Is NICE going too far?

[Sal321]

This BBC news story is about a suggestion by NICE (national institute for clinical excellence) that all pregnant women should be breath tested for smoking at their first MW appointment. I know I don't smoke, why should I be tested? I appreciate that I could refuse, but isn't this a bit of a weird recommendation?

oh and I meant to add, save those clever little machines for the anti-smoking programme clinics. Give the clients a test when they first book in there and show how the levels decrease over the weeks of the programme, nice and encouraging, like Weight Watchers. Then it would be useful.

The national health sevice is there for everybody. It is national. It is there for people who smoke, and also people who drink, take drugs, or judge other people till they poison themselves with their own bile. The criterion for being treated is that you are a UK national. That should be all.

For ideas about what to do if a woman fails the breath test, the govt could always use the ideas some US states apparently use for drinking in pregnancy, as mentioned in this article - lock 'em up

Lol @ Missedith01 :D

MissEdith01 - it's a service to society overall - not just to the individuals that make it up. Treatment (both medical and personal) of individuals needs to be based on what gives the best overall outcomes.

Alana, good article.... there's that slippery slope we were all anticipating )

ConstanceWearing - I don't think anyone has said it isn't and this advice doesn't say it isn't. The advice says:-

a) We want to reduce maternal smoking.
b) Interventions with pregnant women reduce rates of smoking
c) Many women lie about smoking
d) Testing, applied in the right way allows the women who would benefit from interventions to be identified more reliably.

I don't understand why this is so contentious.

TCHY I could object to all tests during pregnancy actually I have choice..coercion implys I have no choice and puts pressure on mothers you may be happy for MWs to do this but I'm sure some of them wont be...forcing mothers to become victims?...do you really think it would work forcing people??...and how would it work?..you test positive then what?...you cannot embarrass someone into giving up an addiciton my dear..

Women are entitled to smoke. They are entitle to lie about it too, unless they're in a court of law. They are not obliged to inform the government. It is contentious because it is invasive. They have no right to ask.

Mumcentreplus - see above for what the advice actually says. (well my summary)

Left to choose for themselves, people will drink and drive, smoke and drink during pregnancy, smoke and drink to excess, have sex in ways that limit their life chances and damage their health etc. etc.

Everyone pretty much agrees that we should try and coerce people out of doing these things. We just disagree on the degree of coercion.

Drink driving now has legal coercion, smoking and drinking have mainly social coercion.

Women who smoke during pregnancy SHOULD have pressure applied to them. There is no suggestion that this should lead to coercion beyond offering access to existing services.

I don't think I'd mind being asked:

'We've got a test that measures CO - it might be higher than is good for the baby if you live in a smoking household, or even as a result of leaky heating appliances -do you want this test?'

At which point I'd probably reply that neither dh nor I have smoked in years, but what the hell, the boiler might've Gone Bad...test me!

I would object strenuously to any form of testing without informed consent, which seems to be where this is going - mumbling about 'we're testing everyone for CO' without explaining why is v dodgy & unethical imo.

ConstanceWearing - Why do we not have a right to ask? It is relevant to the care they are provided.

Giving up smoking is MUCH easier than it is made out. There is a massive industry with a vested interest in making out that it is hard.

I've done what I said I would never do which is post without reading all the replies, so sorry if all of this has already been said.

I think that the new recommendation by NICE is unbelievably reckless. It has the potential to breakdown the relationship of trust between midwife and mother. I am going back to college in September and hope to train as a midwife, so I have been doing a lot of research into midwifery and I think I would feel extremely uncomfortable pressuring a mother into taking this test. I am well aware of the consequences of smoking during prengnacy and I do not smoke myself (neither does DH). I just really worry that this sort of testing is actually crossing the line...

IMO the money would be better spent on ante-natal testing such as GBS swabbing for mothers.

TCNY have you ever smoked?...

Bunnyjo - how do you feel about the standard HIV test? Surely this is much less contentious than that.

Mumcentreplus - Yes, I did for quite a few years.

oh right, TheCoalitionNeedsYou - if giving up smoking is so easy then why do people give up again and again? Why do people take such a long time to give up? It's not just myth or vested interest.

I've never smoked myself but I've watched people try to give up, some succeeding and some failing. I'm really glad I've never had to try - just cutting down on booze pre-TTC was hard enough. And that's not even addictive in the same way!

but was it really easy...why did you give up?...are you saying the addiction is all in peoples minds?...

"smoking causes autism and all sorts" WTF!!
I've never heard that one!!!

I've not bothered to look back at the autism points, but I'll just observe that if smoking causes autism, we would expect to see rates of autism falling as the rates of smoking are falling. Is this what we are seeing?

It's made harder by people being constantly told that it's hard. The physical craving only takes about 3 weeks to go. It's not THAT big a craving - it is, mainly in peoples minds - the physical addiction side is comparativly mild.

Its more a psychological addiction for many though.

And a HIV test is comparable. I may have HIV without knowing. I do not need a test to tell me if I smoke or not.

The Coalition Needs You, the HIV test was offered to me during both pregnancies, but there was absolutely no coercion and refusal wouldn't be questioned. WRT smoking, the midwife already asks the mother about her and the household smoking habits - so to request the mother to do a test afterwards is almost like saying 'I have heard your answers, but I don't believe you'.

I am a little at you comparing the test for smoking alongside the test for HIV, though.

I agree it could be relevant to the care mothers receive, in adverse circumstances. But that is not a sufficient reason to ask everybody surely? And I really do not believe that this is the reason they are asking. That's my basic objection.