Pregnant Smokers Keeping it Secret?

Wednesday 15th of May 2013 | Category: Pregnancy News | Written by: Siobhan Thomas

You would have done well to miss the backlash from mums and mums-to-be on parenting sites this week over the latest guidelines for midwives during a woman's first antenatal appointment. It has been suggested that all pregnant women ought to be tested for carbon monoxide to see whether or not they smoke, and the notion has received fairly extensive criticism.

The guidance itself comes from the The National Institute for Health and Care Excellence (Nice) and proposes a simple breath test which would detect the amounts of carbon monoxide (a poisonous gas contained in cigarette smoke).

Another sign of our dictatorial nanny-state or are too many guilty consciences getting defensive?

Many women responded to the guidelines angrily, with accusations of bullying and being made to feel like a child. And what happens when children are asked whether they have done something naughty? They tend to get defensive and angry, and often want to avoid telling the truth...

The idea that by trying harder to establish whether a pregnant woman is a smoker is not itself something that offends me. If it's intrusive to be pushed as to whether or not we are smokers, then we ought to start protesting against being weighed and being asked about our diet.

The hard fact is that smoking is seriously damaging to your unborn baby. Smoking during pregnancy immediately increases the chances of all of the following:

Premature baby
Low birth weight baby
Complications during labour
Miscarriage

And that is not all. Infant mortality increases by a staggering 40% where the mothers are known to smoke. Smoking poses extremely serious health risks that ought to be beyond defence from those who think it's their right to conceal their habit from the NHS - the very body that is in charge of looking after pregnant women and ensuring their babies have the best possible chance of survival and a healthy life.

Would I be comfortable with the test?

Whilst I can say now with confidence that I am not a smoker, it is not to say that I have a clean track record. I was never a heavy smoker - my own vanity and sense of self-consciousness was enough to defeat my cigarette cravings at work and around friends who didn't smoke. I gave up altogether during pregnancy and I even forced my husband - a heavier smoker - to give up, because I knew how dangerous it was for my baby. On the rare occasion that I've been away from the children I have been known to be led astray by friends on a night out (alright, so I'm too old to be blaming other people now) but I was adamant that I would not knowingly do anything that might put my baby's life at risk during pregnancy.

All the same, I had been a smoker in a former life and that is a black mark on your maternity notes regardless of how much you might have changed.

I appreciate that the booking appointment (your first antenatal appointment with a midwife) is often daunting and that it can be stressful. And I didn't enjoy being quizzed about my lifestyle pre pregnancy, but that's not to say I didn't appreciate why the questions were necessary. Is it my right to only be asked questions that I am comfortable with at antenatal appointments? I received my pat on the back for taking folic acid and remembering not to eat blue cheese, and then I squirmed a little, like a child admitting a crime to a teacher, as I was asked about my pre-pregnancy smoking habits. So no, I probably wouldn't be comfortable taking the test - particularly if I knew it would show that I had smoked recently. But that isn't the same as resenting it. I would still want to be honest with my midwife so that she could maintain accurate health notes during my pregnancy and offer me appropriate advice and support for tackling issues such as nicotine addiction.

How effective could the test be?

In terms of measuring carbon monoxide as a clear indicator of whether a woman is smoking or not, the test is effective. But there is one big downfall with the new proposals. The test is optional and many critics of the plans have been quick to point out that women who falsely deny smoking or those who knowingly understate the quantity of their habit are quite likely to decline to have their answers disproven by a test.

That said, if women know in advance of their appointment that that they will be offered a test, might it not encourage at least some of them to be more honest about their addictions in the first place? Of course a lot would depend on the handling by the midwives, but they know as well as anybody how quickly you can put someone's guard up (for good) so it would be in their interest to be sensitive to women's feelings.

What really is so wrong about making the test compulsory?

OK, so I can hear the arguments for human rights heading my way already, but if it is the case that 1 in 5 mothers today in the UK are smoking during pregnancy then surely the pain of having our right to secret smoking curtailed is a small price to pay? If you were putting cigarettes in a baby's mouth it would amount to child abuse and you could find yourself in court. If people are denying putting their unborn babies at serious health risks then why should they be outside the law?

Making the test compulsory in itself doesn't amount to banning smoking altogether, but it will highlight those women who might benefit from help and guidance in giving up the habit. What's more, if all women are being tested then it will reduce the stigma of having the test at all. Professor Mike Kelly, director of public health for Nice explained on BBC Radio 4's Today programme that he hoped the test would act as 'a cue to talking it through' for midwives.

Worth a try?

It remains to be seen whether the test will be an effective means of getting women to open up about their smoking habits. The plans are undoubtedly limited in terms of their chances of reducing the number of pregnant women smoking. But the intentions of carbon monoxide testing are honourable and the arguments for women's right to withhold such important health information are too weak to challenge this attempt to reduce the number of babies whose health is at risk.