Women Smoking


MOTHERS and midwives have responded angrily to guidelines which will 'pressure' all pregnant women to take breath tests to check if they have told the truth about smoking.

In proposals due to come into force this year in the UK, midwives will be told to test mothers' carbon monoxide levels at their first antenatal appointment.

This will reveal if they are being honest about whether they smoke, with those found to have high readings given "appropriate support" on how to quit.

It follows concerns that while up to one-fifth of women smoke during pregnancy, many feel too embarrassed to admit it to their doctor or midwife and miss out on help to quit.

In Australia, current figures from government body Tobacco in Australia state that 11.7% of pregnant women smoke.

The head of Quit Victoria Fiona Sharkie agrees with the UK's guidelines, telling the Australian Women's Weekly that "around 30 to 35 per cent of women who smoke who are pregnant might not disclose that they are smoking.

"They're fearful of being criticised because they know that it's bad, they know that they'll be told they shouldn't do that."

But UK mothers are furious at the change, proposed by British health watchdog NICE, with members of website Mumsnet branding the plans "utter meddlesome nonsense" and "intrusive nannying".

One member said: "I think this is outrageous - why aren't pregnant women being trusted to tell the truth?"

Another commented: "Really terrible idea. Women are not just baby incubators once they're pregnant."

Although the tests will not be compulsory, mothers may feel obliged to take them after being asked to do so in hospital.

Last night midwives made it clear that the guidelines are unhelpful, saying having to carry out tests could undermine the trust between them and their patients.

Louise Silverton, director of midwifery at the Royal College of Midwives, said: "It is a bit draconian.

"They are asking us to test each pregnant woman for carbon monoxide on their very first visit.

"It is not allowing women to say no or midwives to use their judgment. And it puts pressure on the first visit when a lot of women are already dealing with a lot of information and stress.

"Our concerns are they may just say no. All you can really do is make sure that women understand the risks."

Smoking during pregnancy can increase the risk of miscarriage, premature birth, stillbirth and sudden unexpected death in infancy. Exposure to smoke in the womb is also associated with psychological problems in childhood such as lack of attention and hyperactivity.

Children of smokers tend to suffer from more respiratory problems such as asthma or bronchitis and to have problems of the ear, nose and throat.

NICE - the National Institute for Health and Clinical Excellence - is concerned that women who do smoke during pregnancy may find it hard to admit to their habit because of social pressures.

In its draft recommendation, the watchdog says: "This makes it difficult to ensure they are offered appropriate support. A carbon monoxide test is an immediate and non-invasive biochemical method for helping to assess whether or not someone smokes."

Simon Clark, director of smokers' lobby group Forest, said all mothers should be encouraged not to smoke when pregnant, but warned against putting pressure on women to take the tests. He said: "This seems incredibly invasive. If they are going to undertake any test then it has to be entirely voluntary.

"Our concern is what happens if a mother says no, will she be pressured or penalised? This could be the start of a slippery slope and it is important not to breach an individual's privacy."

Cathy Warwick, chief executive of the Royal College of Midwives, said a lack of midwives was a major reason why many women did not get proper help to give up smoking.

"The real solution here in cutting the prevalence of smoking in pregnancy is more midwives and more continuity of care from the same midwife," Mrs Warwick said.

"The shortage of midwives, particularly in England, means that often a midwife does not have as much time as she would want with each pregnant woman in her care and that women often see a different midwife at each visit."

She added: "We would like them to make clear in any advice to women that midwives should offer the test but that ultimately the final decision must lie with the woman."

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