Smoking in pregnancy Executive Summary
The case for intervention is clear and the evidence to support this is found in secondary and primary research. Smoking is harmful to mother and baby and the financial costs of maternal smoking to the NHS is high.
Pregnancy presents an opportunity for significant and positive behaviour change. We have found during this research a willingness to change behaviours from the moment a woman discovers she is pregnant such as stopping drinking alcohol and consuming different foods. However, for some, quitting smoking is not on the top of their quit list and is not prioritised by mum’s to be.
Pregnancy is a time that can be stressful for many parents and it is an addiction. To give it up is not easy – especially for long term and heavy smokers. Many see smoking as a way to alleviate stress and boredom or an opportunity to have some ‘me time’. We have found during this research that most pregnant smokers are willing to cut down when pregnant but not quit. Most believe that smoking just a few cigarettes a day will not harm their baby and they feel they have already made great progress cutting down from a 20 packet to a 10 packet. A woman smoking 20 a day or more in pregnancy is considered by pregnant smokers as ‘irresponsible’.
This research has also shown that many women who continue to smoke in pregnancy tend to live in circumstances that make it difficult for them to quit – poor housing, money problems, unemployment and relationship breakdown (partner and family). A few have struggled with drug addiction, homelessness and depression. Smoking is a norm in almost all of the families we talked to. Partners smoke, mum’s smoke, friends smoke. This makes it incredibly difficult for the pregnant smoker to quit.
NICE guidance published in 2010 suggests a number of actions to reduce smoking in pregnancy. One of the measures for midwives is to assess the woman’s exposure to tobacco control through discussion and use of a carbon monoxide test. The research found that very few midwives use the testing equipment – either because they do not have access to it or because there is little time to do this in appointment slots.
Interestingly, research with the target audience found that use of the carbon monoxide testing kit when it had been used heightened awareness of the possible damage being caused to baby from smoking and brought it ‘home’ to women in a way no other technique did. Using the carbon testing kits would help women to see that even smoking two cigarettes a day can cause harm. It is highly recommended making this reading personal by conducting it and giving them a card copy with the results and a call to action – similar to giving them a picture of the scan. This is a reminder to them that their smoking levels are affecting the baby.
This report recommends greater efforts made at earlier stages – ideally in the first trimester when behaviour change is more likely. Attracting pregnant smokers to address their smoking at GP practices (when they book their midwife appointment), pharmacies (when they are buying their pregnancy test, buying relief and medicine) and in baby outlets (such as shops, online forums when they are preparing for the baby’s arrival and discussing pregnancy related matters) is key. Currently, a lot of effort and responsibility is placed on the midwife and although highly influential and crucial in persuading women to quit, this should be seen as the last opportunity rather than the first.
It is recommended that the maximum amount of support is offered to pregnant smokers at the midwife appointment. A lapse of even a few days to follow up on a midwife referral is too long and unlikely to persuade the majority of smokers to attend a stop smoking service. Ideally a midwife who is the most trusted healthcare professional to a pregnant woman would lead on smoking cessation or have critical support at the meeting to persuade women onto a quit...
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