to me is obvious as someone who needs to be risked out. That’s just so sad. Babies that far along usually can survive with no or minimal complications with actual medical care. I’m glad to see some people are being held responsible in similar cases and not given religious immunity.

      • fishcake
        June 6, 2017 at 1:19 pm #

        I just don’t get how all those people stood by. So sad.

        • Heidi
          June 6, 2017 at 1:54 pm #

          I read about the 15 year old boy they let die of a urinary tract blockage. I imagine his suffering was great. It’s so sad.

          • fishcake
            June 6, 2017 at 4:38 pm #

            Unimaginably sad. Unfortunately these aren’t isolated incidents. Sounds like the mother’s sister and brother-in-law also allowed their premature child to die and they got sentenced to jail. I wonder how often midwives are involved with this church.

          • demodocus
            June 11, 2017 at 8:03 am #

            probably have one or two member “midwives” like the Duggars’ daughters

    • Heidi_storage
      June 6, 2017 at 4:20 pm #

      Okay, see, this is bad parenting. Having a little wine while pregnant is something about which reasonable people can disagree, and should be at the discretion of the parents. Failing to get medical attention for premature twins with breathing problems, on the other hand, should not be allowed.

    • The Bofa on the Sofa
      June 6, 2017 at 5:43 pm #

      Fucking monsters. All of them. Fuck them and their fucking religion.

    • lawyer jane
      June 6, 2017 at 6:07 pm #

      I’m glad the responders were able to convince the parents to take the suriving twin to the hospital. Kudos to them – I imagine it took a great deal of sensitivity and skill to persuade them.

      • BeatriceC
        June 6, 2017 at 6:22 pm #

        I read a different article and got the idea that emergency CPS got involved and they forced the issue. I could be wrong on that.

      • fishcake
        June 6, 2017 at 6:23 pm #

        Also took a welfare check from the Oregon City police. But I’m glad she did make it to the hospital eventually.

    • Gæst
      June 7, 2017 at 11:23 am #

      From what I’ve read, the followers in that sect think medical assistance is wrong. So it’s not that they didn’t think to call 911, they have made a conscious decision not to. I think it’s horrible, withholding medical care from children, but there it is. So I assume any midwife they are willing to work with knows about this and accepts it.

  5. Dr Kitty
    June 6, 2017 at 11:48 am #

    It all just makes me think of the time I caught “I drank a single drink and my son has severe FAS” stories on daytime TV.

    It was obvious to me on first glance that the woman concerned had several of the stigmata of chronic liver disease, and had likely been concealing her alcohol dependency from her family before and during pregnancy.

    Which is very sad, but not a reason for hysteria about an occasional small glass of wine in pregnancy.

    Self reported alcohol intake surveys aren’t worth the paper they are written on. People say what they think you want to hear and underestimate intake massively.

    My non pregnant patients say things like “I only drink at the weekend” or “no more than twice a month” or “only when I go out”. On further questioning what they’re drinking is three pints watching the match in the pub, then half a bottle of wine in the restaurant with dinner, and then a few more pints and a few shots in the night club afterwards. Easily 18-20 units of alcohol in one go.

    • EmbraceYourInnerCrone
      June 6, 2017 at 12:27 pm #

      It’s mean when ever I hear about research that depends on people’s self-reporting it makes me think of the TV show “House”

      “Patients always lie”

      • Steph858
        June 7, 2017 at 9:27 am #

        I always think of the ‘Sickness and Wealth’ episode of Only Fools and Horses. How many patients out there are like Delboy, claiming to be celibate non-smoking teetotallers when in reality they’re promiscuous chain-smoking binge-drinkers?

    • BeatriceC
      June 6, 2017 at 3:22 pm #

      Some of do honestly rarely drink and drink only small quantities. I don’t have anything against alcohol, but I almost never drink at home. MrC gets no end of amusement out of the fact that when I do drink, it’s half a beer and then I give the rest to him. If we go to a bar to watch a favorite local band, we do have to order something, so my one drink lasts for 4 hours because I only ordered it because it’s rude to go to a bar and not order anything.

      All this ends the moment I cross the Cow Cannel Bridge from Stock Island to Key West. For some reason, this brings out the drinker in me. I used to go to Key West every other month or so (when I lived in Miami, and it wasn’t a terrible distance), but these days it’s an entire continent away. But I did admit to that to doctors.

      • mabelcruet
        June 7, 2017 at 6:11 am #

        I’m the same-I live in the backend of nowhere so it’s impossible getting taxis home if I’ve had a drink, I prefer to drive instead. And I like my empty calories as cream cakes or chocolate not alcohol. And the older I get, the harder it is to recover the next day-I’m at the stage where 2 glasses of wine are enough to make me grumpy the next day, so I’ve basically given up on alcohol. About the only time I have it is a hot port if I have a cold (it’s supposed to be hot whiskey and lemon but I can’t stand the taste of whiskey). So my alcohol intake is about 1 unit every 6 months. I refuse to declare my cream cake or chocolate units.

    • Gæst
      June 7, 2017 at 11:29 am #

      I do have trouble estimating my alcohol consumption when asked by medical providers, because they always ask how many drinks a week I have. But I don’t drink every week, so that’s actually a complex math problem to try and work out in my head. I usually answer by counting the drinks from a recent “heavy” drinking week and then picking the category one below that. So if one week I had five drinks (never all in one day anymore, but maybe one a day for five days, or two days of two drinks and one of one, etc.), I pick 2-3 drinks a week, because of the other two weeks in the month where I had none. I have no idea what the correct answer is in that case. I guess I could start some sort of drinking schedule to make sure I’m drinking a consistent amount each week, but I don’t want to drink that often! I enjoy my weeks when I don’t drink just as much as the weeks I do.

      • Dr Kitty
        June 7, 2017 at 2:13 pm #

        My computer system wants a weekly average.
        I don’t mind what it is, as long as it is in the ballpark.
        If you say “I drink half a bottle of wine every 2 weeks” I’m quite happy to average that as 3 units a week.

        Then I usually nag them about binge drinking when it turns out they go out with their mates once a month and drink half a bottle of vodka and twelve pints. My spiel usually starts “I know we’re Irish, and this is how everyone here drinks, but it really isn’t good for you…”

        I put everyone who would occasionally have a drink for special occasions as 1 unit/ week, even if it is less in reality, because 0/week is coded as teetotal on the system.

        It does matter for some things, like life insurance and driving licence admin. It’s good to have something reasonably congruent with reality on the system.

        • Gæst
          June 7, 2017 at 2:28 pm #

          I never put zero. I consider myself a drinker even if I go for a month or two without.

          • Christy
            June 8, 2017 at 2:39 pm #

            Those questions always get me too. I so rarely drink alcohol, maybe once or twice a year. But that’s not “never.” I usually go to the lowest category other than never but it bugs me. lol

    • FallsAngel
      June 8, 2017 at 9:33 am #

      “On further questioning what they’re drinking is three pints watching the
      match in the pub, then half a bottle of wine in the restaurant with
      dinner, and then a few more pints and a few shots in the night club
      afterwards. Easily 18-20 units of alcohol in one go.”


  6. lawyer jane
    June 6, 2017 at 11:26 am #

    It seems to me that if they have to dig SO HARD for any evidence that tiny amounts of alcohol make any difference, they seem to be working very hard to prove a pre-decided hypothesis. If 1 glass of wine had serious impacts on fetal development it would be easy to see … by definition, because the impacts would be serious! I’m not sure what the point is of designing complex studies to find very, teeny tiny, CLINICALLY insignificant differences is, other than a prejudice against the underlying conduct.

    • Sarah
      June 6, 2017 at 4:26 pm #

      Yes, yes, a thousand times yes.

  7. mabelcruet
    June 6, 2017 at 10:55 am #

    I was at the hairdressers yesterday-her daughter is 37 weeks along with dichorionic twins. All well, babies both doing great. The poor woman is having a lot of pelvic pain, back ache, symphysis pubis pain. I asked if she was taking anything for pain relief-she has a baby band and her midwife has told her to try aromatherapy but she must check with her first to make sure the essential oil she chooses is safe. I suggested paracetamol, or maybe a wee glass of wine to help relax muscles. You would have thought I’d suggested poison by the looks I got after that! Absolutely no way, never, ever must you drink any alcohol in pregnancy-ok, this is third hand anecdata, but apparently the midwife told her that if she was craving alcohol during pregnancy that meant she had an alcohol dependence issue and might need referral to the addiction service. Have we lost perspective on risk management completely?? 37 weeks, babies fattening nicely, what possible harm could 80ml of wine cause?

    • June 6, 2017 at 11:28 am #

      In the Bad Old Days [the Sixties and Seventies] it was recognized that alcohol could stop premature contractions in many cases. Now, there are medications [like ritodrine] which act on the same neuroreceptors as alcohol does, and which are given, IV, to preterm women with contractions but intact membranes and minimal or no cervical dilatation. Back then, the patient got a bottle of her favorite tipple plus a drip containing alcohol, and she would soon be stinking drunk. But it was worth it if a premature delivery could be avoided. I remember one patient being taken by the nurses’ station to the delivery room who heard Janis Joplin on our radio. “Groovy!” she cried — and the doctor unplugged the radio and put it next to her ear. Alas, in her case, labor could not be stopped. In the patient’s notes, the doctor wrote “normal spontaneous vertex delivery over intact perineum. Anesthesia: Janis Joplin”.

    • June 6, 2017 at 11:29 am #

      What it could do is relax her a bit, maybe ease some of the painful Braxton-Hicks contractions.

      Perhaps someone ought to give that midwife a drink.

      • mabelcruet
        June 6, 2017 at 11:55 am #

        That’s what I thought-I’m not an obstetrician but having two babies both with estimated weights over 3.5 kg suggests that things might be getting a wee bit stretched in there. Alcohol is a good muscle relaxant.

        I don’t know if you recall the organ retention scandal in the UK around 2000/2001 when it was discovered that some hospitals had retained baby organs after autopsies? At the time, I was a newly appointed consultant and I was asked to speak to a woman who had delivered in 1965-before I was born. Her baby had died shortly after delivery and she said she had never found out why, so with all the publicity she got in touch and we went through the records for her. Her husband (since deceased) had signed the consent form because she wasn’t capable. It turned out that she had gone into premature labour and the only treatment available was to get her drunk-she was given intravenous alcohol to try and relax everything. It meant she had no recollection of the birth or of seeing her baby afterwards, and no memory of any discussion. I was speaking to her with one of our senior midwife supervisors who’d been around for ever and she confirmed it-giving mums alcohol was a way of trying to stop premature labour. I’d never heard of it, I felt so sorry for the poor lady, having no memories of her baby.

        • BeatriceC
          June 6, 2017 at 3:25 pm #

          That’s one of the saddest things I’ve heard in a long while.

          • mabelcruet
            June 7, 2017 at 1:03 pm #

            Yes, the organ retention issue brought up a lot of very sad cases. In the end, it wasn’t so much that organs had been retained, it was that mothers and families had very little understanding of why the autopsy had been done (many cases were coronial, mandated by law and the families wishes were irrelevant in those cases), or the autopsy had been done but no one had ever given the family a proper explanation of what was found. I spoke to a lot of now elderly parents who had had their babies in the 60s and 70s and the publicity surrounding the retained organ issue had stirred up an awful lot of heartache for them.

            One case I won’t forget is an elderly woman who had a stillborn baby at 27 weeks in the early 60s-this was when the legal age of viability was 28 weeks. The parents were Catholics, and at the time the Catholic church would not allow non viable stillborn babies to be buried in consecrated ground. Some families chose to bury their baby just outside the church boundary. Others used a local funeral director who would organise a burial-allegedly-but this was an informal arrangement and there were no permanent records kept, so for many of these babies we have no idea where they ended up. This particular mum had been unwell after the birth, so her husband arranged for the disposal of the baby-the mortuary records showed that the baby was collected by a funeral director, and nothing more. The funeral director was no longer in existence, so there were no records to trace that way. Because the baby was non viable, there was no legal requirement to note it’s burial or cremation, and because the church didn’t allow non viable stillbirths to be buried in a churchyard there was no church record. She never asked her husband what had happened to her baby and he never raised it. So she came to us in her 70s, desperate to know where her baby was. We had absolutely no way of finding out though. However, there had been an autopsy performed, and we still had some tiny samples of tissue preserved in paraffin wax blocks. We were able to give her those, all that remained of her baby-just a few wee slivers of heart and lung, but she wanted to hold a proper funeral. Thankfully the church nowadays is far more accommodating-our lovely hospital chaplain presided and I went to it with some of the midwives and hospital representatives. One of our local schools provides the choir for music at our service of remembrance for babies, so we asked them if some of the girls could come and sing, and we held the service in the hospital chapel.

            Thankfully, nowadays, we are much better informed about what parents want and need after the loss of a baby, even those lost very early on. Hopefully we can respond better than we did in the 60s and 70s.

          • Christy
            June 8, 2017 at 2:57 pm #

            Well now I’m crying. I’m so thankful for compassionate people.

        • rox123
          June 7, 2017 at 1:36 am #

          alcohol intravenously? isn’t that fatal? could it have been intramuscular?

          • June 7, 2017 at 4:34 am #

            No, in those days it was by IV, but obviously not “neat”. I forget the percentage. BTW, FAS, like so many other forms of fetal defects, requires large amounts of alcohol at particular times in the pregnancy, generally early. A glass of wine in the 9th month is nothing like a bottle of vodka at10 weeks.

            Also, certain populations seem more at risk. Native Americans seem to have problems in metabolizing alcohol that European Caucasians do not. This may have something to do with having evolved to cope with a very different diet than Europeans. Some of the health problems of Native Americans today, such as a huge increase in diabetes, comes from eating like white folks, apparently. There should be more study about this.

          • mabelcruet
            June 7, 2017 at 12:36 pm #

            As a medical student we used ourselves as subjects in physiology and biochemistry practical classes. We had a sizeable contingent of students from Malaysia and Singapore, and folk from that ethnic background also have difficulty metabolising alcohol. We used to test alcohol serum levels after measured doses, and the poor Malaysian students would be going bright red after half a pint of beer and feel absolutely awful whilst us Irish were sinking pint after pint.

          • Dr Kitty
            June 7, 2017 at 1:10 pm #

            I have a memory of a biochem lab that involved being made to down two 500ml cans of Dutch Gold and then measure urine output for the next two hours, some of us had to run around the cricket pitch to see the effect of exercise on ADH secretion, the smokers got to smoke two cigarettes instead.

            I’m pretty sure the experiment was designed just so the class could get drunk and smoke, because the lab was on a Friday afternoon and half of us would skip out and go to the pub if we finished the lab work early.

            I gather your university had similar strategies for keeping medical students out of the pub and in the lab.

          • mabelcruet
            June 7, 2017 at 3:39 pm #

            Sounds like an identical syllabus! We did one experiment sticking NG tubes down each other and sampling stomach acid for some reason. And there was one where they got all the rugby players and fed them alcohol and compared them to non-rugby players to see how muscle mass affected alcohol metabolism.

          • mabelcruet
            June 7, 2017 at 6:04 am #

            Intravenous ethanol was a standard treatment in the 60s and early 70s to try and stop premature labour-I think toxicity depends on the speed of infusion so the dosage was quite low (but 1-I wasn’t born at the time so no professional experience of it and 2-I’m a pathologist and don’t have live patients so I’m no expert).

    • Dr Kitty
      June 6, 2017 at 11:36 am #

      At least the addictions team would bounce that referral straight into the circular file!!
      They’re too busy with people who drink a litre of vodka a day or are. Ontinying to take codeine and ibuprofen despite renal damage and stomach ulcers.

      Dear lord!

      Does the midwife refer women who crave chocolate too?
      Theobromine dependency might cause untold harm!

      • mabelcruet
        June 6, 2017 at 12:09 pm #

        Do you remember the Christmas BMJ paper about recognition of the different wrappings and flavours of branded chocolates like Roses and Quality Street between different types of staff (I think it was doctors-trainees and consultants, midwives and general nurses). That didn’t go down too well!

        • Dr Kitty
          June 6, 2017 at 3:36 pm #

          This one?

          Goodness knows there were days as a junior doctor when literally the only thing I ate were chocolates some kind patient had left at nurses’ station.

          • Dr Kitty
            June 6, 2017 at 3:41 pm #

            This piece of important research also added much to the little studied topic of “where did all the chocolates on the ward go”.


          • mabelcruet
            June 6, 2017 at 7:28 pm #

            I wonder which flavours of chocolates were lost to follow-up. I seem to remember the strawberry ones being left til last. The big purple one always went first, you had to be quick to get one of those. The toffee pennies were popular, but as they took a bit of chewing you ran the risk of having to see patients with a gob full of caramel-not a professional look!

          • Nick Sanders
            June 6, 2017 at 8:29 pm #

            Big purple one?

          • mabelcruet
            June 6, 2017 at 8:38 pm #

            Big purple chocolate. It’s got a hazel nut with liquid caramel around inside a milk chocolate shell. It’s shaped sort of like a Cornish pasty and is wrapped in purple cellophane. It’s a favourite quality street chocolate that tradionally gets fought over (except in our house because my grandmother called dibs on them and you didn’t want to get on the wrong side of her if you could help it)

          • Nick Sanders
            June 6, 2017 at 9:44 pm #

            Sounds delish.

          • Dr Kitty
            June 7, 2017 at 5:10 am #

            To understand this you have you understand British Chocolates.
            There are basically two brands- Quality Street and Roses that sell individually wrapped chocolates in a big tin or tub for about £6.
            This is generally the “thank you” gift patients give to nurses, because there’s enough for everyone to have at least one chocolate.
            Most households would also buy one at Christmas.

            The chocolates are various flavours- fudge, coconut, toffee, caramel, coffee cream, orange cream, praline etc.
            You can distinguish them by the colour of the wrapping and the shape of each chocolate.

            Some flavours are almost universally popular, some less so.
            If you don’t make it to the tin quickly enough, all that will be left is the strawberry and orange creams and the coconut ones.
            The purple ones and green triangles (praline truffle centre) always go first from Quality Street.

          • Gæst
            June 7, 2017 at 11:38 am #

            I would make out like a bandit – orange cream is my favorite!

          • mabelcruet
            June 7, 2017 at 12:31 pm #

            I loved the coconut ones! Pale green wrapper and slightly knobbly I recall.

            I’m not quite sure that British chocolate would qualify as proper chocolate to Europeans used to Belgian, German or French chocolatiers. Possibly it qualifies as some sort of milk product. Personally I could eat my body weight in Dairy Milk. Anyone else remember Caramac? Droolworthy…

          • Dr Kitty
            June 7, 2017 at 2:20 pm #

            Irish Dairy Milk or British Dairy Milk?

            And do you have a preference for brand of Cheese and Onion crisps?

            My theory is that people like the ones they grew up with. So, as a norn iron person it’s British Dairy Milk and yellow and red Tayto crisps for me, but I’ll take Irish Dairy Milk and blue and red Tayto in a pinch. Other brands of cheese and onion are unacceptable.

            Possibly only the Irish could make a crisp factory into a theme park BTW.

          • mabelcruet
            June 7, 2017 at 3:35 pm #

            British Dairy Milk for me. But I hate Tayto cheese and onion (I’ll probably be deported for saying that!). And you can’t beat a Pear Picking Porky lolly on a hot day.

          • Dr Kitty
            June 7, 2017 at 4:25 pm #

            Pear Picking Porkies (which are just a pear flavoured ice lolly made by a Northern Irish Dairy co-operative) were one of the few things I could stomach during both pregnancies.

            I’m honestly not joking when I say my daughter had more fun at Tayto Park than at Disneyland Paris. There’s a zoo, rides, Ireland’s biggest wooden rollercoaster, a tour of the crisp factory and you get free crisps on entry.

          • Sarah
            June 7, 2017 at 2:22 pm #

            Noooo, the creams are amazeballs!

            My husband decided to be contrary and bought Cadburys Heroes for the staff when I was in the postnatal ward. Someone needs to do a Part II of that BMJ thing with those and Celebrations too. There’s got to be a research grant in there somewhere!

          • Dr Kitty
            June 7, 2017 at 2:46 pm #

            There’s always a bit of a battle over the Maltesers Celebrations and nobody wants the Bounties (I realise this makes no sense to the US readers).

          • Dr Kitty
            June 7, 2017 at 2:59 pm #

            Now I’m in GP the patient’s offerings consist of home baking (which we eat if we can trust their hygiene and ability to read and remember a recipe and discreetly dispose of if we can’t), and tins of biscuits.

            Usually more at Christmas, so we save up the things that will keep from November and divide them out equally amongst the staff.

            My admin staff know me well enough to bring me chocolate and biscuits mid afternoon if they have things they need me to do.

            Occasionally patients think outside the box- nice hand wash, bottles of wine, some of those room fragrance sticks.

            Anything over £30 value has to be politely declined.

          • mabelcruet
            June 6, 2017 at 4:42 pm #

            That’s the one. I recall nurses complaining at the time that it was unprofessional and undermining. I don’t think they quite understood the light hearted nature of reports in the Christmas BMJ

    • maidmarian555
      June 6, 2017 at 11:37 am #

      Jesus. Since the weather turned lovely, I’ve quite fancied a nice G&T in the sunshine. Do I need referring to addiction services too? Just for *thinking* it would be nice to have some lovely gin?! Or maybe a Pimms? Addiction services are stretched way beyond capacity, on what level is it ok to even suggest wasting such precious resources on people who are showing no actual signs of requiring them?

      • Dr Kitty
        June 6, 2017 at 11:52 am #

        It’s called “scaring people straight” I think.

    • StephanieJR
      June 6, 2017 at 11:52 am #

      I’m pretty sure alcohol is safer than essential oils in some cases. And having a craving after nearly nine months of abstinence means you have a dependency- good lord, the stupidity hurts.

      • mabelcruet
        June 6, 2017 at 12:05 pm #

        I’ve said it before, I work with some amazing midwives, dedicated, hard working, super skilled professionals. But some of the sisterhood occasionally seem somewhat oligosynaptic. I’m sure I’ve done enough stupid things in my lifetime, but I try not to do it in public!

    • Madtowngirl
      June 6, 2017 at 1:17 pm #

      The only thing I craved when I was pregnant was red wine….I didn’t drink any, but I am shocked that someone would spin that into me having an alcohol dependence issue. WTF? Sure, I did a bit of binge drinking in my college years, but I am by no means “alcohol dependent,” and never have been. Wow.

    • SporkParade
      June 6, 2017 at 3:10 pm #

      Seriously? I craved red wine during my last pregnancy for the simple reason that pregnancy heightens my sense of smell and red wine smells really, really good. And I definitely don’t have an alcohol dependency because alcohol gives me acute gastritis looooooooooong before I drink enough to be legally drunk.

    • guest
      June 6, 2017 at 3:40 pm #

      My husband was a real worrier about any alcohol consumption in my first pregnancy so I refrained until my water broke and I started having a bit of a freak out. The midwife suggested a small glass of wine and some deep breaths before heading to the hospital.
      My second pregnancy, we toured a brewery in the last few weeks of pregnancy. Husband tried to object to me drinking anything, but I vetoed him. I got lots of dirty looks from strangers for the little sips I took from each tasting glass we got.

    • June 6, 2017 at 4:36 pm #

      Say what?

      I craved alcohol during my pregnancy with Spawn. Alcohol sounded like it would actually taste good for once. I didn’t drink because I don’t have good luck when it comes to really rare events so I figured I would be the first case of “No, seriously, I drank one drink in my second trimester. What do you mean my kid has FAS?!”

      The craving passed at some point before I made it home from the hospital after he was born.

      The two overly-sugary alcoholic drinks I bought the week before I realized I was pregnant are still sitting in my refrigerator. They don’t sound particularly appealing now.

      Remind me what part of this insanely boring story cues in on alcohol dependence? Silly midwife…..

      • KeeperOfTheBooks
        June 6, 2017 at 8:36 pm #

        Same here. When I was pregnant with DS, I craved two things: red meat (and lots of it!) and alcohol. Not even my usual red wine or beer–any strongly alcoholic drink sounded good. I was craving the taste of alcohol itself.
        Mind you, I drink hard liquor perhaps once or twice a year max, and there was no way in hell I was going to be downing margaritas while pregnant. It was just a craving I oh-so-very-much had. Like many cravings, it was an odd one, and had little to do with my usual habits, and yep, once I delivered, I wasn’t interested in liquor anymore. *shrug* Further proof the pregnant body is weird, I suppose.

        • rox123
          June 7, 2017 at 1:24 am #

          I wish I had cravings for red meat. I can’t even look at a piece a meat without my stomach turning inside out.

          • KeeperOfTheBooks
            June 8, 2017 at 12:06 pm #

            It varies from pregnancy to pregnancy for me. With DD’s pregnancy, I wasn’t interested in meat much at all. DH once took me to a fantastic churrascaria while I was pregnant with her, and I totally pigged out…on the grilled asparagus.

          • rox123
            June 8, 2017 at 12:34 pm #

            Haha, that sounds like a wasted opportunity!!

          • KeeperOfTheBooks
            June 8, 2017 at 8:44 pm #

            It was!!! In retrospect, the meat sounds HEAVENLY. At the time, though, it was “meh” at best, while the asparagus, on the other hand…mmmm…

      • Sarah
        June 7, 2017 at 4:07 am #

        I can’t imagine craving alcohol in pregnancy, I couldn’t stand even the smell once the nausea kicked in and could literally not be in the same room as the stuff at times! Lasted for months after giving birth too, and unlike you when not pregnant I do drink moderately (and I mean actually moderately, as in a couple of units maybe once a fortnight, not Dr Kitty patient moderately). It was just too urrrrrrrgh.

    • Spamamander, pro fun ruiner
      June 6, 2017 at 8:55 pm #

      Just wow. I had a somewhat emergency amniocentesis with kidlet #3 after some things showed on his 18-19 week u/s and the perinatologist told me to go home and have a glass of wine or two to relax my uterus and me.

      • mabelcruet
        June 7, 2017 at 6:15 am #

        I thought the same-her daughter is quite young and it wasn’t a planned pregnancy so I wonder if it was the midwife thinking ‘young girl, likely to go clubbing, let’s put the frighteners on her to scare her not to drink’.

    • Gæst
      June 7, 2017 at 11:32 am #

      Damn, that midwife is out of line. Pregnancy cravings can be weird, we all know that. If you crave wine but control yourself, that’s not a sign of underlying dependency. (Or if it is, I have an underlying dependency on strawberries, olives, and potato chips.)

      • Heidi_storage
        June 8, 2017 at 1:04 pm #

        The other day, my dear ones (3, 2, and 5 months) were being a bit…much, and I wanted to grab my husband and drive off to get some drinks, leaving them to fend for themselves. Instead, we spent the evening playing with them on the swingset, but I guess I’m both an alcoholic and a neglectful mother because I indulged in a little fantasizing.

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