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?

What about women who live in heavily polluted areas?

sassybeast - I can't imagine that if I had smoked when I was pregnant that making me do a test to see whether I was lying or not when they asked me if I smoked would have been any more likely to make me stop. I think it would have made me feel bullied and like my midwife was the pregnancy police rather than supportive and on my side.

Everyone knows you shouldn't smoke when you're pregnant. I can't see what this test will achieve. It's basically questioning our honesty as far as I can see.

Er, ham is fine for toxoplasmosis as far as I know. That is a risk for uncooked or undercooked meat. I think you're thinking of Listeria.

On which point there was a whole long thread on Tuesday re goats cheese.

Toxoplasmosis could be far better handled by screening for whether you've had it. In which case you don't need to worry about fresh exposure. And then supporting women not already immune by screening during and treatment if necessary. But ooooh nooo, instead we guilt out all pregnant woman.

Anyone see a theme developing in how the medical profession and 'authority' view pregnant women?

i think some people are overreacting a bit
i dont smoke, i wouldnt be offended or particularly bothered if they ask me to do this test. cant even remember if i was asked it for ds1 & ds2, so that's how little i was bothered. but yes it is a waste of resources

Bullying a woman into having a test against her will is a terrible way to begin the relationship between a MW and a pregnant woman. I don't smoke and never have but I would resent having to prove that I'm not a liar.

You don't think it's calling into question pregnant women's integrity firawla? Maybe some women do lie when they're asked if they smoke, I don't know. Is there any evidence of that? I haven't seen any stats being bandied about and they would be if they were there surely?

CaptainNancy - sounds like my first labour, willfully ignored. Oh be quiet you silly woman, you can't possibly be in that much pain at Xcm (turned out later something was wrong).

We risk setting up a totally adversarial relationship between midwife and patient. It should not be a teacher/pupil relationship, with one policing and checking up on the other.

Helping pregnant women stop smoking is quite clearly a good thing. I just don't think this would do that. I think it could do the opposite, and will damage the relationship between midwives and other women for whom it is not relevant.

No Ribena, salame and parma ham (uncooked) can carry toxoplasmosis.
I know this, as I'm Italian and had my first dc there. I got tested for toxo as soon as I found myself pg, and because I was negative I had to avoid salame, parma ham, raw meet through the entire pg.

Yes, I wish they'd offer screening for toxoplasmosis in early pregnancy (would be very useful to know whether I've already had it and am immune) and for GBS in late pregnancy.

Firawla - but what if you did smoke. What if you were a 16 year old single teenager who felt bullied and looked down on already. Might this reinforce that view? Might it make you less inclined to turn up next time?

I have stopped smocking when I realised I was pregnant but still think this test is wrong. I agree with Belgo, LadyBiscuit and coppertop.

Oh yes, GBS screenings. I agree.

I think toxoplasmosis is rarer in countries like the UK, as it's more unusual to eat uncooked hams and raw meat. It's more common here in Italy to do so.

Franca - that's very specific types of ham and I did say that the risk was for uncooked meat (which those both are). Normal, UK, cooked ham is fine for toxoplasmosis. US women are advised to avoid it for listeria though.

I actually researched and drew up my own eating guidelines for pregnancy (avoided some stuff you're not told, ate some stuff you are told to avoid), but parma ham (unless cooked thoroughly) I did actually avoid.

but if people admit to smoking wont the midwifes be quite kind and nice to them if they said yes i do smoke but i want help to quit? im sure they are supposed to be supportive and would give them the info to help them out, especially for a young mum. its better if people feel they dont have to lie to them in the first place? if midwives are welcoming and make people feel able to be open with them in the first place it would be less of an issue..
but if someone lies cos they smoke and want to continue smoking i dont really care if they are made to feel bullied then, as it is wrong to smoke in pregnancy, so if it makes them think about their actions then fine

coppertop- thank you- you said it much more succinctly than I!

Yes, Ribena I did realize that after I posted! The first thing I think of when reading ham is Parma ham

Another bizarre difference is that my over zealous obstetrician here in Italy didn't even mention lysteria, and advised me not to smoke more than 5 cigarettes a day

listeria

Franca - Are you Italian by any chance? The first thing I think of the wet yucky wafer thin ham my mum used to put in my school sandwiches!

Listeria is v v rare, and we are hysterical about it. Roughly the same risk as getting killed in a car accident in a given year (even taking into account the fact that pregnant women are more likely to catch it).

Firwla - Giving up smoking is very, very hard. They may feel supported at the first appointment, but what if they haven't managed to stop by the next appointment, or the one after that? I'd think that's a pretty strong incentive to avoid the appointment and therefore the breath test (assuming it is followed up). Lying may not be a great idea either, but at least they are getting the rest of the ante natal care. At least warning signs on poor growth or heart beat are picked up.

Or what if you don't realise they'll be nice but you've heard about the breath test at booking in and know you'll 'fail'?

Yes, I am I had ds in Italy and dd in the UK.

hmm yeah i suppose you have a point

Franca - You see, even an ex pat would, I reckon, think of nasty 'honey roast wafer thin' ham hearing the word ham. Or nice home boiled stuff if they were posh. Not parma. Far more sophisticated take on the whole issue!

Sorry. Hijack over!

I don't smoke, but the test is a waste of resources, and yes, patronizing and pointless. They would be better off testing for Strep B or something they could actually do something about.

Actually, if we are going to start talking about known risks and known causes of serious damages to babies, then why the hell isn't there a standard test for toxo- whatsits? i ASKED for the test as I have had cats all my life when I had my booking in appt, and was just told 'we don't do that'.

Ribena, I actually grew quite fond of the wafer thin/honey cured etc English ham in the years I spent there...

Sorry for hijack!

Yes, GBS would be worthwhile. Dd was poorly when she was only a few days old. We took her to A&E. The first question was "are you positive to GBS?" How would I know, it's not tested for

Anya - if you've had cats all your life you were actually at low risk because you've probably already had it and you only pass it on if you catch it during pregnancy. If that's any retrospective comfort!