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

[RowanMumsnet]

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!

Fran, I totally agree with you.

The NHS should offer a routine scan in the 3rd trimester, that is more important for the health of a foetus.

Did you not have a Carbon monoxide monitor and alarm in your home youaintallthat? I ask because if I had a friend die of CO poisoning I would buy one, test it and change the batteries religiously. Or did it fail and that is how your family ended up in hospital?

Can I urge anyone who still believes this test is checking your gas appliances to read Mumsyblouse's excellent post at Mon 13-May-13 10:02:31. This test does NOT check your gas appliances.

What is so wrong with midwives trying to care and protect the health and wellbeing of the unborn child? To take the tack that you would not attend an appointment is dangerous for you and your unborn child. Smoking is very addictive and extremely harmful, why would we not expect the health profession to do everything they can to prevent the harm from tobacco use.

FranFrankland, the other tests that you cite are screening tests which are not within the mother's power to confirm - I have no way of knowing what my urinary protein levels are and therefore I consent to the test to alert me to any increased risk to me and my unborn child.

Nobody is disputing the huge risk of smoking to unborn babies. The objection to the smoking breath test is that the risk can easily be assessed with simple questioning of the mother. The test itself is nothing more than a lie detector of her responses.

I did have a carbon monoxide monitor but I didn't realise until afterwards if your house is open plan - which my house is i.e. the kitchen hall staircase and lounge are all open the levels have to get dangerously high before the monitor will alarm (which is not documented in the instructions - we didn't get offered this little gem of information until after we had all been admitted to hospital) carbon monoxide initially rises to the ceiling then sinks to the floor and begins to rise again - ours was set at the right height but because the carbon monoxide basically had to fill pretty much the entire house before it got to a level where it could be picked up on by the monitor we were all super exposed to it...

Haven't read entire thread, discussion may have moved on.

I was asked to do a carbon monoxide detector test at my booking in appointment in December 2010 so this has been in use for some time in some areas (Bristol). I didn't really mind, also the midwife said one non smoker had a carbon monoxide + result - it was due to low level carbon monoxide poisoning due to a faulty boiler in her house.

I understand the idea that health care professionals should accept people's word - but on that analysis they should just ask our weight and height rather than measuring.

Ok I see the boiler point has been covered. I still don't see the problem.

FranFrankland, I absolutely agree that health professions should do everything they can to prevent harm from tobacco use, but not at the expense of the underlying principles of patient care (previously quoted by better informed Mumsnetters than me).

The previous system of asking a woman if she smokes and making her aware of smoking cessation services (which, even as a non-smoker I was made aware of during pregnancy) was in my opinion sufficient.

Otherwise, what is the next step? A midwife assesses that a woman is lying but the woman won't stop smoking, so she is hospitalised for her pregnancy to stop her?

Ultimately, our system is based upon individual patient responsibility. If a woman wants to risk her child by smoking in pregnancy, all we as a society can do is inform her of the risks and attempt to provide support for her to stop. If she refuses this, there is nothing we can do - this is a basic human right.

Checks to see if women are lying (and disguising the reason behind the tests) is not part of a healthy or balanced approach to healthcare.

Boiling mad - just listened to Radio 2 Jeremy Vine (yes, not a good idea if you don't ever want to get wound up by 'discussion') and in response to an interviewed MW saying about getting positive test, JV said something about 'having to expose the lie' of a positive result for someone who has said they don't smoke. Now I don't smoke (tried it once about 20 years ago), neither does my partner, and BOTH my tests (at Glasgow, 2007 and 2010) were positive. I don't have a faulty boiler (we only had central heating installed after DS was born) BUT I did cycle to work, and lived above a heavy smoker in a Glasgow tenement, and we lived in the central part of the city. If someone had taken this 'expose the lie' attitude with me I would have been fuming (yes, I'm sure there's some irony about being fuming and NOT being a smoker). Luckily the MW did believe me. I would be raging otherwise, and I do have concerns about the test.

I don't see a problem with a woman being offered this test, as it does pick up on carbon monoxide leaks in the house as well.

But forcing it?

I struggled to quit smoking entirely while pg, I had the odd one. I knew it was terrible, I'd cut down from being a regular smoking when my unexpected pg happened, but I had a very difficult pg for many reasons and I occasionally struggled and had a cigarette. It is nothing to be proud of and I wish I hadn't done it, but I did.

If I had had this test done at the booking in appt it would have come back as positive, as I found out quite late I was pg and, as it was unexpected, it took a few weeks to cut down and quit. If I had had this test done later it could potentially have come back as positive.

But none of that would have actually achieved anything. I was scared enough and hated myself enough for struggling to completely quit, knowing that I might get 'caught' (yes, as if I was a teenager nicking sweets from a shop) would have made me even more stressed and would have probably damaged my relationship with my mw. As it was I generally had supportive mw's who didn't judge and who helped through each relapse.

Women who are struggling to quit smoking during pg need support, just like anyone struggling to quit any addictive substance. For many women pg is a hormal, emotional, even scary time and feeling bullied by HCP's is not going to help one iota. They need someone who will ask what can be done to help; they don't need judging. I do understand why people judge women who don't manage to quit while pg, but if you honestly think that attitude will actually help anyone, that is extremely blinkered.

There are many other tests, as mentioned above, for problems which are completely unseen during pg. Spend the money on that. Support women in pg, stop telling them what to do.

I flicked from channel 5 to 3 today whilst eating breakfast and had to laugh that while Wright was discussing this very topic Kyle was berating a posse of pondlife who all had children everywhere and clearly needed a good scrub.

I think there are much, much bigger issues surrounding children's long term welfare than does Mum have a ciggie during pregnancy to be honest but then I'm probably just old and delusional which is why I turned it off tutting

Pointless paternalistic woman blaming with zero benefits to care in pregnancy.

Women inclined to lie (as is their right anyway) will simply refuse the test. All others will have their relationships with healthcare professionals potentially undermined. As has been previously said even if they do catch some out and refer to smoking cessation then it is unlikely to be successful at actually helping reduce smoking.

I suspect it is for monitoring purposes and nothing else. I would refuse the test on principle. I don't smoke.

Nobody measured my height at either booking in. They took my word for it. My weight I had no clue so I weighed myself there and then.

Noboy felt they had to check to see if I was lying about being 163cm instead of 170cm or 158cm tall. Same thing with this bollocks smoking test.

Re CO monitors they should be positioned next to each gas appliance. My cooker and boiler are close enough to share one alarm. The MW smoking test is not a test of faulty gas appliances.

I dont see the point,make sure mothers know there is help available if they want to stop and that they know the risks of smoking,what else can you do?

what would they do if it comes back positive?nothing.its pointless.and i would decline it if offered,as i am a non smoker and dont need it.ridiculous stupid idea.

Lying during pregnancy!! How dare the dirty fuckers!!

Berate them and take their kids from birth!!!!!!

and they cant force it,you just say no!they cant refuse to give you antenatal care just because you wont take a test.

'but on that analysis they should just ask our weight and height rather than measuring.'

In 2 pregnancies that is exactly what they did. In my 3rd they wanted to measure me and I told them I really hadn't grown since I last gave birth and coukd tell her my weight.

She didn't seem that worried tbh.

smoking test? how stupid.

there's no routine blood testing for measles immunity or to determine if mum has STREP B. nor routine checking baby's mouth for tongue-tie. these would be far more useful and in some cases life-changing if not life - saving!

I don't smoke and even if I did I'd refuse it.

agree with freddie - they were high

I'd agree to a cake/chips eating test though yum

I would also have refused the test if it were offered when I was pregnant. My body is my own when I'm pregnant and can do what I bloody well like with it, including having an abortion.

Also most women don't smoke when pregnant. The vast majority of those who do know where to seek help and manage to at least cut their smoking down to a minimum. The few who don't probably have a load of other problems - and this will be identified by the booking in questions anyway. Or they won't get booked in until really late or get any help with pregnancy at all. A mandatory "blow into this tube" test won't help reach out to vulnerable women.

Meanwhile all mostly responsible women would be patronised and infantilised by this test. It's the worst idea I've heard this century. I was utterly appalled when I heard about it this morning.

This is my third pregnancy and they've taken my word on height weight at all of them (3 different MWs) unless I said I didn't know. Everyone knows if they smoke or not, ergo no need for a test. Job done.

i had a god awful pregnancy thanks to my caring midwife.

i was 37 when i found out i was pregnant, and after 9 pregnancies of doing everything right and miscarrying from 9 weeks through to 7 months, i kind of let my guard drop a bit with this pregnancy.

with regards to testing, i was asked to take the HIV test, all screening tests and the smoking tests...i refused them all apart from the basic screening for iron levels and that type of thing.

well if i did, the 1.5hours at my booking in appointment was basically the MW telling me that i was 37 and a geriatric mother, and the risk of me having a down syndrome was extremely high given my age. honestly i sat there feeling like i was doing the worse thing ever....in the end i said look i am 37, i am not old, i am not dying, i'm having a baby which apparently is very wrong as far as you are concerned, if the worse that happens is my baby has down syndrome then i will still consider myself very blessed!!! didn't shut her up mind up....

every appointment after that my age and down syndrome were brought in to it!

9 months later, after smoking approximately 6 cigarettes throughout my entire pregnancy -not something i am proud of let me tell you - but from smoking 20+ a day i considered this to be a major acheivement, after telling the midwife this, she kind of brushed it aside and said "don't worry about that you'll be fine"..." now are you sure because of your age you don't want the amnio or blood tests done"...i mean seriously WTF is 37 really that old these days.

anyway i am pleased to say, my daughter was born 11 days over her due date, extremely healthy weight (9lb 12ozs) and is a happy well adjusted littled toddler