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Pregnant women should take 'smoking test': what do you think?

489 replies

RowanMumsnet · 12/05/2013 10:39

Hello

There are reports in a couple of papers today (here and here - paywall) that NICE has recommended that all pregnant women be given a carbon monoxide test by their midwife in early pregnancy - effectively, a smoking test. If they test positive, the idea is that the midwife will signpost them to NHS smoking cessation services. The Royal College of Midwives is quoted as saying that they think the idea will adversely affect the relationship between women and their midwives.

We're getting asked what you all think about this - so do please let us know!

OP posts:
Rubysmommy · 13/05/2013 07:12

*assess!

tribpot · 13/05/2013 07:43

if you smoke it may help you make an informed decision.

But how does the test inform the decision, Rubysmommy? If you smoke whilst pregnant you know that it is not recommended and the midwife could and should remind you of this and what options there are to help you stop.

The test proves you are smoking. Which by definition you already know, unless you smoke in your sleep or have severe amnesia, in which case you have other risk factors for the pregnancy to put it mildly!

The test is not aimed at showing whether the level of smoking or exposure to smoke is harmful or not (i.e. something you couldn't assess with your own knowledge). It's aimed at proving whether you're lying to the midwife. If I am lying to the midwife, how does proving it to me encourage me to want to stop smoking?

So beyond the fact that the test is being administered for reasons which are dubious at best, the way it is being administered, based on feedback in this thread, is unacceptable by the standards of care to which the NHS is held.

The NHS Constitution (for England) says "You have the right to accept or
refuse treatment that is offered to you, and not to be given any physical
examination or treatment unless you have given valid consent." Further "You have the right to be given information about the test and
treatment options available to you, what they involve and their risks and
benefits."

Smellslikecatspee · 13/05/2013 08:23

Can I also point you all in the direction of the NMC: Standards of conduct, performance and ethics for nurses and midwives

4 You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support.
Respect people?s confidentiality

13 You must ensure that you gain consent before you begin any treatment or care.

14 You must respect and support people?s rights to accept or decline treatment and care.

15 You must uphold people?s rights to be fully involved in decisions about their care.

In particular number 13 & 14.

I've never been pregnant but have had a lot of dealings with gyne and have always been treated as though I had a lobotomy as I walked in to the waiting room. With both nursing and medical students been ushered in to the room as I was undressing with no warning. (As an ex HCP I understand the need for students to be involved, but you ask permission first, teach them the right way. . )

As so many people have pointed out above, this is being used to 'prove' women cant be trusted with thier own health.

cardamomginger · 13/05/2013 08:28

It seems these tests are being touted as able to pick up CO problems in the home from dodgy boilers, etc, yet I assume that the results of said test on the day will not be able to differentiate between an elevated CO level due to smoke, an elevated CO level due to a dodgy boiler, and a CO level due to the effects of pollution (including exposure to second hand cigarette smoke).

Will a woman who scores positive on the test, no matter what the explanation for her elevated CO, still be pushed in the direction of smoking cessation services? Will the only NHS response be the disbelieve her if she says she does not smoke?

Another thought for the medics/science types amongst us: how long does CO hang around in the blood at the level that would score positive on this test? Could you just not have a fag a few hours before your MW appointment and obtain your negative score?

cardamomginger · 13/05/2013 08:31

PS to my previous post:

And if the MW DOES believe her explanation that she doesn't smoke and her CO level is due to eg passive smoking, or the MW goes on other evidence such as smell of smoke on clothes to conclude that the woman does in face smoke, then the test is useless!

LadyLapsang · 13/05/2013 08:48

I have never smoked and no one in our home smokes, our Carbon Monoxide Alarm registers 0. Out of interest, if you live in a smoking household what does your alarm register?

GlaikitFizzog · 13/05/2013 08:48

On that point then, what do they do if the levels are high, the lady says she isn't a smoker, but does have a boiler at home? Is there a crack team of gas appliance engineers waiting to swoop? Or will she be assumed to be a liar about the smoking and sent off the quitting MW?

TooExtraImmatureCheddar · 13/05/2013 08:54

I think this is an appalling waste of money. I don't smoke and have never smoked, and as it happens, I deplore the fact that anybody smokes during pregnancy because of the risk to the baby. However, this measure is not going to change anyone's behaviour whatsoever. No one is any doubt that smoking during pregnancy is "bad", and being harassed by the NHS isn't going to make anyone quit.

This is a waste of money that would be better spent employing more midwives or increasing the number of scans women are given - we need a better tool for assessing the health of the unborn baby between weeks 20 and 40 than a sodding tape measure. Let's not forget that Britain has one of the highest rates of stillbirth in the developed world. I know smoking can be a factor in stillbirth, miscarriage, prematurity, low birthweight etc etc and is therefore important, but this initiative is unlikely to make women stop, because they already know they shouldn't be smoking.

The number of women who lie about smoking country-wide is probably insignificant - ok, so allegedly 1 in 4 women in the west of Scotland lie about smoking in pregnancy, but what about the rest of the country? Glasgow isn't representative of Scotland, much less the whole of the UK. It is known for having areas of economic deprivation, poor education etc etc (Glasgow is a lovely city, btw! Not meaning to knock it) which are associated with poorer health and, in fact, higher levels of smoking, alcohol abuse and drug abuse. I also think there is a culture of smoking in Glasgow, much more so than in Edinburgh or Aberdeen, across all levels of society (although that's based on personal observation, so I can't substantiate it).

I think to devote money to catching women out in a lie is shocking, particularly when there is no proof that it actually makes them stop smoking.

Patchouli · 13/05/2013 08:56

"utter meddlesome nonsense" Grin

They've been doing this in our area for at least a year. DD's one and I had it. Maybe the midwife thought I looked like I was fibbing.

It's tricky as on one hand people are saying 'don't they trust us to tell the truth' and on the other hand they are catching a lot of smokers.

The midwives job is to look out for the baby and it probably helps them to know what risks they're dealing with re. how long the placenta might last and all sorts of complications that could arise.

All they can do is refer you to the cessation people anyway. It's just typical of the way things run nowadays - I know in my job we have to log everything, make the right referals etc: all arse covering.

Chislemum · 13/05/2013 08:57

The UK is at risk of becoming a bit of a nanny state, isn't it? A bit like the HVs that never tell you that you do not need to see them and then monitor you like we are living "the lives of others" (I refer to that film about the former GDR). I don't smoke and never have but this is just not right. Perhaps teenage mothers might benefit from some more explanation (doubt it) but not really from a test. I just don't like the 1984 feel of it.

Patchouli · 13/05/2013 08:59

GlaikitFizzog, well you'd know to get your boiler checked.

GlaikitFizzog · 13/05/2013 09:09

Yes I would, but does the MW give advice on that, or does she assume the patient is lying? They can't be offering a test for something (check your boiler isn't faulty) and then use the results for something different altogether and not provide the relevant info on getting your boiler checked.

VisualiseAHorse · 13/05/2013 09:11

I'm in Scotland - not had this test, and I was handled by two different sets of HCPs.

I did smoke very occasionally while pregnant - maybe 1 fag every couple of weeks.. I often feel very guilty about it. But I never lied when asked in an appointment - in fact if I had lied, they would''ve been able to tell, I'm such a bad liar! I was always told 'not good for the baby, have some leaflets' but never ever felt like I was pressured or guilt-tripped into stopping. My GP said that if I wanted help to stop, it was there.

This is invasive. Yes, some women will lie. Some will tell the truth. Honestly, if someone asks me to do it next time round, I'm going to say NO. I am informed, I know the risks.

VisualiseAHorse · 13/05/2013 09:14

on the other hand they are catching a lot of smokers.

Catching? Like we're naughty school girls having a fag behind the bike shed?? Give me a break.

marthastew · 13/05/2013 09:14

They did it to me at my booking appointment but did not explain why they were doing it or what they were looking for.

Patchouli · 13/05/2013 09:14

But you know if you don't smoke. And get your boiler checked.

It doesn't matter to you if you get a call from the smoking cessation people.
If it were to actually happen that the MW doesn't believe you, you'd be having another test in a while anyway and if you've had the boiler fixed the CO levels will be within normal.

ShadowStorm · 13/05/2013 09:19

If they're really worried about pregnant women having high CO levels due to a faulty boiler, it'd be much better to advise all pregnant women to make sure that they buy a CO monitor, make sure it has working batteries in, and to call a registered gas engineer if the carbon monoxide monitor detects a problem.

And of course a CO test won't be able to tell whether high CO levels are due to smoking, passive or otherwise, a faulty boiler, or living next to a busy road.

The notion that a MW would assume a non-smoker was in fact a lying smoker because of high CO levels is worrying.

ExcuseTypos · 13/05/2013 09:24

A man from NICE and a midwife were on The Today programme earlier.

The NICE person said very clearly, that if a woman doesn't want the test, she should just say so. No one will be forced to take it or feel they have to.

I think women need to just say no- if enough do, they'll stop offering it.

GlaikitFizzog · 13/05/2013 09:26

Patchouli, if I were to get a call from the smoking cessation people I would be livid, absolutely livid. My MW has decided I have lied to her. My trust in her is gone. If I had any problems in my pregnancy I would feel uncomfortable discussing them with her incase she then takes something else I say and twists it.

Patchouli · 13/05/2013 09:30

The readings are higher if you live in London than rural, or next to a busy road - but nowhere near as high as a 10-20 a day smoker.
If you don't smoke and live in clean air your reading might get to zero or 1, if you live in a city and don't smoke it might get down to 4 or 5.
The difference in the readings is clear.
If you are a mechanic you know you can can explain a higher reading.

I think people are getting carried away with the boiler story. There might have been an occassion once when someone quit and their reading stayed high and he discovered a faulty boiler.

Patchouli · 13/05/2013 09:33

GlaikitFizzog, it's pretty unlikely you'll have a broken boiler that's going to give you high readings and make your MW think you're a liar.

Smellslikecatspee · 13/05/2013 09:33

on the other hand they are catching a lot of smokers

Last time I looked smoking was still legal.
Bad idea, but still legal.

StarlightMcKenzie · 13/05/2013 09:44

'catching them' ? Hmm

Why would you want to 'catch' them?

Sod that. Next time I get pregnant I shan't attend the booking in clinic at all.

NotSoNervous · 13/05/2013 09:47

It's ridiculous. Smoking while pregnant might be wrong but at the end of the day it's the women's choice. It's made ovbious that smoking whilst pregnant can cause problems and help is always offered but its the women's choice and if its forced upon them it will cause a lot of negative and ill feelings

TunipTheVegedude · 13/05/2013 09:47

A call from the smoking cessation people would strain my marriage in the same way as an accusation of infidelity would - dh is virulently anti-smoking as a completely understandable result of his father dying of smoking-related illness in his early 50s.
I'm not saying he would leave me or anything but he would not respond rationally and it would make things very awkward.