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!

Themilkywoman, see, this is where I'd get nasty. No-one would "pretty much refuse to let me leave", not without regretting it at any rate. I'm totally unsurprised but horrified and angry nonetheless that women should be treated like this. The same applies to Cardamomginger and the HIV tests. What did you do in the end, Cardamomginger? Where you told what "trouble" you'd make for yourself by refusing?

I've had a few midwives with "But you have to!" in the past. Knowing that they must be fully aware that they're overstepping the mark and their legal rights they've all been met with a very angry, "I don't fucking well have to do anything!".

Hear, hear Ramboscar. Last time I looked, this is a free country. There are very few things that we have to do.

Madness! I'm shocked that this is done when it seems to carry no benefits and have such a negative impact. A waste of money and policing of pregnant women.

Starlight interesting question.

Given the NHS is on the way to being privatised, could they refuse treatment to women who refuse nicotine replacement?

DH and I are ex-smokers - me 7 years, him 3 years. We live near a main road, a tip and the M25. My asthma has been horrendous since I've lived here.

We're unlikely to have kids (long story) but if I was pregnant I would resent not being believed about not smoking, and being told that I was lying if my CO levels were high because of the sodding roads etc.

I've never smoked in my life but I would refuse this test.

Are there any other medical test, in the UK, which are forced on men or unpregnant women

Sorry I don't think "unpregnant" is even a word!

I'm just really cross reading this thread!

I declined anti d injections, my MW was surprised, I think most people still unquestioningly do what hcp's ask. But she was fine, no one made me feel bad.

Excuse Judging by my GP surgeries constant letters while I was pregnant with DS, I would say smears are pretty pushed as well.

I think the question should be does anything like this happen to men.

Rowan- I was bullied by my smirking bitch of a midwife into doing this test 5 years ago, despite having told her I'd never smoked in my entire life!
I was in a very emotional state- had just had a miscarriage, found I was pg again, very scared and worried about losing the pg again. This she knew btw, though she didn't listen to a single word I said about my previous pregnancies and births, nor any of my family history.
(She also referred me to the specialist MH midwife because I'd suffered depression 15 years earlier (though tbh the MHMidwife just laughed in disbelief when she looked at my notes)).

I had the test, but felt angry and resentful. It's strange. I usually ensure that I am fairly well educated about all matters health when it comes to me. But when it came to my pregnancy, I pretty much accepted what I was told, including that I 'had to' consent to certain things. It's almost like I thought that being pregnant meant that I was somehow less in charge.

Now I have had DD, I have reverted to my usual well-informed stroppy and bolshie self.

God I am so, so sick of all this backlash stuff to try and get women back under control and the way pregnancy and birth is used to do this - just at the time when you're most vulnerable so you can't fight back.

I'm a non-smoker, think smoking is naff, but I'm totally against this.

I know, I've got an idea, how about introducing tests to find out whether men are physically abusing their partners? 1 in 4 women are victims of Domestic Violence, it is the biggest danger to a woman's health in pregnancy and lots of men pretend they aren't beating up the women they live with when they are, so maybe a universal test to find out whether men are health risks to their partners and babies because of their DV, would be a better use of resources? I'm sure all men everywhere would be delighted to comply with such a test, after all, it's all in the name of healthy babies.

Cardamomginger, stroppy and bolshie is good.

Basil You are already forced to have 15 minutes of your booking in appointment on your own so they can quiz you about your partner possibly beating you up.

I tried to refuse that as well! For the same reasons I gave before, that I was in a vulnerable place, didn't trust the maternity system and staff after previous pregnancy and didn't want to be on my own.

She refused to see me unless I came in on my own and that was after I told her in front of DP that I knew why she wanted me on my own, the answer is no and it will be even if I go with her.

I'm sure DP felt great about that especially when he was allowed in then she said to his face that he might have given me HIV since DS was born by sleeping around!

i had one - it wasnt described to me as such she just asked me if i had detectors in my house and i said no - she asked me if i wanted a test i said 'yes' and had it

definitely should have them absolutely !

I had the test this pgy - am a "never smoked" but she shrugged and said you never know if you've got a dodgy boiler or something.

They've been nagging pregnant women about smoking for years without properly explaining why it matters. It's just another thing in the list with alcohol, Mr Whippy and blue cheese.

The number of people who are saying things on this thread that are quite clearly in conflict with the rules on consent is highly alarming.

For the record the following are paragraphs directly from the GMC's guidelines on consent:

42. You should do your best to make sure that such patients have considered the available options and reached their own decision. If they have a right to refuse treatment, you should make sure that they know this and are able to refuse if they want to.

43. You must respect a patient?s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational. You should explain your concerns clearly to the patient and outline the possible consequences of their decision. You must not, however, put pressure on a patient to accept your advice. If you are unsure about the patient?s capacity to make a decision, you must follow the guidance in Part 3.

Some of you on this thread would be well within your rights to report your HCPs and I'd encourage you to do so.

Red I think I might just print that out and take it to all my appointments with me, just incase.

Thanks for posting that.

i think people should see the bigger picture
women are being helped by these measures - i might feel put out for a minute but its for the greater good

Schro,

The whole thing is Here if you want to read it in full.

The thing is you have the RIGHT to refuse anything, and they are not allowed to put you under pressure to make a decision as its consent under duress which by its very nature isn't consent.

Also, if you are being told they will refuse to see you if you don't do x, y or z they are very clearly breaking the rules. They aren't allowed to withhold access to healthcare or other treatments even if you refuse something, unless they have a very good medical reason.

This is certainly the case if she really is refusing to see you because you want your partner there because you have anxiety over appointment because of previous experiences and a lack of trust in HCPs.

Even if they do suspect domestic violence they can not do this - you theoretically MORE at risk, and therefore need MORE contact with them, rather than creating a situation where you are actually LESS likely to attend.

This is why I would encourage you to report as you might not be the problem; it might be the other patient she has who does have an abusive partner...

Presumably contacting the police wouldn't be a bad idea either

iclaudius A lot of people are just being put in situations they don't want to be though, pressured into doing things they don't want to, for whatever reasons.

To me that is the bigger picture here.

Thanks Red, I know I can refuse anything that I want to, it's just sometimes some people make it so hard to do so and when you are sat in a room with just that other person putting pressure on you, it can be really hard to be as assertive as you would like.

For that one person at the booking in, I should have complained and I immediately complained to my Consultant when I went into see him after her. At the time I was just too emotionally messed up to complain or do anything about it seriously.

Mostly everyone else has been lovely, I realise that not all the staff are like that and some are just not very nice people.

She did refuse to see me, she said she "couldn't" if I didn't go on my own. I tried arguing that one for over 10 minutes, in the (full) waiting room but was getting no where.

"i think people should see the bigger picture
women are being helped by these measures - i might feel put out for a minute but its for the greater good"

Can you explain exactly how it's helpful to spend a considerable amount of the already overstretched, overworked and underfunded NHS's - no, taxpayer's - money on an initiative which will be used to patronise and bully women, treat them like idiots and liars, alienate them and, as our experiences of the "you have to" and "you have to or else" contingent prove, in some cases cause a breach in UK laws regarding medical consent?

And then can you explain quite what you mean by "the greater good" in this instance, please?

The 'greater good' is something a deeply despite as a justification for this type of thing. The single more important thing in healthcare is having a good relationship based on trust between HCPs and patients.

This can not be achieved by coercion. It can only be achieved with clear communication, respecting the patient as being capable to make their own decisions and live with the consequences even if they don't agree with the patient, respecting the wishes of patients and their right to refuse certain things, and building up a situation where patient feel listened to and can ultimately trust those caring for them.

Anything less, has knock on effects further down the line that may effect their health at a later date - it couple be as simple as putting off a call to the doctor when they find something slightly out of the ordinary.

'Enforcing' tests may well have short term benefits, but I seriously question their longer term benefits. It might not be obvious, but pressuring patients and the break down of trust from patients is a killer.

Help how, IC?
No one's given up smoking by bring bullied into it.
It's harmful for baby and mother, but the midwife has to explain that, not force you undergo tests.

It's counterproductive, the way it's being done.

If they mistrust us how can they expect us to trust them?

ramboscar - why do YOU suggest these tests are being introduced then?