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?

I thought the 'freaks' only came out at night?

Maybe NICE are suggesting this as part of a wider research programme to check whether people tell the truth re. smoking. It may show a discrepency between the actual number of smokers and those who say they aren't smoking, but are. This may lead to an improvement of stop smoking services and the way help is offered to smokers. I think it's a bad idea though as it will prompt people to feel patronised by hcp's and damage early relationships between women and midwives. Also to test people or carry out any procedure or intervention without at least implied consent is illegal and considered assault I believe.

well i have been a smoker and gave up for pregnancy, i would have been interested to do this just so i could see how quickly my levels drop. OFFERING it is one thing, but making women do it! that would have been met with a FUCK off from me.

and re blood tests, the tests for hiv etc are OFFERED you dont have to have them, i did with my first four and now on baby no 5 i didnt bother, purely because i am with the same partner, he hasnt slept around, nor have i etc and i have crap veins so they always struggle taking blood.

i was negative when i had my last child 2 yrs ago and have reason to think ihave been exposed so didnt bother this time and the midwife agreed it didnt seem necessary.

all tests and checks etc during pregnancy CAN be refused, but obviously most choose to have them.

any kind of enforced medical treatment etc is wrong.

love belgos suggestion re testing dads too and passive smoking - yes indeed! couldn't agree more.

Though actually not sure about testing anyone really. NOt sure what it achieves. Obviously anything that reduces numbers of pregnant women smoking is good, but I am not sure how the testing will prove that, I think it might just put the very people who maybe NICE are trying to help, off going to their appointments thereby missing out on a whole lot of other essential ante natal health care and advice.

Maybe better that midwives have a chat with everyone about smoking in a non judgmental way, educate people to decide to stop themselves, rather than weirdo testing.

I don't know what everyone else found, but not one of the many many mdwives I saw during any of my pregnancies seemed to give me advice on anything like that. Like with first Dc, I was very young, and they asked 'are you going to breast or bottle feed' and I said I didn't really know,wasn't sure about any of it and so she said 'I'll put you down as don't know then' - no info about breastfeeding, nothing! So maybe midwives need to up their game in terms of giving out the info on smoking and lots of other things too, rather than simply recording information about the mum, trying to make her improve her health.

The difference that I found between the smoking test and the std tests were that you are offered the std tests and you are asked whether you want to have them or not.

With the smoking test, I wasn't asked if I wanted it, as soon as I arrived at my booking in appointment I was asked to go behind a screen and told that "we're giving all women a carbon monoxide test, so if you blow in to this tube".

I'm not a smoker, but I think the way it is being handled is bullying and unethical. My husband was with me and he thought the same.

When I was on main delivery on the 2nd floor, I was above the smoking shelter! how nasty was that and seeing full term mums puffing away just shocks me.

There is more education now than ever on the damage its causes and who has to pick up the pieces for these children suffering from asthma, bad chests, glue ear and other conditions - the NHS by the tax payer - so many people think that the NHS is free - its not!

So what else can the state do?

I would point blank refuse on principle to be tested on this or any other "lifestyle" choice which is not medically necessary. This is only the thin end of the wedge. Hospitals are already taking baby DNA samples without the proper informed consent of the parents.

I think it's a great idea myself. All the adults in the UK need to be treated like infants, and be tested for anything they might be doing that may harm themselves or others. It should also be assumed that no adult in the country is capable of:

Eating correctly (five a day!!)
Driving properly
Drinking responsibly
Feeding their kids healthy food
Crossing the road safely
Protecting themselves from sunburn
Going out at night and not getting onto a fight
Remembering that sex without consent is rape
etc....

Vast amounts of public money should be spent on informing the population how to go about living. Then we can all be safe, safe as houses.

very sarcastic emoticon

I think this is a terrible idea. I already felt patronised and infantilised by the way I was treated by some medical practitioners during pregnancy, but this would be taking it to the extreme. If, as a responsible adult, I am asked by another responsible adult if I smoke, and I say I don't, I expect to be believed and respected!

This is just mad! Almost unbelievable that it could happen.

There are so many things that irresponsible parents do to adversely affect their children, born and unborn, why on earth introduce this silly test for smoking in a way that is unlikely to reduce numbers doing it but is an infringement on the rights of every pregnant woman?

What next? A breathalyser on your booking-in visit too?

As a lifelong non-smoker who detests being around smoke, I would much prefer no-one smoked, let alone pregnant women but I just can't understand how this test is going to bring about any good at all.

I would refuse the test. God, I'm annoyed at even the thought of it!

Apologies if I've just repeated everything that's already been said, I've only skim-read the middle posts.

fragola - you could have quite clearly refused that test.

And snobear I do hear you, but I have worked in the past with very socially underprivileged people who really wanted to do their best for their kids but simply did not know how, government campaigns like 5 a day have really helped raise awareness among groups who would really struggle otherwise to know how to feed their kids properly. IT seems patronising when you - like you do - quite clearly know what you are doing, but when you don't, I think it is actually really beneficial.

I agree with the suggestion that it could be offered as optional, as it could, for example, be useful to show the baby's father or other household members how passive smoking could be affecting the baby. Everyone knows smoking and most probably drinking is not the best idea in pregnancy and what the effects are, but women have been having babies for centuries and have happily been eating nuts, cheese and cured meat with no ill effects in the majority of cases (sure, bagged salad is only a recent invention). IMHO the government's money would be better spent on eliminating the following major causes of harm to women and children: (a) domestic violence, (b) road traffic accidents, (c) suicide and (d) complications of childbirth.

I got offered this test at my booking appt at the hospital, (Glasgow), not that I have ever smoked in my life! Was very surprised, as I had never heard about such a test before. It was actually very clever and midwife could even tell by my low levels that I hadn't been out much recently (v.bad morning sickness). If your reading was high, you were referred to a 'specialist' team to help. Suppose it can only be a good thing but on the other hand people should stop because they want to and perhaps the NHS should stop wasting money on the rest. Pretty sure we all know the risks by now.

I think that there is something to be said for an anonymous screening programme to try and establish real levels of smoking amongst pregnant women. I don't smoke, but I did have the odd glass of wine (we're talking 1-2 a month, max) and I told my midwife I didn't touch a drop because I couldn't be bothered with a lecture. That must be multiplied a million times for stuff women know is dangerous. I'd blow into a tube anonymously for data collection so that services could be improved.

If they asked me to be tested in these circumstances I would tell them to naff off. I am not a child and do not need to be treated like one. It's another example of the "you women can't really be trusted" attitude that I ranted about re goats cheese on a thread this week.

As others have said, this will just encourage women who need help not to go to appointments. What a massive own goal.

fathersday I think you underestimate the intelligence of 'socially underprivileged people'...

I think there is a clear distinction, though, between saying "This is a test we'd like to do, is that OK?", which is asking for genuine consent, and saying "We are doing this test." which puts the onus on you to say "Hooooooooooold on just one moment, I don't think you are..."

Tattyhead78's analogy is a good one, I think. Domestic violence in pregnancy is a serious problem and they quite rightly ask about it at your booking in appointment. But if you say you aren't having any domestic violence issues they don't then go on to say "Uh-huh. Right, now just strip off and I'll check you for bruises..."

o god, mumcentreplus, i am not casting any aspersions about anyone's intelligence, it has nothing to do with intelligence - if you are raised in a family, or in fact not in a family, in and out of foster care and eventually living on the streets as many of those i am talking about did, it is not that you are stupid, it is that lots of knowledge and family life skills that we all take for granted have never been learnt, as there has never been anyone to learn them from. Not for everyone in those situations of course, but for many many people living on the poverty line or below, who really love their kids and want them to have a much better life than they have had themselves, big posters all over the GP surgery saying '5 a day is good for you!' or whatever they say, coupled with the free fruit and veg vouchers for people on income support really does make a world of difference.

agree professor re the celar distinction, but i do think even with the changed onus, it is still perfectly possible to refuse. unless you are seriously wimpy.

Fathersday, thank you for telling me what I "quite clearly" could have done. I have hyperemisis, standing upright, let alone holding a conversation is often a struggle for me. I am therefore in more of a vulnerable position than usual.

The way in which the hospital handled the testing was not designed to give women a choice, it was designed to coerce them, which is unethical.

Anti-oppressive practice anyone?

I think the assumption that 'all' pregnant women know the harm that smoking can do to their unborn child is naive tbh. Smokers exist in a bubble of self denial - all the cancers etc WON'T happen to them. I don't think that offering a CO2 test at an initial consultation is nessecarily a bad thing - smoking assessment at the minute constitues ticking a box and given the number of low birth weight babies who are still being born to smokers, with all their associated health problems and use of resources, clearly illustrates that ticking a box and moving on to the next question isn't addressing the issue. A test result is a 'real', visible illustration that smiking DOES affect your body, rather than being given some abstract message that smoking kills (but only other people)

Of ciourse it can't be a compulsary test - but if it even starts a percentage of women thinking honestly about the impact of smoking on their and their childs health, WHY is that so unnacceptable ? And as for all the references to the mothers rights, who represents the rights of an unborn child ?

un-twist ya pants fathersday...a breath-test during your first meeting with your mid-wife will not make a jot of difference if a woman smokes or not..being in foster-care, living on the streets or whatever happens to your does not make you not understand the dangers of smoking,drink,drugs/bad food..just more susceptible due to circumstance..straight talking and honesty is what is needed not a rubbish test that gives the MW a chance to berate you..

ok sorry fragola didn't know there was any reason above the norm that meant it was more difficult for you to refuse. Could DH not have spoken up for you? Defo if a midwife is aware of a particulr difficulty it should be handled more sensitively. I have no problems like this so have difficulty empathising - as you can probably tell from my presumption that 'well why didn't you just say no then you wimp?' - for which, really truly sorry. I'm an insensitve cow sometimes.

yep - agree mumcentre - if you read my first post on this I was anti the tests, and pro education and information on dangers of smoking, general health in preg etc. stop jumping down my throat woman!

mumcentre totally disagree with this part of your post though: 'being in foster-care, living on the streets or whatever happens to your does not make you not understand the dangers of smoking,drink,drugs/bad food..just more susceptible due to circumstance' - absolute rubbish, if everyone around you smokes etc during preg, you will of course think this is the norm and therefore fine. everyone is educated to some extent by their peers.