Presentation on theme: "RCN TOBACCO POLICY ADVISOR European representative to ICN and TFI/WHO"— Presentation transcript:
1RCN TOBACCO POLICY ADVISOR European representative to ICN and TFI/WHO SupportingPregnant women to stop smokingJENNIFER PERCIVALRCN TOBACCO POLICY ADVISOREuropean representative to ICN and TFI/WHO
2Every midwife has seen a premature birth due to the effects of maternal smoking in pregnancy
3BARRIERS TO DISCUSSING SMOKING DURING PREGNANCY EXPRESSED BY PROFESSIONALS Fear of damaging the relationship with the womanLack of timeConcern that smoking cessation knowledge and skills are insufficientDoubts about the effectiveness of adviceLack of good resources to back-up counsellingAssuming a colleague has dealt with the issueIntermittent contact with individual women
5Health professionals need to know.. Facts about Tobacco controlHow to link a persons health problemsto their smoking historyHow to make effective brief interventionsIn the UK this is not yet included in basic training.Without training staff can rely on their own experiences which can be very negative …….
9WOMEN WHO SMOKE DURING PREGNANCY have a 27% higher chance of a miscarriageincrease by one third the risk of perinatal mortalityare 3 times more likely to have a low birthweight baby (on average 200grms or around 7oz lighter)are more likely to have children who suffer breathlessness and wheezing in the first 6 months of life
11Will not like me or let me care for them Staff attitudes to the topic of smokingMyth No.1If I ask about my patient’s smoking habits they:Will not like me or let me care for themWill think I don’t understand or am judging themWill not return for their antenatal careWill not let me visit their home
12Many nurses who smoke believe that: Staff attitudes to the topic of smoking if they smoke themselvesMany nurses who smoke believe that:It would be hypocritical to talk to patientsabout stopping smokingIn countries where nurses have a high rate of smoking this will have a negative impact on them making helpful interventions
14UK Research showed smoking is often a pregnant woman’s assertion of herself Quotes:“I care more than anything about this child.I’ve stopped drinking, I eat more healthily now.I smoke because it’s something for me.”Smoking is a way of signifying control over your life.Continuing to smoke preserves the pregnant woman’s precious self-esteem.
16I’ve tried giving up before but I can’t do it. WHAT TYPE OF THINGS DO WOMEN SAY WHEN YOU ASK ABOUT SMOKING IN PREGNANCY?My last baby was ok.I’ve tried giving up before but I can’t do it.I enjoy it - I don’t want to give up.Nothing works for me. I’m more stressed when I try to stop.I use it for weight management.I have cut down a lot. I don’t smoke that many a day.My partner smokes so it’s really hard to give up.I’ll have a smaller baby so the birth will be easier.I’m not having any health problems so why should I stop.I get cheap fags so can afford it.I can’t be bothered to try and I don’t think it’s a problem.All my family smoke.
20RAISING THE ISSUERemember that most smokers expect to be asked about their smoking.The research shows that pregnant women want convincing evidence of the harm done and practical advice on stopping.IF THE ISSUE IS NOT ADDRESSED MANY WILL ASSUME THAT SMOKING DURING PREGNANCY IS OK.
21Non-smoker Recent Ex Smoker Congratulate herTell her not smoking is an excellent choice for herself and her babyAsk if she is planning to stay a non smoker after delivery?
22Current smokerAssess motivation to change by asking the following questionsHow many packs do you smoke a day?Have you tried to stop smoking in the past year?Are you interested in stopping now you are pregnant?
24A COMMITTED SMOKERElicit what the pregnant smoker already knows and her interest in receiving informationExplain the link between smoking and possible complications in pregnancyProvide all information neutrallyCheck out the woman’s ongoing decisionand her interpretation of your discussion
25THINKING ABOUT STOPPING? Check her understanding of the health risks and benefits of stoppingTake a carbon monoxide readingSeeing the measurements of expired CO will give her objective information and can be very motivatingEncourage her to believe she can succeed in stopping if she really wants to.
26‘CUTTING DOWN’ IS OFTEN SEEN AS AN ACCEPTABLE COMPROMISE Often this is in response to naggingMeans of reduction include switching from high tar and buying standard length.Exonerates her from further efforts.Take up can rise in response to stress.In practice they cheat themselves on amount smoked and make an insignificant reductionWomen should be encouraged to quit rather than reduce consumption.
27Making plans to quit?Congratulate this decision and offer your support or referral to specialistRecommend they use a treatment productHelp them decide a dateCheck their expectations of quittingAsk‘What could get in your way andWhat can you do to help yourself?
28DURING THE PREGNANCYShow a continued interest and follow up the subject at each visit.Record the number of cigarettes smoked.Reinforce the benefits to the baby from her stopping.
29RELAPSE Why do some smokers fail to quit? Stopping under pressure from someone elseLack of personal motivationAttaching insufficient importance to stoppingWithdrawal symptomsPoor timingA question of self-image“I thought `just one’ wouldn’t hurt”
30NICOTINE REPLACEMENT THERAPY NRT products licensed for use in UK since early 1980sNRT is generally very safe and much safer than continued use of nicotine from cigarettesNicotine is a vasoconstrictor, so should be used with caution in those at high risk of acute cardiovascular events, unless the alternative is continued smoking.As with all drugs, NRT is better avoided in pregnancy, but again likely to be safer to mother and child than continued smoking.Shorter acting products may be better in pregnancy since they probably minimise fetal exposure30
31The pregnant women who are most likely to succeed at quitting are those who have: Thought about stopping for some time before becoming pregnant.Health concerns for the babyBeen prepared for withdrawal symptomsAn action plan for stopping which they have written downA coping strategy for critical timesSupport at home or friends to help them stop smokingNo major stress occurring in their livesA willingness to return for follow up appointments
34HOW CAN YOU PROTECT CHILDREN FROM HARM? You can protect children by keeping their playing, sleeping and eating areas completely smoke-free.Always try to smoke outdoors or away from children.What if that’s not possible for me? Open a window or door when smoking and blow the smoke outside.