Helping women to quit smoking during pregnancy
All pregnant women should be assessed to determine whether they - or their unborn child - are being affected by tobacco smoke, whether it's from the mother-to-be or others around her who smoke. The best way of doing this is to test them using a carbon monoxide monitor.
If they do smoke they should be automatically referred to local stop smoking services and offered the help they need to quit.
These are just two of the recommendations made in new NICE guidance published in June to help women and their families give up smoking during pregnancy.
The aim of the test is not to check whether women are telling the truth - or to make them feel guilty if they smoke. Rather, it is to see if carbon monoxide is an issue for them (and, as a result, their unborn child).
If it is, this physical proof may help those who don't smoke to encourage smokers in their household to quit (people can get a high CO reading simply from being around other people who smoke). What's more, it will ensure those pregnant women who smoke - but who may not feel able to admit it - don't miss out on the offer of help.
As Professor Mike Kelly, NICE's Director of the Centre for Public Health Excellence explains: “The test isn't to penalise them if they have been smoking but, instead, is a useful way to show women that both smoking and passive smoking can lead to having high levels of carbon monoxide in their systems.”
NICE says pregnant women who do smoke should not be condemned for their addiction but, rather, should be referred for help to quit.
Our aim is not to force women into using stop-smoking services, adds Professor Kelly. Anyone who decides that they don't want help can opt out at any time. But it's crucial to give them the option of personalised help, support and information offered in a positive, non-judgmental way.
It's an approach that has already been successfully adopted in Leicestershire where all community midwives, equipped with carbon monoxide monitors, have helped hundreds of pregnant women quit smoking in the past 3 years.
“Together, Leicester City Stop Smoking Services and Leicester County and Rutland Stop Smoking Services are one of the leaders in using the approach of routine breath tests - and we have helped in developing the guidelines drawn up by NICE,” explains Tina Booth, manager of the NHS Leicestershire County and Rutland Stop Smoking Service.
“We work in partnership with local maternity services and, for the past 3 years, all pregnant smokers and those who have recently quit have been offered breath tests. It is rare that the test is refused, as it is always presented in an appropriate and sensitive way.”
‘Our philosophy is about giving women all the information they need so that they are in a position to make choices for themselves, their babies and their families,” adds Julia Austin, consultant midwife, public health, University Hospitals of Leicester Trust. “Women respond to having all the facts, including what their reading tells them.”
Smoking during pregnancy can increase the risk of miscarriage, premature birth, still-birth and sudden unexpected death in infancy. Exposure to smoke in the womb is also associated with attention and hyperactivity problems in childhood.
Children of parents who smoke tend to suffer from more respiratory problems like asthma or bronchitis.
It costs the NHS an estimated £20 million to £87.5 million each year to treat mothers and small infants under 12 months with problems caused by smoking in pregnancy.
See the NICE guidance on 'Quitting smoking in pregnancy and following childbirth'.
This page was last updated: 26 July 2010