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?

mumcentreplus, my mum had pretty much the same experience and smoked whilst pregnant with me. Lots of my family other than my dad were also heavy smokers. Fortunately, I don't think I have any health problems as a result (at least none that I'm aware of ) and I'm really sorry that you did and it's no wonder that you feel really strongly on this point. I've never smoked and never allow family members or friends to smoke around DS BUT at the same time I honestly don't think making a pregnant woman blow into a tube to see if she is a smoker is going to have any effect unless they really do want to give up smoking. It would be far better to channel the resources being spent on all these tubes into programmes for those that really want to give up and educating everyone on the dangers of smoking/ passive smoking not just targetting pg women. If NICE are also concerned about CO levels in the home from boilers etc. again common sense would suggest that you get given a safety in the home leaflet or similar advising you on simple checks you can make.

At a time when massive cuts are being announced, introducing this seems not only bullying but an utter waste of resources

Sorry fathersday, I didn't mean to be short. My husband didn't get a choice to say anything, quite literally I handed my notes in at the counter and was whisked off!

whats if perish the thought...a MW spoke to a woman about smoking...offered her a test without making it seem like she would judge her...I agree it gives you a chance to see how smoking affects an unborn child and a mother and this can have an impact...its about respect no matter your position in life...they are all mothers...

Ezma i dont think i have problems due to my mothers smoking...well i did have allergies? and a dodgy nose..lol

I agree a person can be 'educated' by their peers..but as i said...you can speak to a woman about somoking..no need to subject her to a breath-test like shes lying or comitting a crime...if it's about education then as you said a poster could do the job..

Lafybiscuit - the point about resources is a n interesting one -I wonder if the thinking is that the cost of the tests will have a long term impact on the amount of money spent on SCBU beds for smoking related low bith weight babies ?

LadyBiscuit - Totally agree. I dread to think how much the kit, admin and processes have cost to implement - not to mention ongoing costs.

fathersday - re refusing to take the test. I don't mean to bang on about this when you've already apologised v nicely to fragola but I think that there are tons of women who would find it hard to say no in those circumstance, 'special reasons" or otherwise. I don't think that makes them a wimp.

Many women already feel vulnerable and 'like a patient' when they're pregnant and want to build a relationship of trust with their midwife. Also, in those type of appts you often feel like you're bombarded with tests, questions and info, whilst often feeling quite ropey - none of which is conducive to understanding what a test is for and then refusing it!

I quit smoking on 18th October 2009, the day that little stick said 'pregnant' and have had one since, at my works Christmas do after my son was born.

My son just turned one on 11th June 2010.

There has not been one day that has gone by that I haven't wanted a cigarette. I haven't had one, but there are days I would kill for one. Days I have thought about offering strangers on the street £5 for just one cig out of their pack.

Cigarettes are as addictive as heroin. And just as hard to quit.

I was lucky. I had, and have, the willpower to just up and quit when I knew I had a baby inside of me.

Lots of women don't.

And plenty of women go on to have healthy babies despite smoking every day of their pregnancy.

And plenty of women go on to have sick babies despite not smoking/drinking/whatevering.

There is no definite answer on any of these things.

So get out of my bedroom/my life choices/my decisions UK government.

sorry, mumcentre, meant to address second bit of my comment to weetabix - my fault for flitting between this, my email and what I am actually supposed to be doing which is working! I have allergies too and a dodgy nose (although that's me being vain and thinking it needs some cosmetic surgery ) but these are exactly the same as my dad's allergies and he's had them all his laugh and is a non-smoker.

if there is no definite answer on any of these things why did you give up smoking Tee?

Because I really was just looking for an excuse to quit, and we all know smoking is bad for you, fathersday.

For goodness sake there are no definite answers on anything in the world. Does that mean we don't do what we think is right?

I am a professional, 30-something, pretty fiesty woman. I just know that on my first pregnancy, if they had said "we need to do this test now" I would just have said ok and taken it. Then I would have felt pissed off and patronised, just as I do about many elements of my midwifery care and subsequent birth.

If I know I would have gone along with it, how many other women would have done. And having come up positive and been 'looked down on' (whether they were being or not) how many vulnerable women would skip the next few appointments if they hadn't been able to stop?

I think that the idea of you having to proactively turn down this type of test is positively dangerous to people who need it actually getting support.

Really don't understand what all the fuss is about. I am an ex-heavy smoker and luckily managed to give up five years ago but I would not be at all offended if I was tested for Carbon Monoxide.

To me its the same as being overweight. You don't need to test me to see if I'm overweight - but the MW still gets you to step on the scales. Although I am perfectly aware that being overweight isn't great for my health, in a first pregnancy I would much rather someone sat down and explain exactly what the risk factors were for me as a pregnant woman, because how else am I going to learn? Even if I know the exact medical reasons and implications of being overweight, why would I find it patronising?

IME the only people who feel patronised are the ones who think they know it all but actually don't, but when it comes to medical conditions, unless you're a medically qualified yourself, then do you really think you know more than your MW or doctor?

(BTW, I'm just about a normal weight (well, till I got up the duff - just using it for an example).

How many women out there really know exactly how "smoking when pregnant harms your baby". I consider myself to be well educated and up to date with many things (including being slightly OCD about all things pregnancy related) but still I only have some ideas about how smoking leads to low birth weight and breathing problems. If I were a smoker and someone were to sit down and explain things exactly what the implications were, I might, just might, find the facts were enough to tip me over the edge into giving up?

A breath test? And then what will they do to those who smoke?

Why don't they invest money in offering a 3rd scan to check on the health of the placenta and the cord like they do in most European countries, instead of testing breaths?

And after the breath test, when it's time to leave, will the midwife pat you on the back and tell you "drive carefully"???

You see, midwives have never got me to step on the scales. They've asked how much I weigh, presumably believed me, and written it down. Perhaps if I'd said I weighed seven and a half stone they might have gone a bit and asked me to step on.

If I am a lifelong non-smoker, my DH is a lifelong non-smoker, no one in my family smokes, no one smokes around me and I have a carbon monoxide detector in my house, and I've told them that, the only reason for telling me to take a CO test would be if someone thinks I'm lying. That's what's patronising. And, yes, I do think I really know more than my midwife or doctor about whether or not I've ever smoked.

Sorry I didn't get a chance to finish my answer to fathersday because son needed me.

So my complete answer is:

Because I was looking for a reason to motivate me to quit and it was my choice to quit. Because of the health risks to the baby, because of course there are some.

But it was also my choice to eat an occasional ham sandwich and a bit of unpasteurized cheese. And to have the occasional glass of wine.

The key words being, of course, my choice.

But I am an anarchist from way back. I believe no government is really necessary, except perhaps to protect the people in a time of war on its own shores, i.e. under attack. I certainly don't think they need to be telling me what to eat, whether I can smoke and how to raise my son.

But contracting toxoplasmosis from ham and passing it to foetus might be riskier than smoking during pg.

I think it would be fine to offer a chance to have a test if a woman wanted it - I don't think the midwife is always the right person to do it as that would require each community midwife having a machine, a waste - if a woman wanted it then it should be at a different time and place so it doesn't put her off going to her regular appointments.

I am not suggesting this is a good idea (because, to be honest I've not fully thought it through yet) but I am surprised such a suggestion has been made before it has been suggested that school aged children are offered/given the test to see how much exposure from CO2 they have.

Could be francagoestohollywood. But since neither happened, not really worrying about it now.

And there was me thinking that this new government would put an end to the nanny state?!

Unbelievable. I'd refuse to do it and I'm a non smoker. I think it's an outrageous waste of money considering the state the economy is in and the cuts we are facing.

What does the test pick up, exactly? Does it just register if the mother has been smoking, or the level of smoke in the body from passive smoking etc (assume this would need a blood test)?

I've never smoked, but I wouldn't be offended if asked to have the test. It's a small price to pay if it picked up high levels of toxins in someone who didn't realise how much smoke she was passively inhaling.

I don't know what the NHS would do with the information though. Unless they linked not smoking with receiving some sort of financial benefit, there are still unfortunately going to be people (men and women) who think it is acceptable to smoke when there is a pregnant woman living in their home.

Yes, it could FioFio.

The fuss is because this is an infringement on our liberties- "Oh you empty-headed fluffy pregnant woman- of course we just need to confirm whether or not you smoke to protect your unborn child".

My DS is now 17mo, and at my booking appointment I was forced to do this test- I say forced because I was actually bullied into it by the midwife
I have never smoked, she wouldn't believe me/listen to me, and kept on insisting (this certainly was not the case with the HIV/SDI tests done by the hospital).

She made me feel like a stupid, naughty 2 yo, and tbh with lack of sleep (courtesy of my toddler); pg exhaustion, hormones, and confused emotions (had just m/c 6 weeks previously) I did not stand up for myself and say no.

I am an articulate, well-educated strident woman... heaven help any mousy-types out there.

The whole attitude at the booking appointment destroyed the relationship between me and the m/w- I felt unsupported throughout my (extremely difficult) pg; not just unsupported, but wilfully ignored - particularly around all the information I provided about my underlying medical condition.

Infantilising pregnant women is dangerous.