The following news story appeared in Essentially MIDIRS, vol 4, no 8, September 2013, p24.
The call for effective and targeted government programmes directed at smoking cessation in pregnant women has been getting louder and more organised for some time now, as more organisations join together prior to (at the time of writing) NICE’s expected new quality standard dealing with the issue.
Draft guidance from NICE went out for consultation in March 2013, and recommendations in it, that pregnant women should be encouraged to have their carbon monoxide levels tested to determine levels of tobacco exposure (NICE 2013), were met with anger by some of the press (McDermott 2013), keen to label it as ‘nanny state’ intervention.
This was dismissed by Professor Mike Kelly, Director of the Centre of Public Health at NICE, who pointed out that tests wouldn’t be obligatory and that they would not be intended “to penalise them [the women] 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”.
In June the Scottish government announced that it would be offering carbon monoxide tests to pregnant women and there has been a recent flurry of research and reports on smoking cessation in general. The Cochrane Library has recently updated four of its reviews on a variety of smoking interventions, including mass media, internet-based, opioid antagonists and physician advice (Bala et al 2013, Civljak et al 2013, David et al 2013, Stead et al 2013). Each intervention was found to have success in different populations, which would suggest a need for varied and properly targeted methods.
Perhaps the most relevant to those working with pregnant women in England, is a report by the health charity Action on Smoking in Health (ASH), Smoking cessation in pregnancy: a call to action. This report is endorsed by many leading British organisations linked with childbirth, including the RCM and the Royal College of Paediatrics and Child Health. It takes up the call from NICE in recommending that NHS England include the requirement of carbon monoxide screening at each visit. As well as a means of identifying smokers so that they can be offered relevant help, the primary reason it gives for the tests is to validate data collected at visits to ensure that they are consistent across Trusts and of a high standard. Good data, of course, form the basis of good research and are required to measure the effectiveness of interventions, but there may be occasions when a midwife might feel that the suggestion of a test, even if not obligatory, is not appropriate and likely to form a barrier in a relationship that should be built on trust. It is essential that midwives are given an appropriate level of training in dealing with this, and in particular as recent research in Birth journal (Perlen et al 2013) assessed to what extent the introduction of smoking cessation guidelines in pregnancy in Australia had changed practice in hospitals in Victoria. The results suggested that there was an overall improvement in the extent to which women received advice and support, but that half of all smokers included did not receive all the advice required by the guidelines and that there was variability depending on the individual health care professional involved. It is therefore vital that, for this guideline to be successful, midwives are confident that it is appropriate and not likely to damage the relationship they have with women. The most important factor in the Perlen et al (2013) study in ensuring that women received all the appropriate information as set out in the guideline was continuity of care, and this is definitely something that would be of benefit to all.
ASH (2013). Smoking cessation in pregnancy: a call to action. London: ASH. http://tinyurl.com/qejo27c [Accessed 31 July 2013].
Bala MM, Strzeszynski L, Topor-Madry R et al (2013). Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews, Issue 6.
Civljak M, Stead LF, Hartmann-Boyce J et al (2013). Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, Issue 7.
David SP, Lancaster T, Stead LF et al (2013). Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews, Issue 6.
McDermott N (2013). Fury at smoking breath test for all mothers-to-be as it is revealed one in three still light up during pregnancy. Daily Mail. 12 May. http://tinyurl.com/cppdmeg [Accessed 31 July 2013].
NICE (2013). Draft quality standard for smoking cessation: supporting people to stop smoking. London: NICE.
Perlen S, Brown SJ, Yelland J (2013). Have guidelines about smoking cessation support in pregnancy changed practice in Victoria, Australia? Birth 40(2):81-7.
Stead LF, Buitrago D, Preciado N et al (2013). Physician advice for smoking cessation. Cochrane Database of Systematic Reviews, Issue 5.
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