Pregnant women should take 'smoking test': what do you think?(484 Posts)
There are reports in a couple of papers today (here and here - paywall) that NICE has recommended that all pregnant women be given a carbon monoxide test by their midwife in early pregnancy - effectively, a smoking test. If they test positive, the idea is that the midwife will signpost them to NHS smoking cessation services. The Royal College of Midwives is quoted as saying that they think the idea will adversely affect the relationship between women and their midwives.
We're getting asked what you all think about this - so do please let us know!
That is mad Schro. Isn't Nicotine actually a poison? Am I right in thinking that the NHS is giving pregnant woman who don't smoke a poison because of the results of this test?
As for the "we will allow you/we will not allow you" comments from HCPs, that's totally fucking rude and should be banned. If there's any allowing going on, it should be from a woman giving informed consent not by some militant jobsworth midwife
The more and more shit like this they keep coming up with, the less and less I want to quit smoking.
And I didn't really want to quit anyway. Quite enjoy it. NICE are just pushing me even further away really
I thought this test was the norm. During all pregnancies I've had it tested at booking in appt, so has my DH (we're in Scotland).
Really didn't bother me as neither of us smoke (I was still referred to smoking sensation despite this - think it was a mistake).
Apparently the nicotine is harmless, it's just the rest of the cigarette they're bothered about.
Uck, it's fine. I realise that the NHS MWs are over stretched and probably have targets to hit to get people to take these tests.
K8 I actually said that to the MW who made me take the HIV test, that she could do it as she obviously wasn't taking no for an answer but I do not want to consent to it and feel forced, I said those words and she said "are you sure, that's great. We'll just do that now then" After accusing my DP of being a cheat shagging about.
The community mws have been lovely though.
Logan I forgot about that, yes DP was convinced to take the test as well.
Also in Scotland
I'd love to see NICE's rationale for this recommendation. As a HCP and a pregnant woman (non-smoker) I can't see any benefit to the health of either the mother or the baby in this, or how it could possibly improve therapeutic relationship-building between woman and midwife. CO2 tests are already used as part of the smoking cessation service, and in that context they are extremely useful, but I think the current system of providing information and allowing women to make their own decisions using that information is how it should be.
I think this is outrageous - why aren't pregnant women being trusted to tell the truth?
Sunny It's not just the Mothers though, it's the partners too. In my experience with the hospital booking in MWs they seem to think that every soon to be parent is a cheating, lying promiscuous idiot.
False positives would concern me. When I was pregnant, my job exposed me to passive smoke (visiting people, some of whom smoked, in their homes at a stressful time of their lives).
If this passive smoking was picked up by the test, it is possible I would have been considered to be a liar. If a midwife doesn't then trust her client, she may well be less likely to take concerns and symptoms seriously which could lead to serious consequences.
Here's a wild and crazy thought. Why not just ask?
Too out there?
I think this is invasive - I would refuse and I am a non smoker and have never smoked
I am all for helping pregnant women quit smoking, but enforcing it this way just starts the relationship between midwife and patient out on the wrong foot. Women need to feel comfortable discussing any worries with their midwife and they're not going to be comfortable if they feel like naughty children.
Ok I've just looked it up. Nicotine crosses the placenta and there do seem to be issues with it so this looks like an even worse idea than I suspected.
I am looking up Cochrane reviews now. Will be back.
Schro, where the fuck are you in Scotland?
I refused a few things during pregnancy and was never made to feel bad or forced into anything.
They can't make you do anything that you don't consent to, just refuse.
Glasgow, this was at the Southern general but the annoying smoking cessation people were at my local health centre.
The rest of the MWs I have met at the SG have been nice though and the community MWs and HB ones have been lovely.
Bumbolina tbf if a woman is making an informed choice to keep smoking when pregnant and not try to stop then it is unlikely she cares too much about the UNBORN baby's right to choice. In any case an unborn baby cannot choose either way so I honestly don't see the relevance there.
I am in no way saying that I think it is ok to smoke during pregnancy, I actually think it is stupid and selfish, BUT it is also the choice of the mother and a woman's right to autonomy over her own body should not be taken away for any reason.
Why bother? if they're thick enough to smoke how could this stop them? The help is out there already.
I would have refused this test. I don't smoke, didn't smoke when pregnant, and would have resented the suggestion that I was lying.
I think it is OK for midwives to offer this test to women - some might find it useful, I suppose, as a spur to stop smoking - but if midwives are going to insist, or to force it on women (as has happened to women on this thread) then that is appalling and those midwives should be disciplined for this.
Really though If a woman continues to smoke during pregnancy it is no one else's business.
According to a quick check of the NICE website, this already is guidance and has been since 2010:
This was specific guidance on smoking in pregnancy. The guidance currently in development, and referred to by the Daily Mail is broader in reach about smoking cessation in acute, maternity, and mental health services.
This guidance in development is currently out to consultation, but references the previous guidance about a CO check.
I don't agree with this guidance, and find it surprising that it doesn't reference giving women a choice to opt out of the CO test, but does about the smoking cessation referral (although they must be asked about it at every subsequent appointment too...)
They say the evidence they have used to make this recommendation is that the CO test picks up more pregnant smokers who can be referred to smoking cessation clinics, not that this ultimately leads to them quitting:
"There is good evidence that women in the UK under-report smoking during pregnancy and that CO monitoring can aid in the identification of pregnant smokers. Two studies found that around one in four pregnant women in the west of Scotland do not accurately disclose their smoking status when asked during the booking visit with a midwife. One of these studies described how routine CO monitoring in antenatal clinics, if implemented consistently, can improve the accurate identification of pregnant smokers and facilitate referral to smoking cessation services."
Well it hadn't been widely implemented before, then! I have has two Pgs since 2010 and not been asked to do the test.
I remember hearing a similar news story when I was pregnant with DD2 in 2010/2011. The criticisms were very much the same as they are now. I was never asked to do a test for it but I was prepared to tell them where to stick it.
I have serious concerns about the advice and guidance being given at the smoking cessation services. If the action that is taken as a result of the test is to refer people to the service then the effectiveness of the advice and medications offered is very relevant.
According to a Cochrane Review of Drug treatments for stopping smoking in pregnancy there just isn't enough evidence to know if nicotine in pregnancy is safe but more worryingly, there is not enough evidence to know if the treatment has any effect.
From that review:
Medications to help stop smoking include nicotine replacement therapy (NRT), bupropion and varenicline, which are widely used and effective outside of pregnancy. However, little is known about their safety or effectiveness when used by pregnant women to help them stop smoking. NRT can be offered to smokers who have been unable to quit smoking using other methods as it delivers medicinal nicotine and obtaining nicotine from NRT is likely to be safer than from smoking tobacco. NRT is metabolised a lot faster by pregnant women, which means that higher doses are likely to be needed. This review sought evidence for the efficacy and safety of any smoking cessation drugs when used in pregnancy, but found only six randomised studies that enrolled 1745 women trialling NRT. These studies provided insufficient evidence to conclude whether or not NRT is effective in helping the women to stop smoking in later pregnancy (determined between 20 and 28 weeks' gestation in one study and at or after 32 weeks' in the others). The studies also provided insufficient evidence to conclude whether or not NRT had either positive or negative impacts on rates of miscarriage, stillbirth, preterm birth (less than 37 weeks'), low birthweight (less than 2500 g), admissions of babies to neonatal intensive care or neonatal deaths or whether this affected mean birthweights amongst infants. NRT can result in adverse effects such as headache and nausea and also local reactions (e.g. skin irritation from patches or foul taste from gum). Where adherence was reported, this was generally low as the majority of participants in the studies did not use complete courses of NRT. The included trials were generally of a high standard and three used a placebo. More research evidence is needed.
I think this is dreadful. I work in healthcare and always tell people it is only worth taking any test if the result is going to encourage you to follow a different course of action or change behaviour in some way. No-one ever successfully gives up unless they want to so to try to force people into something is ludicrous.
Having said that, the smoking cessation folk are evangelical and dogmatic in my experience. I have had patients cut down from 30+ to less than 5 per day and been told by scs that I should have pushed them harder or refused to prescribe. There was no acknowledgement of the achievement of reducing that much or the health benefits of that, in their eyes it was a failure as not a total quit.
Message withdrawn at poster's request.
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