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Smoking: stopping in pregnancy and after childbirth [PH26]

Measuring the use of this guidance

Recommendation: 1

• Assess the woman's exposure to tobacco smoke through discussion and use of a CO test. Explain that the CO test will allow her to see a physical measure of her smoking and her exposure to other people's smoking. Ask her if she or anyone else in her household smokes. To help interpret the CO reading, establish whether she is a light or infrequent smoker. Other factors to consider include the time since she last smoked and the number of cigarettes smoked (and when) on the test day. (Note: CO levels fall overnight so morning readings may give low results.) • Provide information (for example, a leaflet) about the risks to the unborn child of smoking when pregnant and the hazards of exposure to secondhand smoke for both mother and baby. Information should be available in a variety of formats. • Explain about the health benefits of stopping for the woman and her baby. Advise her to stop – not just cut down. • Explain that it is normal practice to refer all women who smoke for help to quit and that a specialist midwife or adviser will phone and offer her support. (Note: a specialist adviser needs to offer this support to minimise the risk of her opting out.) • Refer all women who smoke, or have stopped smoking within the last 2 weeks, to NHS Stop Smoking Services. Also refer those with a CO reading of 7 ppm or above. (Note: light or infrequent smokers should also be referred, even if they register a lower reading – for example, 3 ppm.) If they have a high CO reading (more than 10 ppm) but say they do not smoke, advise them about possible CO poisoning and ask them to call the free Health and Safety Executive gas safety advice line on: 0800 300 363. • Use local arrangements to make the appointment and, in case they want to talk to someone over the phone in the meantime, give the NHS Pregnancy Smoking Helpline number: 0800 1699 169. Also provide the local helpline number where one is available. • If her partner or others in the household smoke, suggest they contact NHS Stop Smoking Services. If no one smokes, give positive feedback. • At the next appointment, check if the woman took up her referral. If not, ask if she is interested in stopping smoking and offer another referral to the service. • If she accepts the referral, use local arrangements to make the appointment and give the NHS Pregnancy Smoking Helpline number: 0800 1699 169. Also provide the local helpline number where one is available. • if she declines the referral, accept the answer in an impartial manner, leave the offer of help open. Also highlight the flexible support that many NHS Stop Smoking Services offer pregnant women (for example, some offer home visits). • If the referral was taken up, provide feedback. Review at subsequent appointments, as appropriate. • Where appropriate, for each of the stages above record smoking status, CO level, whether a referral is accepted or declined and any feedback given. This should be recorded in the woman's hand-held record. If a hand-held record is not available locally, use local protocols to record this information.

What was measured: The proportion of mothers known to be non-smokers at time of delivery.
Data collection end: March 2014
86.6%
Number that met the criteria: 548203 / 632956
Data collection end: March 2015
85.6%
Number that met the criteria: 533178 / 622643
Data collection end: March 2016
86.2%
Number that met the criteria: 544282 / 631225
Data collection end: March 2017
87.5%
Number that met the criteria: 542096 / 619234
Data collection end: March 2018
89.2%
Number that met the criteria: 531595 / 607294
Data collection end: March 2019
89.4%
Number that met the criteria: 518596 / 591701
Area covered: England
Source: NHS Digital. Statistics on Women's Smoking Status at Time of Delivery, England.

What was measured: Proportion of women whose smoking status at time of delivery was known.
Data collection end: March 2015
97%
Number that met the criteria: 604057 / 622643
Area covered: England
Source: NHS Digital. Statistics on Women's Smoking Status at Time of Delivery, England.

What was measured: Of those women who are recorded as being current smokers at their booking visit, the proportion who are no longer smokers by the time of birth.
Data collection end: March 2016
19.5%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit



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