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!

[FrebbieMisaGREATshag]

I asked a question and said I could be wrong. How is that drivel?

[Offred]

Stress is not linked to harm in pregnancy unless it is extreme stress. In my second pregnancy which had resulted from being raped I was being constantly harrassed and intimidated by my ex and then take through family court and dd was not harmed, that is considerably more stressful than arguing on the Internet.

No-one has said smoking doesn't harm the baby. I have said a number of women smoke in pregnancy in varying amounts and logically most of their babies are fine so a blanket judgement of irresponsibility is overkill and also just plain mean.

Honestly I think the best thing you could do in this pregnancy is relax and stop trying desperately to prove you are perfect and responsible, you will make yourself anxious and paranoid. You still get to be a person when you are pregnant.

[RedToothBrush]

Pro-life. Why am I not surprised?

Research can often be rather grey not black and white. And it can be hugely manipulated for a lot of reasons. Like life generally.

I'm sure that as a student nurse, Bad Pharma should definitely be on your reading list for a good starting point.

Thing is, lots of stuff is 'bad' - but its still can be the less evil than the 'good' alternative. And is very much dependant on what you are measuring too.

As I said upthread, the idea of this test may well look good on paper, but its only good if they also measure how this might affect the relationship of trust between midwives and patients.

It is entirely possible that if this seriously damages that relationship and stops women seeking prompt medical advice when they need it - both during their pregnancy but also later in life (for them AND their child/ren), that it could actually cost more lives in the long run. I don't know this. You don't know this. Chances are no one actually knows this.

If something is not measured, the truth is still the same. But we can be blinded by 'facts' which might well be true, but only tell part of the story - which distort what we think and are lulled into false sense of security about 'the right' course of action.

I very much believe that if you practise medicine and are so inflexible and believed in fixed 'rights' and 'wrongs' you are in the wrong job. There generally isn't ever a correct way of doing things that applies for every patient since every patients is simply different - and all these Care Pathways drive me nuts because they refuse this grey area from medicine and instead force everyone into nice neat little boxes that need to be ticked. It removes the human element of actually listening to a patient.

People aren't tick boxes and forcing them into them actively causes distress in a growing number of cases.

[expatinscotland]

Please, please, don't refer to patients as 'Mum', 'Dad', 'love', 'sausage' or anything but their names, either. This practice is utterly unprofessional and lazy.

[GlaikitFizzog]

Whoa, you smoked weed! Well that's my judgey pants hoiked right up. Pg or not that's illegal, you have now lost the argument based on your inability to make healthy choices.

(See how ridiculous that sounds???)

[tribpot]

I don't think anyone is saying pregnant women should smoke. In fact I loathe smoking to the point where I think it should be banned completely.

But that does not change the fact that this test is conducted to prove to pregnant women that they are lying. Why not impose it in general practice as well, so we can catch out more of the population who lie to their GP about smoking, thus depriving him or her of valuable income derived from asking you to stop smoking? Because generally speaking good clinical relationships are not fostered when one party is trying to call the other a liar. Or trying to diagnose boiler problems at arm's length (apparently).

[FJL203]

Has that patronising young woman with a lot to learn in life gone yet?

Good. I was getting stressed in the end, never mind her and her baby!

Although like Frebbie I was wondering how she managed to filter out the smokers from the non-smokers in clinic and refuse to deal with the former.

[Offred]

Meh, I think she's getting a hard time fairly deservedly based on what she actually said but I think we shouldn't forget her circs. Being pg at 18 means she'll likely feel very much on the defensive, and may be beig made to feel so in ordinary life by other judgemental peopl. I don't think she should have to defend her existence at all. It makes me a bit sad and I remember having the same feeling being pg at 20 of wanting to pre-empt other's judgement of me. Think we should leave it now and move on.

[RedToothBrush]

tribpot, it wouldn't surprise me if it was brought it in general practise. Not because it actually benefits anyone, but because someone makes money from making these tests and it sounds good on paper as an idea to decision makers.

I think pregnant women are the easiest target to get a foot in the door and start making it commonplace in the market.

Spot the cynic.

[FJL203]

RedToothBrush, I think you're spot on.

[K8Middleton]

With health related insurance premiums being on average something like three to four times more expensive for smokers I can totally see this moving into general practice.

[RedToothBrush]

You see, from that point of view, if you were testing me because of insurance premiums i'd be more inclined to actually take a test - not because of my health or because it was about damaging trust - but because it benefited my pocket and because it gives a very clear motive for people to lie.

But as things stand, I struggle to understand the motive behind lying - unless people are afraid of the judgment of those treating them. And if thats the case, shouldn't we be closely examining that relationship and what doctors and nurses are doing and trying to remove that rather tha making the patient the 'bad guy'. Perhaps its actually the attitude and manner of the profession that actually the real problem here?

[FJL203]

"Perhaps its actually the attitude and manner of the profession that actually the real problem here?"

RedToothBrush, see my post at 22.27.

[BlackSwan7]

Futterby

The privilege of bringing a child into the world ???

That makes it sound like the baby is doing us a favour. Quite the opposite actually. The woman does the fetus a huge favour by bringing it into the world. That too after such a lot of discomfort, pain and after all the health risks that come with pregnancy and childbirth.


Bringing a child into the world is not a privilege. It's a fucking hard job that spreads over 40 weeks and those 1-3 days it then takes to bring the wee one out.

[BlackSwan7]

Let's just make one thing very clear. It's the woman's body and her choice. She can do what she likes while she is pregnant and she can give birth however the hell she wants. Nobody has the right to stop her or patronise her.

[5madthings]

Ofgs women know smoking during pregnancy is not OK, offering the test is fine as long as a woman can make an INFORMED choice, but often in pregnancy I found that things weren't offered in that way, its just presented as a done deal, bit like when you get to 10-14 overdue and they book you in to be induced like you have to/its the only option. You often have to have a very determined mind set to question what you are told when pregnant or do anything different from 'norm' and that is not right.

women have bodily autonomy and anything against that is a VERY slippery slope.


BTW fluterby I got preg at 19, didn't realize for eight weeks etxmbut once I did I stopped drinking etc, fast forward nine year and I started smoking again after having post natal psychosis after ds4. When I got oreg with dd I was then still smoking occasionally, never more than three or four a day is that. I was honest with my midwife and consultant and cpn who I was still seeing and they actually all agreed that maintaining my mental health was more important than trying to quit totally. My living children needed a mum in good mental health and my baby needed a mum without ante natal depression and one that was less likely to get psychosis again MORE than she needed me to give up the occasional fag whilst pregnant.


Its a balance of risks, you have no idea what is going on in a woman's life so do stop being so judgemental as you will never make a good nurse with that attitude tbh.

[5madthings]

And what black swan said, tho as you have already said you are pro forced birth flutterby your attitude doesn't surprise me.

[Snog]

Most women don't smoke and would answer truthfully "no" to the question "do you smoke".
At which point the midwife effectively calls them all liars by suggesting/forcing a test to prove if they were lying or not.
Because we all know that women cannot be trusted and should not be treated with respect by healthcare professionals.
Damn right this would alienate me from healthcare services,

[Teaandflapjacks]

I replied a while back on this but couldn't help dipping in again. Futterby is clearly overzealous - but I suspect this is to with life experiences lacking and wishing whole heartedly to do the right thing - partic since she was drinking, smoking and smoking weed early on in her pg (up to week 8 or more from what I read) - here
I'm 18 years old and as you can imagine I had been drinking regularly (more often than I'm proud of - verging on an alcohol addiction), chain smoking and I even tried weed in the two months I was pregnant without knowing it.
....which of course would worry her, since the embryo was already feeding from her blood stream and taking in whatever she was doing at that stage. It would worry me TBH. I did hear recently that some research suggests up to 8 weeks babies are unharmed in anyway by what the mother has done (a move forward from the original 4-6 weeks cut off point) but I don't have a link to that research.

Back to the issue - I just find the whole thing disgusting. I am sure it is to do with tobacco companies being in bed with the government to some degree (since quitting smoking stuff always involves nicotine which just keeps you in the same loop of addiction - I think Alan Carr or Hypnosis is more effective longer term TBH). Any pregnant woman knows perfectly well she shouldn't smoke - but she is addicted. Cigarettes are more addictive than heroin (I believe). Women who continue to smoke in pregnancy deserve support and compassion and understanding, not vilification. I think stressing them out would make them smoke more - not less and achieve the opposite effect anyway. I also think this causes all women (myself as a non smoker included) to say stuff all the advice then - to some degree - and you would feel like you are back in the early 1900's!

This is actually more worrying to me than anyway having a cigarette - because what do you then chose not to do - that could have an impact later - such as with vaccinations for the child for example, which could in turn affect a whole load more things? It is a very slippery slope. I also would worry about such info being kept on file, and I am sure parts of the creaking NHS will end up privatised, then insurance companies would see this and fiddle your insurance accordingly, or even refuse to pay out, even if you got a false positive, i.e. from living in London. And anyway, for arguments sake - if you know that such a test would be conducted, and it has been proved how to skew the results (12 hours or 24 hours etc) would you not just not smoke upfront to avoid being bossed about in such a way? I live in Germany, such a ridiculous test does not exist here, and if it did I would tell them firmly where to stick it, and yes I am a non smoker.

To keep us all a bit more cheerful - women 'know your place'....

[youaintallthat]

if people don't want it just say no...i really don't think if i was offered this test it would adversely affect my entire relationship with my midwife and the health care establishment in general. Its just another guideline that is enforced on the people who work for the nhs to reduce the risk of complications and subsequent litigation against nhs trusts.

[Snog]

yeah fairplay kinda like a lie detector then
I wonder if they would doubt the word of the father?

[keelo123]

Good idea to have the choice, like for someone who is seeking help with quitting smoking whilst pregnant - but being mandatory is a stupid idea! Why not legalise canabis and amphetamine, it will create a better public environment and lower the governments spendature. Well, thats comparing that to all the offended pregnant women with raging hormones running around after stressed out midwives! Can you imaging all the mayhem!?

[amazingmumof6]

snog "Because we all know that women cannot be trusted and should not be treated with respect by healthcare professionals."

at that. well, they are right, aren't they? I mean how could they trust us, after all we were stupid enough to get knocked up in the first place - haven't we all heard of condoms?

smoking test - they should test us right now, I'm fuming!

[Snog]

So would the test be optional then?
How does that work?

MW: do you smoke?
Pregnant woman: no
MW: would you like me to test your breath to see if you are lying or would you prefer for me to believe what you just said to me?
Pregnant woman: why don't you go ahead and spend nhs time and money on seeing if I just told you the truth
We both know that I have nothing better to do with my time than participate in tests I do not need and that it is reasonable to assume that I tell lies. Afterall I am an adult woman who is pregnant.

I don't want to live in a country that treats women like this.