I’ve just come back from a trip with my sister, who is pregnant with her first child. During our time away (we were in a larger group), she was often sneaking off to drink, coming back reeking of spirits, while mentioning conspicuously in front of the group on several occasions about what a lightweight she is since she stopped drinking. We shared a bedroom in which I came across a litre bottle of spirits by accident (it was hidden, but not very well), which was empty by the end of the two days.

I don’t know if (or how) to act on this. I feel nothing but compassion for my sister, and have no interest at all in judging her, but I would love to support her and I also now feel things are complicated by my obligation to her unborn child.

I don’t know who else in the family, if anyone, is concerned. My husband has previously expressed concern when he’s found vodka, gin and wine hidden around our house when she’s visiting, and also when she shared a room on holiday with our teenage children. We almost said something then, but decided on balance that this wasn’t our business and that we would be supportive if she ever wanted to open up, but not to bring it up.

I don’t want her child to come to any harm, and also have my own experience with alcohol, which means I understand how hard it can be to break the cycle without help and support.

You didn’t say how pregnant your sister is and I’ve tried to answer this as fast as possible, because if your sister is drinking as much as you say, it’s imperative she gets support to stop ASAP. You mentioned her husband in your longer letter, but only in passing and I wonder what he knows and if you can get his help, and if is he concerned?

I went to two people this week, psychotherapist Becky Harris, who has extensive experience with addiction; and maternity social worker Nandita Vytelingum, who has a specialism in substance misuse and is a member of the British Association of Social Workers (BASW).

Harris said: “Nobody can say with certainty how much alcohol is or isn’t safe. But the current guidelines are that no drinking is safe while pregnant. When there’s secrecy around drinking there’s usually a huge amount of shame there too, but it’s now an urgent thing to address.”

Realistically, some women do drink a bit while pregnant. However, from what you’ve said, it sounds like your sister is drinking a lot and there are numerous risks associated with this– not only of miscarriage or premature birth but also if the drinking is excessive, of foetal alcohol spectrum disorder (FASD). I once taught two pupils with FASD and it was tough to see.

We all appreciate this is difficult and only you know your sister and how best to address it. You could, Harris suggested, maybe use your own drinking experience in the past as an “in”. Because if your sister is using alcohol now to cope with something, that will probably continue once the child is born, so she urgently needs compassion and support.

“You could try,” said Harris, “something like: ‘The last thing I want to do is make you feel bad and I am absolutely not judging and I love you, I only want to support you, but I’m really worried about you and your baby. And if you don’t seek support I’m going to have to tell someone.’” Harris felt it was important to name what was going on.

Of course, no one can stop your sister drinking. So what you do if she won’t voluntarily seek support is tricky. But what you could do is discuss it with her midwife team (have they not noticed she’s drinking?) or go to social services.

Vytelingum says: “Many family members worry that social workers will be instantly seeking to remove a baby at birth from the parents where there is an alcohol misuse issue. As a social worker with pre-birth experience, I can assure you this rarely happens and when it does it is usually a last resort. Good social work is about working with families rather than doing something to them.”

Vytelingum suggested having the conversation with your sister and then encouraging her to seek professional support through her GP or midwife who can then decide whether to refer to a social worker. But that if you had immediate concerns for the baby and worry there is the potential for “serious pre-birth damage, neglect or injury post-birth then I can only advise an immediate referral to the social work child protection services”.

Help and support can come in the shape of local alcohol treatment services, involving wider family and your sister’s husband.

I know this is hard, but everyone I spoke to wanted to stress to try to see this as support for your sister, not judgment. And, as Harris says: “Imagine how you’d feel if you don’t say anything.”

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