Study finds pregnant women are reluctant to seek help in kicking the habit despite dangers to the foetus, writes MARESE McDONAGH
PREGNANT WOMEN who smoke are often more reluctant than other patients to seek help kicking the habit – but staff at one regional hospital recently managed to achieve a tenfold increase in the number of expectant mothers taking steps to quit.
A study conducted at Sligo General Hospital in the 12 months to September 2010, showed that 16 per cent of women attending the antenatal clinic admitted that they smoked – but staff believe the real number was much higher.
Despite the fact that smoking during pregnancy increases the risks of miscarriage, complications during labour, cot deaths and respiratory and problems with cognitive ability in childhood, many women find it difficult to quit.
In 2008, 11 per cent of women attending the antenatal clinic at SGH admitted that they smoked, but staff say that under-reporting of smoking in pregnancy is well documented. Disappointingly for midwives, only 5.5 per cent of those who admitted to smoking agreed to a referral to the Smoking Cessation Service (SCS) at the hospital in 2008.
But two years later, a study by the SCS coordinator in the hospital found a tenfold increase in the number of pregnant smokers who agreed to avail of the service.
Coordinator Pauline Kent told the hospital’s annual research conference that the referral rate jumped to 56 per cent from October 2009 to September 2010 after smoking status tests were introduced and midwives were briefed on ways of motivating the women rather than criticising them or making them feel guilty.
All of the 716 pregnant women, aged 16 or over, attending the hospital in the study period were invited to participate in the study, which involved two simple tests to establish smoking status as well as advice from midwives. Of the 716, 114 women or 16 per cent admitted that they smoked.
Only 12 per cent of the 716 agreed to participate in the study, some of them smokers while the remainder were concerned about passive smoking. A carbon monoxide breath test and urine cotinine test was used to measure the level of nicotine in their bodies.
“We obviously had to get the consent of women and so it is probably fair to assume that many who won’t give consent are smokers,” Ms Kent pointed out.
She told the conference that a key aspect of the project was the interviewing skills training given to midwives who focused on listening and motivating the pregnant women, rather than judging them.
Ms Kent pointed out that the breath and urine tests were non-invasive, inexpensive and give a very accurate reflection of smoking status.
The Sligo study has sparked interest around the country because the methods used are in line with the NICE (National Institute for Clinical Excellence) guidelines.
Ms Kent said the study was sparked by concerns about the low number of pregnant smokers who were availing of the SCS.
“We found that many pregnant women were misinformed – they still don’t understand the consequences of smoking during pregnancy and many were unaware of the advantages or nicotine replacement therapy,” said the SCS coordinator, who added that oral products such as gum and Nicorette inhalers but not patches were recommended.
“There are four and a half thousand chemicals in each cigarette and all of these pass to the baby when a woman is pregnant,” said Ms Kent, adding that that while women regularly lie about their tobacco habit, midwives are not fooled.
“Midwives can tell from the placenta if a woman smoked during pregnancy. If she did, the placenta will be black, not red, and there will be an odour off it”.
She said that when people smoke, carbon monoxide displaces oxygen and this means that a baby in the womb gets less oxygen.