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?

Bunnyjo - but you didn't refuse did you? Because of the way the question is asked. I suspect almost noone refuses. This will be the same.

You won't ask the mother to do the test after asking the question. You will do the test first, then follow up with the questions afterwards.

Runnybottom - Do you mean not comparable? (I disagree obviously) ;)

I refused it last time as I knew my status.

I did mean not. I'm tired.

Actually The Coalition Needs You, I never said whether I accepted or refused the HIV test.

Secondly, in some PCT's the basic green pregnancy notes are filled in prior to seeing the midwife (at the first GP appointment to register the pregnancy for example). Unless there is a change of procedure across the board, there is a chance the mother will be asked the question before having the test.

I reiterate, I do feel the money, especially under the current climate, could be better spent elsewhere in antenatal testing.

Anniegetyourgun - unlike you, I know how difficult it is to give up smoking because - well surprise - I gave up smoking.

And I was a heavy smoker - loved me fags - not one of my friends and family would have thought I would have stopped - I'd also been one for shouting about how difficult it was to quit - boohoohoo, poor me. Oh - and I have absolutely NO will power.

The easy part of giving up smoking was as much as a surprise for me as anyone - it is as uncomfortable as giving up having a cake when your on a diet.

I am just so grateful and glad that I don't smoke anymore - it has saved me an absolute fortune and I don't breathe smoke over my littl'uns. I gave up the day I got a postitive pregnancy test and found my growing child all the motivation I needed for giving up a harmful, pointless and very expensive habit.

And rather than being a negative experience, it was overwhelmingly positive - you really feel like you can do anything if you give up a long term smoking habit - probably due to the fact that everyone constantly talks about how difficult it is to stop. And it motivated me to get fit too.

These NICE guidlines are going to help mums give up the fags for good - excellent, what a fabulous health service we have.

AND WILL PEOPLE PLEASE READ THE GUIDELINES - VERY USEFUL FOR EXPLAINING THE REASONS THEY ARE RECOMMENDING THE TESTS!!

What I wonder is why people smoke and why they can't give it up (having been a long-term smoker and having two out of three twenty-something offspring who smoke - though one may have stopped now).

Ok, it is an addiction but why do you need that 'fix' - purely the nicotine? why lower classes more than upper classes?

I suspect that, in my case, it was partly a sort of compensatory fix for feeling not in control of life and a sort of comfort blanket. So the lower classes (big generalisation) are more likely to need smoking than more assured upper classes.

Dealing with the psychology around the need to smoke would be a better bet.

Perhaps providing counselling for the addicted would do more to stop smoking (the shame of needing counselling (which is seen as being, in this country, for wooosses who can't cope) might do more to stop it).

I spent many weeks on the ante-natal ward in both pregnancies. Some of the other women there smoked- pretty reckless you might think if they were already in with pregnancy complications, but there it is. Naturally, the midwives gave a telling off to anyone they caught sneaking a fag outside the hospital entrance. Afaik they were not successful with a single one, the only effect was that the mothers felt less inclined to listen to midwives overall. I don't think embarrassing someone is necessarily going to make them stop what they are doing: if they feel stressed or challenged, they are quite likely to cling to their addiction even more. People can only stop an addictive habit if they want to. You are not necessarily going to make them want to by catching them out and proving they are liars.

(for the record, I have never smoked, so no personal axe to grind)

And I think the argument "I gave it up so it can't be that addictive" is totally specious. My MIL was a very heavy drinker. She stopped drinking when my FIL died. Does that mean that alcoholic addiction does not exist and that people only believe they can't stop drinking because others tell them so. Is it not more likely to simply mean that for whatever reason she was able to drink heavily without becoming addicted.

OFGS, smoking is addictive and you can have physical and many other reactions when you come off it, but the fact is SMOKING IS HARMFUL TO THE BABY!

So.... it's best if you give up.

The test serves no purpose in decresing smoking in pregnant women.

I was a smoker and I smoked during my second pregnancy. The midwife asked me at my booking in appt if I smoked and I said yes, I smoke two a day. She asked if I wanted help giving up and I answered honestly. I said no. An expensive test would have not told them any more than I told them and would have not increased the likelihood of me giving up smoking.

If someone was hs lied in that situation a test may uncover this HOWEVER, it is not going to make them more likely to quit smoking!!!

Cory - I have a lot more sympathy for drug and alchohol addicts. They are actually giving something up. Those drugs lift or depress your mood, allow you to escape from the possibly miserable life you are living etc. Though they can end up exacerbating the problems they are being used to escape from.

Nicotine does NONE of that. It is an entirely useless drug, which should be reserved for use as pesticide.

But smokers percieve that they have a beneficial effect, that they help with mood, or nerves, or whatever. Perception is everything.

It will cost a lot of money.

What will they do when they find out you have been smoking?

It is not illegal to smoke in pregnancy.

Women will simply stop going to midwife appointments.

The problem with smoking and the government (and government bodies) is that they really should make it illegal, but they won't because of finances. So they bring it ridiculous initiatives like this.

It is the psychological part of smoking that makes it harder to quit. I gave up 6 years ago and the physical cravings were relatively easy compared to the fact that I STILL dream about cigarettes even now.

I'm glad that I gave up, I don't wish that I still smoked, but it's incredibly difficult not to have "just one". Even though I know that if I did, it would taste like ass and I would hate it, the pull is quite something, even after 6 years.

thesecondcoming - when did you smoke in the second pregnancy? Was it a stress thing, a social thing or some other trigger?

There is a presumption that giving up is very difficult that is reinforced by the NRT industry and by social perception. It is much easier than is generally made out. It's not entirely trivial, but people telling themselves they are doing something very difficult is one of the reasons many of them fail.

To reiterate,

The advice says, and includes reasons and evidence for:-

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.

Pffft - that's a learned response rather than an addiction though - and comparativly easy to resist - unless people around you are constantly saying how hard it must be for you to resist!

I'd quite like some Ecstacy and a wank, but you know, I've got shit to do.

I dont 100percent agree with the tests but if you cant give up something for your own child's health then are you really ready to become a mother? When a baby is born you wouldnt stick a cigarette in its mouth or breathe smoke into their tiny faces. Something needs to be done about it!

stupid rubbish! Of course women should be advised of dangers of smoking whilst pregnant. Beyond that that should butt out! Would a breath test pick up if someone has smoked the previous day? And what if it did give a positive reading - smoking prison? Seems incredibly stupid to me.

I predict this will go the same way as HIP's and other 'well intended' but overly meddlesome govt policies.

Very frightening. If you want women to take responsibility for their own health and that of their unborn child, infantilising them by treating them as liars is NOT the way to do it.

And what if you refuse to do the test? If you're already on Social Services radar (for whatever reaon, possibly something as simple as a history of depression) then refusing would be described as 'not engaging with healthcare professionals' and counted against you.

SS already get care orders against unborn babies on the basis of neglect before birth (eg because of taking illegal drugs). How long before this is extended to include smoking during pregnancy?!

IMO it's also the first step down the slippery slope of compelling women to do things (eg be induced, have a C-section) against their will 'in the baby's best interests'.

natalia, you are missing the point. Can you provide an evidence-base stating that offering this test will decrease rates of maternal smoking? And can you confidently say that automatically treating all pregnant women as liars is not in the least bit likely to harm the client-scare provider relationship?

No-ones arguing that smoking when pregnant is sub-optimal, merely commenting that testing for it is both costly and possibly unhelpful for the relationship of trust between a woman and her mw.