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Midwives ‘need more training’ to address smoking in pregnancy

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Midwives need more consistent training in how to communicate the harms of smoking to pregnant women, according to a new report.

They also need more training in the use carbon monoxide monitors, said the report, published by Action on Smoking and Health (ASH) on behalf of the Smoking in Pregnancy Challenge Group.

“Staff are clear on the risks of smoking, but not all are quite so clear on how they could help women to stop”

Misha Moore

The report – titled Smoke-free Skills: An assessment of maternity workforce training – outlines the training that midwives and obstetricians currently get to tackle smoking in pregnancy and highlights what further training is needed.

Smoking is a major cause of stillbirth and sudden infant death, and also leads to more babies being born with health problems and with a low birth weight, noted the report.

Evidence shows that short and straightforward conversations with midwives and doctors can increase the chances of a woman accessing services that will help her to quit, it said.

The report said that, while staff were taught about the harms from smoking in pregnancy, training on how to communicate this message to women, how to use basic equipment such as carbon monoxide monitors, and how to provide short effective advice was not being provided consistently.

“There is a clear need to improve the training and education provided for student midwives”

Cathy Warwick

Report author Dr Misha Moore, an expert in both public health and obstetrics, said: “Throughout this process, people would tell me the importance of reducing smoking in pregnancy ‘goes without saying’.

“But leaving things unsaid appears to be just the problem,” she said. “The majority of staff are clear on the risks of smoking, but not all are quite so clear on how they could help women to stop.

“Simple, low cost, training delivered by every trust in the country could go a long way to addressing this issue,” said Dr Moore.

Francine Bates, chief executive of the Lullaby Trust and co-chair of the Smoking in Pregnancy Challenge Group, said: “We know that pregnant women listen to their midwife and their obstetrician. With the right training, they could make a big difference to the number of women smoking in pregnancy.”

The report was launched in parliament yesterday at a joint event between the All Party Parliamentary Group on Baby Loss and the APPG on Smoking and Health.

“Undergraduates must not leave midwifery and medical schools simply with knowledge on harms from smoking”

Will Quince

Will Quince, MP for Colchester and co-chair of the APPG on Baby Loss, said: “Undergraduates must not leave midwifery and medical schools simply with knowledge on harms from smoking. They need practical skills so their interaction with a woman who smokes actually helps her to quit. These must not only be taught but be tested too.”

The report also highlighted that training of maternity staff was not enough on its own and that there had to be co-ordination with the local services that helped women to quit smoking.

Bob Blackman, MP for Harrow East and chair of the APPG on Smoking and Health, said: “Stop smoking support is incredibly cost effective. Every local area needs to find a way of maintaining these vital services, particularly for pregnant women.”

The report was published the day before the government revealed its new Tobacco Control Plan, in which it said one of its priorities was reducing rates of smoking in pregnancy.

Local areas would be encouraged to identify and implement local smoke free “pregnancy champions” to promote implementation of best practice, according to the plan.

Cathy Warwick, chief executive at the Royal College of Midwives, said: “Reducing smoking in pregnancy is one of the most important steps that could significantly reduce poor outcomes in pregnancy such as stillbirths.

Professor Cathy Warwick

Professor Cathy Warwick

Cathy Warwick

“This is why it is so important that the recommendations in this document are looked at and acted on by governments and other relevant organisations,” said Professor Warwick.

“There is a clear need to improve the training and education provided for student midwives, and for ongoing training for midwives and their colleagues working in our maternity services,” she said.

She added: “We need to ensure that midwives, doctors and their colleagues are equipped with the right knowledge and skills so that they can offer the best advice and support to women.”

The RCM has an online learning course, called Very Brief Advice on Smoking for Pregnant Women, on its e-learning platform

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