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Plans for midwives to 'challenge' pregnant smokers criticised

Plans to make pregnant women take a carbon monoxide breath test to check if they are telling the truth about their smoking habits have been criticised by midwives.

The course of action advocated by NICE has received a sceptical response from midwives, who say pregnant women should be offered encouragement to quit rather than being made to feel guilty.

The guidelines are designed to help women and their families give up smoking during and after pregnancy and are not aimed at penalising smokers, the watchdog claims.

Professor Mike Kelly, director of NICE’s centre of public health excellence, said: “This isn’t to penalise them if they have been smoking, but instead will be a useful way to show women that both smoking and passive smoking can lead to having high levels of carbon monoxide in their systems.”

However, Royal College of Midwives (RCM) education and research manager Sue Macdonald said the use of the breath test may make women feel “guilty”.

Ms Macdonald said: “Use of the CO monitor has the potential to make women feel guilty and not engaged. We need to look at a range of individualised interventions for women that meet their needs and aspirations.”

The RCM welcomes the guidelines, because reducing smoking helps the health of women and their babies, but are also sceptical about the use of the breath test monitors because of cost.

Readers' comments (14)

  • And why shouldn't they be made to feel guilty?

    They should be put in stocks and ridiculed in my opinion!

    Smoking is a nasty, selfish and disgusting habit, if people want to go and poison themselves, fine. Go off in a corner and do it. But if you are pregnant that is a whole different matter.

    I remember my parents smoking heavily around me from the day I was born (and probably before) all through my childhood until I was big enough to force them to keep it away from me.

    I hated it, I stank, the house stank, and more importantly I suffered really seriously all throughout my childhood with asthma and chest problems because my parents were too selfish too not keep their disgusting selfish habit away from me.

    People who smoke when they are pregnant really wind me up, and damn right they should be challenged!

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  • it will only be a waste of money - if a mother is prepared to carry on smoking whilst carrying her child then she will obviously not have any consideration either to it once its born - so will no doubt continue to damage the poor childs growing lungs. theres enough education and advice available - people know the risks of smoking doing these tests wont change anything - 'ok so theres high levels of carbon monoxide in my stream - and?!' if theyre prepared to damage babies health like this carbon monoxide will change nothing. are they also going to target smoking partners of pregnant women??

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  • Martyn Butcher

    This is yet another crack-pot idea from people who've lost touch with reality. Sure, mums-to-be shouldn't smoke, but get real; some will no matter what professionals say. Introducing yet more tests are a total waste of time (and this at a time when funding will be cut-back). Midwives should educate all mums about the risk of smoking during pregnancy (active and passive), the decision is then up to them.
    Forcing women to have tests will simply alienate midwives and damage relations between mums and staff. It will also cause problems where mums are desperately trying to quit but are having problems succeeding.
    It's easy for some healthcare workers to criticise women who smoke, but none of us are perfect; if we were, there would be no smoking, overweight or unfit nurses in the profession!!!

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  • Mike, environment only plays a part as a trigger of asthma, so it's not fair to blame your asthma entirely on your parents' smoking. I have never smoked and my husband stopped before we were married. However, both of my daughters are asthmatic.
    Surely the greatest worry here is that some women who smoke will not turn up to antenatal appointments if they are going to be tested for smoking? This will put their already at-risk babies at even more risk. The "Big Brother" strategy doesn't really work - it just creates other issues. Yes, smoking adversely affects human beings, born or unborn. Making people feel guilty just puts them on the defensive and encourages denial and a "What's it got to do with you?" attitude. Any CO monitoring should be part of a no-blame educational process, not a finger-wagging admonishment.

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  • Well said Trish - testing will keep them away and we'll end up with women in labour arriving at A&E with no one having any knowledge of them or their medical history...bad idea.

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  • Yes envioronment does has an effect, but the single biggest cause of the majority of chest problems is smoking and second hand smoke.

    I do not disagree with you about the inherent problems of such a scheme, but I do agree with the sentiments behind it.

    I think banning the disgusting things in the first place would work much much better.

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  • D Wright

    I am wondering if a slightly different approach is rquired. I agree with some of the comments regarding the use of the made to feel guilty method.
    Perhaps if we gave them the ACTUAL facts, rather than the 'pink and fluffy' approach we may get somewhere. Then they can make their own choice, might even only have to do it the once!

    An example may be that (I remember this in my student MW days) that the placenta is 'gritty' etc. How about using a few other more 'real time' facts, not just the "you will have a smaller baby". you know what comment comes from that!

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  • I am a smoker who wishes smoking would just be illegal and therefore we would have no choice but to give up, and there would be no cigarettes available... what would we do then? - we'd just have to give up and that's that. Ok, the government funding would decrease substantially, but so would healthcare costs - you don't have to be einstein to work this one out!

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  • There are always reasons why people smoke in the same way there are reasons why people self medicate in other ways.

    Stopping unhelpful habits only happens when someone feels inspired, safe and supported in ways to make it manageable and do-able.

    I've never witnessed anyone stopping by being either terrorised or tyrranised by someone who apparently knows whats best for them.

    I've also noticed people who are passionate in knowing what's best for other people always have their own story to tell and yet find it difficult to acknowledge or recognise their own underlying agendas.

    It worries me that the current trend and descent into rules and regulations, and the apparent safety they would have us lulled to sleep by, we are missing the relationship with ourselves and people volunteered into our care.

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  • Anonymous | 24-Jun-2010 10:33 pm

    your health and choice to smoke is your responsibility, no-one else's.

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  • Anybody bother blaming patients for their unhealthy lifestyle choices? I can't be arsed.

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  • Maybe we should do a forced c-section on smoking mothers at 25 weeks and then adopt the kid to some non-smoking vegans; would that make everybody happy? Apart from the mother of course, maybe tie up her tubes while your in there so we would have to bear no more funny business with a chain smoking fetus? Just a wee thought.

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  • Anonymous | 27-Jun-2010 2:51 am; Maybe we should.

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  • I think that the attitude shown on here from other professionals is down right disgraceful. Of course its down to the patients and the mum-to-be as to whether they want to smoke, however, their baby has no choice whatsoever and as a result will suffer to some degree.

    It amazes me that someone who drinks, or takes drugs whilst they are pregnant is automatically viewed as putting their unborn child at risk (and will be registered on the child protection list in most cases)- however, you see a pregnant woman smoking throughout her pregnancy and no one bats an eyelid. Smoking throughout pregnancy has links to cot death, still birth, miscarriage, learning problems, breathing problems- the list goes on. Its time to tell the facts as it, and cut out the old school midwive myths such as 'cutting down to less than 5 a day', or 'smoking is too stressful to give up whilst you are pregnant' should be banished immediately.

    It seems to me that this is a social taboo that needs to readdressed- there are plenty of support groups/services for pregnant smokers. NRT is safe for them to take, so what is the big issue here? At least encourage them to suspend their smoking for nine months for the sake of their baby!!

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