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

I feel there should be a compulsory IQ test for NICE policy makers.

Spend the bloody money on breast screening.

Totally and utterly barmy. And I am sorry, there is no child to 'choose' anything.

I do agree with Horry that there could be a part for CO monitors for people who are quitting smoking.

If someone fully understands what the machine does, and chooses to be regularly tested while attempting to give up, it could be really motivating. Just like scales for dieters.

But that is not how the machine is currently being used. It's being used as a lie-detector.

The lies about checking for boiler fumes are properly dangerous, given that they might provide false reassurance.

Ugh, can't write today. That's a general comment about deceit-based processes: it's just a guess that the midwives have been fed the line about detecting dodgy gas appliances as both true and as a valid reason for testing CO.

To be generous to the midwives, my experience of deceit-based processes is that the front-end staff have themselves been lied to and manipulated, and are in good faith passing on the lies they have been told.

What I've learned from this thread.

Midwifes are required to assume the mother is lying, about smoking.

Many midwifes are themselves actually lying, about the function of the test.

Was trust supposed to be any part of this relationship?

Presumably if you say you smoke, and take the test, then as your smoking cessation goes on they can show what improvement you have made to your CO levels.

I don't know what the actual numbers are but say you scored 50 on booking, then 40 a month later, and dropped a few points at each SCS appointment you'd have a quantifiable measure of how much better you are doing.

I gather that some who cut down end up getting more CO/nicotine than before, because they make each cigarette last, take deeper drags, etc. So "from 20 to 5 a day" might not be a good indication of the difference to the baby as CO monitoring.

In an ideal world, those giving up could be lent a CO monitor to do frequent self-tests. Could be motivating.

Hi. I had this test but was told it was to make sure there were no leaks in my house! I'm a non smoker anyway. Just don't appreciate the odd reason given for the test!

Hi. I had this test but was told it was to make sure there were no leaks in my house! I'm a non smoker anyway. Just don't appreciate the odd reason given for the test!

dancing - as a chocaholic I really sympathize.
perhaps not as dangerous as smoking, but eating crap and being overweight is not good for my health either (pg or not), but it's hard to stop.

Oh dear Schro that's awful!

I'm lucky all my experiences were positive. I'd have likely told them to fuck off if they tried that with me!

I have read your pp and can't believe you were treated like that. Utterly atrocious.

I'm appalled at the lecturing and hectoring. As a smoker trying to give up I KNOW that what I am doing is stupid and dangerous. I can't imagine there is a smoker in the country who doesn't. But lecturing and hectoring make me feel bad about myself and guess what? That makes me want to smoke.

Lara I think that is the point. I was honest about smoking and was still told to do it, the monitor they use also tells you the amount of CO2 passing to the baby and I was lectured about this and made to feel utterly awful.

It was a very "look what you are doing and what you are passing to your child" type thing.

I did smoke when I fell pregnant. But I also wanted to quit so, when I went to my booking in appt., the MW asked if I smoked, I was completely honest and she referred me to the scs (I wasn't asked to do the test). I had a wonderful smoking cessation in pregnancy advisor, who came to my house every couple of weeks to see me! (And I did this test every time she did. Didn't occur to me that she was checking to see if I was telling the truth about not having smoked!)

However if I had been asked to do this test at the booking in appt. After having already admitting to smoking, I would have refused. I wonder how it would have worked in my case?

I'd already told her that I smoke, I knew that it was bad. I already knew I wanted to quit but needed help. What would be the point of doing this test? To make me feel even worse?

I did question it and expressed my wishes that I didn't want it.

Didn't matter though as they act as if it is mandatory. So yes, this story is reliable.

SarahHillWheeler it isn't imposed "legally". Its just something that the mw tells you is going to happen and because its in a 45min-hour appointment which includes blood tests and is in the first trimester when a lot of women feel rotten the vast majority will just do it.

If you want to question "authority" then you might not do, but it certainly didn't occur to me to do so, it was only afterwards that I wondered why they hadn't taken my word for it because I was trying not to vomit on the mw, making informed decisions wasn't exactly something I was up to. If I was to get pregnant now, knowing the test was likely to happen in the booking appointment then I would probably refuse it as I don't want to contribute to mass data collection without consent.

I don't know how reliable this story is. Legally, I doubt very much whether such a test could be imposed.

If it is voluntary, why not just ask the mother-to-be? If you can't rely upon her to answer that one truthfully, chances are she isn't going to tackle a giving-up smoking programme or other health initiatives particularly well.

At the end of the day, you have got to work with the mother, and this wouldn't get things off to a very good start.

If true, sounds like a terrific waste of money!

Ridiculous idea. I have never smoked and would feel insulted for my word not to be taken without evidence. If someone is going to lie about smoking and the smell of their clothes and hair wasn't obvious, they are unlikely to decide to give up as they have been 'found out' from the test. Why should a cash-strapped NHS fund a pointless test, when I'm sure midwives have enough to do. It wouldn't exactly do a great deal for midwife/ patient relationships.

Just to clarify: I'm not disputing that a false positive could be obtained. Rather, I am querying how they could identify a false positive, given that the easiest way to do so would be to ask the woman whether she smokes or not and prioritise her response when comparing it to the test results. Yet, it seems that her answer to the question 'do you smoke?' is not to be believed, hence the 'need' for this test. By testing in this way, they are stating that test results are to be given greater weight than a woman's statement.

From a (cursory) look at the literature on smoking cessation and pregnancy, it seems that CO testing is acknowledged to not be particularly reliable:

a) false positives - pollution, passive smoking, co poisoning (you could argue that passive smoking isn't a false positive since that's a health risk in itself)

b) false negatives - the levels of co drop to normal if the person being tested hasn't smoked in a relatively short period of time (think it's 12 hours or so).

They can test cotinine levels instead but this is a more invasive and expensive test. It also shows that self-report is unreliable though (similar 25% figure) and the main reason seems to be social stigma re: pregnant women smoking.

I can't see the point of doing it if they're getting a significant number of false positives.

But it seems that part of the (unstated) reason for doing this test is that a woman's report of whether or not she smokes is untrustworthy (if she is to be believed, the MW would just ask the question and tick the box), so it seems hard to fathom how they could determine that a false positive had been obtained. What else could you measure it against, other than a woman's self-report, which is not to be believed?

Patchouli - how does this test tell MWs anything about placental function or help inform them about advice for 'going overdue!?

Placentas can fail at 37 weeks in non-smoking, healthy women. They can still be strong and performing well at 42 weeks.

ALL this test tells you is if the woman has smoked recently. Not that her boiler is faulty. It won't magically make her stop smoking if she's a smoker. A few pence on a disposable tube at every booking in appt will cost the NHS millions but won't save the equivalent amount through not having to treat the effects of smoking.

Agreed, sleepyhead. I think MNHQ should invite those making the recommendations on for a web chat.

Well it did get me stressing about our air pollution and how it was affecting the kids! We now live outside the city, it would be interesting to see if I took a test again whether I would still get a positive. However I have NO intention of having another baby so won't be doing this again...

Actually I didn't mind taking the test (well, given I thought it would be clear); and although I was bothered about the outcome from the point of view of my health/children's health, I didn't think much more about it. However if I'd been young, less confident, other reasons for prejudiced views as to my likely honesty, would I have been made to feel like a fraud?

I do worry about how statistics can be 'translated' at times, given they are usually used to back up a theory rather than showing ALL the evidence.