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!

This test is rubbish, it totally ignores all the potentially pregnant women, what if a woman was to fall pregnant because she wasn't being responsible, and then was too selfish to moderate her drinking, lifestyle and language to allow for the fact that she's female?

I think it's best if these tests are mandatory for ALL women because all of them are potential mothers, and how can you catch them lying and trying to avoid punishment for their transgressions (like being caught in possession of a vagina without a mitigating penis) if you don't test all of them?

Teaandflapjacks, forgive my ignorance, but what is the health service like in Germany? I mean, is it private health insurance based or more like the NHS here? I think that if you are paying directly then they are more likely to treat you like adults, whereas if the State is making massive subsidies, like here, then they feel more able to dictate. I don't agree with the way we are infantilised by the State, especially in pg where it is more noticeable, but I can see the difference direct payment would make.

I remember being told to 'pop' all the time by midwives, "pop yourself up here", "pop your clothes off". I have never popped so much in my life.

I don't smoke but would refuse to take the test and as a taxpayer think it is a waste of resources. What are they going to do if the result is positive, arrest people?

Do they have any evidence this would even reduce smoking, as I don't see how?

I gave up smoking for both pregnancies.

I would refuse to take a smoking test,and taking one wouldn't be my reason for giving up.

I would,however,like to be able to request one to measure my progress and to use it as a tool to give me encouragement and to show me that I had made a difference.

It very much concerns me that some women would also not attend any ante natal care to avoid judgement over their smoking.
Surely if a woman ids going to smoke during pregnancy the unborn baby is going to be safer with ante natal care rather than without.

Don't forget as well, Chunderella, that the answers will have to be written to the patient's medical record, and probably coded. At least one but probably several data returns will need to be made by the collecting organisation to a funding body or two, and then the results will need to be collated and analysed at the other end. Each area probably has a manager with a target to improve the number of tests per head of population and will have to spend time and resources improving the ratio and reporting back on outcomes.

It took several minutes to do mine. She could not for the life of her get the card mouthpiece on the machine. After a while I offered to have a try, turned it round, and fitted it first time, pointing out that one end of the card tube was wider than the other.

She did this face and wondered aloud why none of her colleagues had ever pointed that out.

Jux it is like another world here - basically it is half and half I guess. The entire system is funded via insurance providers - which you pick which ever one you like the look of (they all are basically the same) - a % of your salary covers this up to a threshold, and then you can opt out of the % of salary and pay a fixed amount - but you just use the same companies- this is to not penalise people earning over a certain amount. If you are on benefits, the insurance is covered by the government in the same way (although the whole benefits system is different too). You see a Gyn. for these appointments, and a midwife later on the the pg. They are used here for after the birth mostly to help you out - the same as in the UK - they come to your home if you want, can help with whatever feeding you do (your choice) etc etc.

They do test more here - i.e. more scans, test for toxiplasmosis, everyone has the GD test (well you can refuse if you want but it is covered), etc. You just get treated like you are not a total moron, obv. they do check things like smoking and drinking - and they advise not to do either if you would say yes, there is a very anti drinking in pg stance in Germany. But the drinking habits are diff between countries - regardless if pg or not. They have stacks of alcohol free beers here, that you get everywhere, so pg women just drink those instead. Although they check your blood for stuff, and you see the gyn every 4 weeks, I don't feel 'interfered' with - if you see what I mean. I would loathe to have to sit there with someone going through a checklist and a bit like 'computer says no' if you have something not on the list. I do feel much safer with an experienced Gyn. - she is an expert and has trained as such. They make a firm line here between midwives and doctors etc - so you don't get any conflicting advise. Personally I used to find that maddening in the UK - you get shunted to see a nurse, and they tell you something diff to a doctor anyway, since obv. Then you wait another half an hour for a doctor to sign your prescription etc etc. Then doctors are effectively downgraded into a 'health professional' role and on it goes. And then the patient is frankly fed up with everyone they come across. And now all this nonsense from NICE.....

This just sounds like a very, very daft way to treat women - all I can think of is the Harry Enfield sketch of Mr C 'Women - know your place'! and my worry would be women then go 'honestly sod it' - and treat all advise given the same way - even though some of it could be very valid.

Sleepyhead: 'People lie. All the time. The data from doing the test in Glasgow showed that pregnant women who smoked lied 25% of the time about smoking in pregnancy.'

Presumably as one of those who took the test in Glasgow, twice, who said I was not a smoker (am not, smoked a few when I was 18 but was pregnant aged 37 first time) and then got a positive result: am I one of those 'liars'? Has my data been translated in this way? Is this what is behind the push to have this test nationwide? This is what absolutely concerns me.

I don't know WHY I got a positive, the MW didn't know either. I do not like the fact that my data, the discrepancy between what I said and the result that showed, could be translated in this way without me knowing about it. I DO NOT SMOKE. DH DOES NOT SMOKE. I GOT A POSITIVE RESULT. It was NOT from a faulty boiler because we only got central heating installed after I had my first baby. I lived above a heavy smoker; I cycled to work (though mostly along the canal path, so hopefully got less traffic pollution) and I lived in the middle of the city. These were the only reasons I could think of for why I had a positive, and they were worrying enough (ie implications for the health of my children).

I was lucky - my MW was inclined to trust me; but would that be the case if I had been young? If there had been other reasons not to 'trust' me?

Seems like a waste of time and money. obviously people know if they smoke or not and they can't force people to take a test or to stop smoking. all they can do is give them advice and support to stop smoking if its needed.

I've no idea numptymum. It'd be interesting to read a report on the Glasgow programme - presumably there has been some success in terms of percentage of women enrolling in smoking cessation services/reducing the amount they smoke during pregnancy or they wouldn't do it.

I can't see the point of doing it if they're getting a significant number of false positives. Identifying women who smoke during pregnancy is presumably fairly useless. It's increasing uptake in enrollment in intervention services that has the public health benefit, and again this is useless if it doesn't result in harm reduction (stopping smoking/reducing smoking/reducing smoking by partners around the mother & baby for eg).

I guess NICE must have had access to some evidence to base this recommendation. It would be interesting to see it, or to know if there is no evidence of benefit and they have indeed pulled the whole thing out of their arses as so many posters seem to believe.

I had a quick look for some more information about this and found out it was really pretty old news since the original NICE recommendation was in 2010. There were mumsnet threads about it then as well.

Why has this come up again today?

Well it did get me stressing about our air pollution and how it was affecting the kids! We now live outside the city, it would be interesting to see if I took a test again whether I would still get a positive. However I have NO intention of having another baby so won't be doing this again...

Actually I didn't mind taking the test (well, given I thought it would be clear); and although I was bothered about the outcome from the point of view of my health/children's health, I didn't think much more about it. However if I'd been young, less confident, other reasons for prejudiced views as to my likely honesty, would I have been made to feel like a fraud?

I do worry about how statistics can be 'translated' at times, given they are usually used to back up a theory rather than showing ALL the evidence.

Agreed, sleepyhead. I think MNHQ should invite those making the recommendations on for a web chat.

Patchouli - how does this test tell MWs anything about placental function or help inform them about advice for 'going overdue!?

Placentas can fail at 37 weeks in non-smoking, healthy women. They can still be strong and performing well at 42 weeks.

ALL this test tells you is if the woman has smoked recently. Not that her boiler is faulty. It won't magically make her stop smoking if she's a smoker. A few pence on a disposable tube at every booking in appt will cost the NHS millions but won't save the equivalent amount through not having to treat the effects of smoking.

I can't see the point of doing it if they're getting a significant number of false positives.

But it seems that part of the (unstated) reason for doing this test is that a woman's report of whether or not she smokes is untrustworthy (if she is to be believed, the MW would just ask the question and tick the box), so it seems hard to fathom how they could determine that a false positive had been obtained. What else could you measure it against, other than a woman's self-report, which is not to be believed?

From a (cursory) look at the literature on smoking cessation and pregnancy, it seems that CO testing is acknowledged to not be particularly reliable:

a) false positives - pollution, passive smoking, co poisoning (you could argue that passive smoking isn't a false positive since that's a health risk in itself)

b) false negatives - the levels of co drop to normal if the person being tested hasn't smoked in a relatively short period of time (think it's 12 hours or so).

They can test cotinine levels instead but this is a more invasive and expensive test. It also shows that self-report is unreliable though (similar 25% figure) and the main reason seems to be social stigma re: pregnant women smoking.

Just to clarify: I'm not disputing that a false positive could be obtained. Rather, I am querying how they could identify a false positive, given that the easiest way to do so would be to ask the woman whether she smokes or not and prioritise her response when comparing it to the test results. Yet, it seems that her answer to the question 'do you smoke?' is not to be believed, hence the 'need' for this test. By testing in this way, they are stating that test results are to be given greater weight than a woman's statement.

Ridiculous idea. I have never smoked and would feel insulted for my word not to be taken without evidence. If someone is going to lie about smoking and the smell of their clothes and hair wasn't obvious, they are unlikely to decide to give up as they have been 'found out' from the test. Why should a cash-strapped NHS fund a pointless test, when I'm sure midwives have enough to do. It wouldn't exactly do a great deal for midwife/ patient relationships.

I don't know how reliable this story is. Legally, I doubt very much whether such a test could be imposed.

If it is voluntary, why not just ask the mother-to-be? If you can't rely upon her to answer that one truthfully, chances are she isn't going to tackle a giving-up smoking programme or other health initiatives particularly well.

At the end of the day, you have got to work with the mother, and this wouldn't get things off to a very good start.

If true, sounds like a terrific waste of money!

SarahHillWheeler it isn't imposed "legally". Its just something that the mw tells you is going to happen and because its in a 45min-hour appointment which includes blood tests and is in the first trimester when a lot of women feel rotten the vast majority will just do it.

If you want to question "authority" then you might not do, but it certainly didn't occur to me to do so, it was only afterwards that I wondered why they hadn't taken my word for it because I was trying not to vomit on the mw, making informed decisions wasn't exactly something I was up to. If I was to get pregnant now, knowing the test was likely to happen in the booking appointment then I would probably refuse it as I don't want to contribute to mass data collection without consent.

I did question it and expressed my wishes that I didn't want it.

Didn't matter though as they act as if it is mandatory. So yes, this story is reliable.

I did smoke when I fell pregnant. But I also wanted to quit so, when I went to my booking in appt., the MW asked if I smoked, I was completely honest and she referred me to the scs (I wasn't asked to do the test). I had a wonderful smoking cessation in pregnancy advisor, who came to my house every couple of weeks to see me! (And I did this test every time she did. Didn't occur to me that she was checking to see if I was telling the truth about not having smoked!)

However if I had been asked to do this test at the booking in appt. After having already admitting to smoking, I would have refused. I wonder how it would have worked in my case?

I'd already told her that I smoke, I knew that it was bad. I already knew I wanted to quit but needed help. What would be the point of doing this test? To make me feel even worse?