babyClear© – supporting pregnant women to stop smoking

babyClear© – supporting pregnant women to stop smoking


Smoking has a proven negative effect on
the health of pregnant women and their babies. Pregnant women continue to smoke
despite the known harms for a variety of reasons. In their social circles smoking
may be considered so normal that it’s hard to imagine a different way of
operating. Smoking is of course very addictive, some
women will be genuinely unaware of the harm that it causes. The maternity care team
including midwives and their assistants are in a very good position to support
pregnant smokers to quit because they’ll see them on many occasions throughout
their pregnancy. Midwives accept that offering stop smoking advice and help
are an integral part of their role but unless they’re given the necessary
training and tools they can be concerned about damaging their professional
relationships with pregnant women. In the North East of England the amount of women
smoking at the time their baby was delivered was 20% higher than the
national average. After detailed work with women and midwives, Fresh Smoke Free
North East with support from the Strategic Health Authority commissioned
a package of measures known as babyClear. This was to be rolled out across
the North East, its purpose was to systematically embed NICE guidance and
define clear referral pathways to Stop Smoking in Pregnancy Services. After
training on positive ways to approach the issue with women, midwives were
provided with carbon monoxide monitors to screen all women at each appointment.
Women with raised carbon monoxide were referred for a specialist support to
Stop Smoking in Pregnancy Services. Because it is considered so important,
pregnant smokers had to specifically opt out if they didn’t want to be followed
up intensively. Stop Smoking in Pregnancy Services then followed up with
appointments, smoking cessation advice and treatments, and made sure that the take-up was reported back to midwives. Closing the information loop to make
sure people didn’t get lost in the system. For pregnant women who were still
smoking at the time of their dating scan and a more intense risk perception
intervention was offered in some units using a computer and a foetal doll,
allowing the mother to see the true negative effects that smoking can have
on her unborn baby. Some women can find the facts quite shocking, but most are glad
that they’ve been informed and come to expect this as part of their
routine antenatal care. The package proved successful. Even prior to including the
risk perception intervention, referral rates to Stop Smoking in Pregnancy
Services increased progressively and were soon around two-and-a-half times
higher than before. Quit rates amongst pregnant women almost doubled and were
even higher in mothers who set a quit date. Smoking causes low birth weight which puts
babies at risk of complications. In this study babies born to women who quit
smoking during their pregnancy were on average 6% heavier than babies whose
mothers smoked. In fact they weighed nearly the same as babies whose mothers
had never smoked, so the effects of smoking can be reversed by quitting and
equals an additional healthy 200 grams for a baby born at term. The training of
all frontline staff was vital preparation for implementing NICE guidance and has allowed midwives to make challenging smoking into a
maternity service norm. CO monitoring acted as a strong motivator to quit and
although it was sometimes hard to achieve, cross agency working between
midwifery and Stop Smoking in Pregnancy Services was critical. Most women
accepted the need for a hard-hitting approach and those who struggled to quit valued
the more intense follow-up.

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