Pregnant women should take 'smoking test': what do you think?

Holey :( I think there must be a serious problem with some of the maternity services in Glasgow. A lot of the staff seem to lack any compassion.

I do wonder if it is because we have such a high rate of drug addicts here and being used to being lied too? The staff sometimes seem numbed to actual problems.

They are already here. The results are compared with a chart (red, amber, green). And also how much the fetus is getting.

Women who smoke are offered contact with smoking cessation midwife throughout the pregnancy.

Like all tests in pregnancy it is optional but I don't know how many women know it is.

Had I refused the smoking test, I would have regretted it as they would probably have assumed I had lied about smoking. However having had the test made no difference - they still found a way to make it something I had done wrong.

Even if I had been an anorexic smoker I would still have deserved adequate care and compassion. But they did not have the resources.

I have never smoked, passed the test but was still blamed by midwives as my baby did not grow well. As I had no risk factors and was not overweight, they decided I must have caused the problems by dieting. They clearly thought I was lying as I once had ketones in my urine. I never tried to control my weight.

This was also in Glasgow, which seems to be a theme on these threads.

lem

Out of interest, why did you refuse the HIV test?

I had this test at my booking in appointment in April (sadly miscarried at 11+4 a couple of weeks ago).

I am a non-smoker and found it quite intrusive. Felt like I had to prove something, as if my word was not enough. There was some mention of faulty boilers

As already mentioned upthread , I suspect that those who might lie about their smoking might not be those most receptive to assistance in stopping.

I refused the HIV test - they did it anyway

I am the first person to judge someone who smokes (pregnant or not!), so i obviously don't smoke. I would absolutely tell them to fuck off to fuck - it is the most ridiculous idea I have ever heard. But obviously the NHS has all this excess money it has to get rid of so you can't blame them really

Vinegar, you're an ob aren't you? What are your thoughts on referring women on the basis of a CO test who claim to be non-smokers and giving them nicotine? It sounds bonkers to me but I'm a lay person.

Group B strep is not tested for because there is no evidence to show screening has any benefit (because many women carry it at various points in pregnancy but don't happen to have it during labour and vice versa). It is nothing to do with money saving.

Maybe they should do the Group B Strep test for all women, as that kills babies needlessly every year and one simple test could save them, but no they are wasting money on this! Another nanny state intrusion, where a simple question about smoking would do!

I believe it is wrong to have a nosey into a womans life in such away, surely if smoking is an issue a pregnant woman is dealing with she should feel able to come forward without need for intrusion such as this smoking test. I think there is too much intrusion nowadays, although the health of baby is of upmost importance, the lady should not feel she has to be poked and prodded for answers!
The hiv test is one i always feel forced into participating in, although i have only slept with one partner for 8 years! If you dare say no, the questions start!

The HIV test (whilst I agree it has to be a choice) is in a slightly different category. You may not know you've got it and there are specific health measures that should be taken when the baby is born. So I would put this in the general category of screening. Screening tests for things you may have but you don't know. Smoking is by definition not one of those!

If people living with smokers wanted to take the test to demonstrate their CO levels were higher than average as proof that their fellow smokers should at least alter their habits (smoke outside or whatever) - fine. But surely just 'catching' people who've said they don't smoke but test positive is an invasion of their privacy or preying on people?

I would flat out refuse this test, and I hate smoking.

FFS. NO a million times NO. Is there actually anyone left on the planet who doesn't know smoking in pregnancy is bad? Can't the bloody midwife not just use her nose?

I went to my GP at 7 months PG with a ricked neck. First question: have you still given up smoking?

I gave up smoking 2 years before conceiving.

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.

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 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.

According to a quick check of the NICE website, this already is guidance and has been since 2010:

publications.nice.org.uk/quitting-smoking-in-pregnancy-and-following-childbirth-ph26/recommendations#recommendation-1-identifying-pregnant-women-who-smoke-and-referring-them-to-nhs-stop-smoking

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."

Really though If a woman continues to smoke during pregnancy it is no one else's business.

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.

Why bother? if they're thick enough to smoke how could this stop them? The help is out there already.

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.