Having food/drink policed whilst pregnant

[ForTheSakeOfFuck]

About three weeks ago, buying a full English takeout for OH...
Cook: "How do you want your eggs?"
Me: "Runny please."
Cook: "Ooooh... you know you shouldn't have runny eggs whilst pregnant. I'll fry it till it's hard." vanishes back into kitchen before I can stop her

Last week, in a pub garden with me, SIL, and OH...
Waiting staff: "What drinks do you want?"
Me: "Two white wines and a coke please."
waiting person returns with drinks
Waiting staff, trying to figure out who to give the drinks to, obviously concludes the wines are for me and SIL: "Ummm... did you want something else? I mean because... you know..."
Me: slightly confused stare since I hadn't twigged yet
Waiting staff: "Is the wine for you?"
Me: "No. It's for MIL else who's arriving imminently. I have a bottle of water in my bag."
Waiting staff: "Oh phew! For a minute there I thought you were going to drink whilst pregnant!" chuckles her way back inside

Today, in Spar, buying my lunch, along with three high-protein peanut bar snack things which actually, for once, are for me, and I've checked with the obstetrician that it's okay for me to eat these since I'm otherwise low on protein in my diet...
Checkout woman, looking at me, very deliberately at my bump, and then at the nutritional content on the bars, literally reading the guidance on there: "Are you allowed to eat these?? I don't think these are okay during pregnancy."
Me in a pretty flat, unimpressed voice: "Are you an obstetrician?"
Checkout woman: "... A what?"
Me: "A specialist in fetal development."
Checkout woman: "... Er... no...?"
awkward silence whilst she scans, I pay, and leave

Sat here, now, chomping on a maple and peanut bar, I feel like a bit of an arsehole in retrospect. So... WIBU to get a bit shirty with the checkout woman?

It's just the 'how very dare they' reaction that gets me. This test is saving lives. If people weren't so harsh towards pregnant smokers this test wouldn't be needed in the first place because women would not be too ashamed to seek help.

Smoking rates are decreasing in this country anyway quite rapidly with the introduction of e-cigarettes so the decrease is not necessarily due to CO testing.
I think the "how very dare they" reaction is over the fact that some women are pressurised into having the tests or are not giving informed consent at all. Whilst this is the fault of those doing the tests rather than the tests themselves or even the policy it is still a big issue.

I'm now feeling pretty annoyed about the CO test. I did one at my booking appointment a couple of weeks ago but so much else going on I didn't really give it much thought. Yes I used to smoke but, as I told the midwife, my last cigarette was in 2009(!) and we also have a CO monitor at home. I didn't give it a second thought until I read the discussion on the thread.

I should say, having read the discussion, I don't feel like my consent to the test was informed since it appears the motivation is to find out smokers rather than faulty boilers as was suggested to me.

Indeed roomster. Informed consent is a colossal issue here and an airy 'a complaint to PALS is in order' won't really do. It must be obvious that the women most likely to feel and indeed be pressured into taking the test are going to be the ones least likely to feel confident and comfortable raising the issue? Or indeed to know that PALS are there. I've looked to PALS for help myself in the past and was pleased with the result, but the abilities and advantages that enabled me to do that are the very same things that would make me most likely to be able to give or refuse informed consent in the first place.

While I was encouraged to see the pp stating that informed consent is absolutely required, the structures we have in place at the moment aren't facilitating it. That matters.

Also, this bit:

If people weren't so harsh towards pregnant smokers this test wouldn't be needed in the first place because women would not be too ashamed to seek help.

...doesn't really fit with the stuff about faulty household appliances, cars etc. If the test is genuinely universally needed because there are sufficient pregnant women who don't smoke/live with a smoker but who have high and fixable CO levels to justify it, then it's needed because of that. If it isn't, then the stigma argument comes into play, but if that's the case then women are being misled when they're told it's needed in case of household appliances etc.

Again, informed consent.

I can see why you feel that way MaryThorne. I read the RCM link provided upthread about the tests and it states the following:

NICE recommends that a carbon monoxide (CO) screening service is included within the antenatal care package for all pregnant women (NICE, 2010). This is advocated because annually more than 91,000 babies born in England are exposed to tobacco smoke in utero (Department of Health (DH), 2011a), most of whom are born to young and disadvantaged women (Bolling et al, 2007). Additionally, one in four pregnant women who do not smoke may be exposed to second-hand smoke at home (Bolling et al, 2007).

They go on to mention accidental CO poisoning, but it's interesting that no figures are given. The RCM's own analysis says it's because of exposure to cigarette smoke. And yet you don't appear to have been told this.

They also talk about the need for midwives to facilitate informed consent, choice and refusal. Which sounds great, but yours evidently didn't.

I should say, having read the discussion, I don't feel like my consent to the test was informed since it appears the motivation is to find out smokers rather than faulty boilers as was suggested to me.

Exactly. I find the reasoning given for the test very disingenuous. I doubt very much that there are any resources given to finding the source of CO if the result is positive. It will just be assumed that the woman is a smoker. If they are testing for smokers and if they will assume that you are a smoker if the test is positive, then they should say so.

I think the CO testing is fairly typical of the way pregnant women are treated. I also find the suggestion that a single drop of alcohol may be harmful quite patronising/insulting to intelligence. If that was the case, then a large proportion of older teenagers/adults would have FAS as the guidance used to state alcohol in moderation (one or two units once or twice a week) was okay. They changed it because they thought that silly pregnant women didn't understand the difference between a couple of units a week and copious quantities of alcohol.

YWNU. When pregnant everyone seems to think they have a right to comment and advise judge you on how things should or should not be done.
When I was pregnant with DS I had a colleague who went apeshit at me for smoking and told me about how my child was going to be stillborn or born with all sorts of disabilities. The woman literally screamed all of this at me whilst others stopped and stared at us wondering what was going on. When she finally took a breath I quietly and simply told her that the pack of cigs I was holding were for my friend who was in the toilets, hence why I'm also holding her phone whilst I'm stood outside the loos waiting for her to come out.
I also told her that if I wanted to smoke that would be my business so she should mind her fucking own, not that I ever even dreamed of smoking whilst pregnant, but that wasn't the point.

I'd have understood her rant a bit more if I was stood outside having a cig, but I was just stood holding a packet whilst still indoors,

Summerisdone what a horrible woman drawing attention to you like that!! I hope she felt embarrassed afterwards??
Thing is, even if I SAW a pregnant woman smoking, I would not feel the need to say anything to her as it is none of my damn business!! This is what is even more frustrating - why do people feel the need to say something and why can't they just mind their own fucking business?!

Wanking Monkey, your midwife was talking shit! I was advised on good authority nearly 10 years ago that the reason Guinness was thought to be full of iron and good for anaemia was because it used to be stored in metal barrels and absorbed iron. The method changed many years ago and no no more iron than most brewed alcohol. However back in the day when there was more poverty and mothers often lacked good nutrition (or gave their DHs and DC the best of the food) Guiness was a good source of calories -- something we don't lack now.

Smoking rates generally are decreasing and ecigs are helping a lot. Rates are not generally decreasing by 1/3 in 3 months though! Those are astonishingly good figures. The general rate of decrease is about 1% in a good year.

The 'how very dare you' reactions are absolutely about the suggestion that pg women might be smokers. There are enough comments just on this thread to bear that out.

Obviously it's an issue if people are not being properly informed about this test because informed consent is the absolute cornerstone of medical practice. How can we tackle that while not undoing the massive amount of good this programme is achieving?

'How can we tackle that while not undoing the massive amount of good this programme is achieving?'

But there's no conclusive evidence this programme is doing 'a massive amount of good'.

The 'how very dare you' reactions are absolutely about the suggestion that pg women might be smokers. There are enough comments just on this thread to bear that out.

No, they're about the suggestion that pregnant women who say they're not smokers are being disbelieved and told they need a test to check, and the pregnant women whose informed consent isn't being facilitated. There are enough comments just on this thread to bear that out.

Couple of studies here: In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.

and here: After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12).

NICE say: 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 (one [++] and one [+]) 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.

What sort of evidence would satisfy you?

I mean, the problem is that for this test to be effective in reducing stigma, women have to then be misled about what the primary purpose of it is. Because there really doesn't seem to be any indication that the small possibility of CO poisoning is why this has been rolled out universally, or would justify universal rollout.

Evidence that lying to women or operating on an assumption that they are lying is leading to a decrease in pregnant women smoking, Pencil, when in fact smoking rates across the UK are falling.

*Couple of studies here: In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation

The main difference in this study seems to be that in the old (opt-in) system women were asked if they smoked and then asked if they would like to be referred. In the new system however, all women were tested rather than asked and they were lied to regarding the real purpose of the test. Then they were all routinely referred to a smoking cessation without letting them know they can refuse. Only those women who "spontaneously" refused i.e. realised they had a choice were not referred.
I'm not surprised it increased referral rates but it doesn't mean that smoking was ultimately reduced and it does mean that women weren't giving informed consent for the CO test or the referral.

Couple of studies here: In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation

The main difference in this study seems to be that in the old (opt-in) system women were asked if they smoked and then asked if they would like to be referred. In the new system however, all women were tested rather than asked and they were lied to regarding the real purpose of the test. Then they were all routinely referred to a smoking cessation without letting them know they can refuse. Only those women who "spontaneously" refused i.e. realised they had a choice were not referred.
I'm not surprised it increased referral rates but it doesn't mean that smoking was ultimately reduced and it does mean that women weren't giving informed consent for the CO test or the referral.

I was told what the CO test was for and took the test anyway. I have nothing to hide and so it didn't bother me. I think it read around 2 or 3 (can't remember exactly) and the midwife just said that it would be traffic pollution and moved on. Nothing more was said about it.

Yes roomster I thought it quite telling that the NICE comments didn't deal with informed consent, only about how to more accurately identify pregnant smokers. Nothing on what needed to be said and to who, in order to be able to do that!

If you want to take it 10storey that's up to you. That's informed consent.

Not by 1/3 in 3 months! As I said not many posts above this one, the usual rate of reduction is about 1% a year in a good year.

I get it, people don't like the idea of this test. The fact is though that pregnant smokers do lie - I did. The sense of shame was just too immense to admit it. So I carried on smoking throughout pregnancy in secret. I was lucky, DD was born small but healthy and has grown up without obvious health issues.

Clearly it's easier for some women to breathe wordlessly into a tube than to actually say the words 'yes, I smoke'.

In my ideal world () -

• everybody would be fully informed about what this test is for and their choice to decline would be respectfully accepted.

• the vast majority of women would decide to take the test and treat it as utterly routine, in the knowledge that by doing so they were helping reduce stigma and make it more possible for pregnant smokers to get the help they need.

• Nobody would be going 'how dare they even suggest it, they're treating me like a criminal' because that is deeply unhelpful.

The other intervention that has been found to be highly successful in reducing smoking in pregnancy is to pay women to quit. People don't like that either.

I'd like to hear what better suggestions people have for reducing the figures (10.2% at delivery according to the latest stats. Overwhelmingly women who are poor and/or with MH issues). TBH I'm finding it increasingly difficult to treat people's attitudes to this problem in good faith. I get the impression a lot of people are more interested in being judgmental or outraged at pregnant smokers than they are in actually finding a solution or supporting solutions that have been shown to work.

but it doesn't mean that smoking was ultimately reduced

But the studies show that smoking was reduced

Can I just ask (shit connection so can't be bothered even beginning to try googling this) - how was a "successful quitter" identified? Was this through another CO test? Or through self-disclosure? If self-disclosure, I would be taking any figures proffered with a shovel full of salt.

- Nobody would be going 'how dare they even suggest it, they're treating me like a criminal' because that is deeply unhelpful.

That's indicative of a problem with your ideal world rather than anything else pencils. Women are more than entitled to object to being put in a position where they have to refuse a test that is primarily aimed at checking on whether they're lying or not.

To be quite honest I'm finding your claimed support of informed consent rather lukewarm. You say you're for it, but then you pepper your posts with problematisation of women's objections, dismissive remarks and minimisation.

Personally I have no problems paying, but even if I did, the fact that this test is ethically problematic wouldn't oblige me to come up with a better suggestion. Women's informed consent isn't something we should only be allowed if we can think of ways to improve healthcare outcomes without it.

Best stats use CO tests to identify successful quitters. I haven't drilled down in these studies far enough to see if that's what they used but figures will have come from stop smoking services they were referred to, not midwifery. SSS usually use CO tests to verify success because, among other reasons, a low CO result buoys a quitter up and encourages them to keep going so it tends to be done at every appointment.

Stopping smoking is fucking tough and most don't manage it on any particular quit attempt but the best success rates are for people who use SSS together with additional support - NRT, ecig or champix (can't use champix in pregnancy though). So it's a small chance but unless they access that support they have a far lower chance of successfully quitting.

If you want to dispute SSS success rates that's a whole nother thread about where tax payers' money goes.