Major initiative to tackle smoking in pregnancy underway

Posted on in Health improvement

A major  initiative to protect thousands of unborn babies from the harm caused by smoking and tackle the worst rates of smoking during pregnancy in the country is being rolled out in South Tees and across the North East.

Babyclear, led by Fresh and the Tobacco Control Collaborating Centre, is a UK first aimed at reducing premature births, stillbirths, miscarriages and complications after labour due to smoking.

The project is supported by all eight of the North East’s Foundation Trusts including North Tees and Hartlepool and South Tees Hospitals foundation trusts, heads of midwifery and NHS stop smoking services to ensure every woman smoking during pregnancy is given full, frank and factual information from a trained health professional about the harmful effects of carbon monoxide (CO)and encouraged to quit.
Although the North East has seen large drops in smoking over the last decade, the region still has the worst rates of smoking in pregnancy in England. Smoking at the time of delivery (SATOD) statistics show nearly one in five (19%) women are smoking compared to around one in eight (12%) nationally.

Under Babyclear:

  • Midwives in every North East trust are now including systematic carbon monoxide testing as part of the routine tests all women receive at first booking appointment, which is part of national NICE guidance. Raised CO readings can indicate smoking but also second-hand smoke exposure, inhalation of fumes from faulty exhausts, or poorly ventilated cooking or heating appliances. All high readings will be referred to NHS Stop Smoking Services within 48 hours as a matter of concern.
  • At the time of the dating scan, any women who are still smoking will be given a more detailed explanation of the potential harm to the foetus, from being exposed to carbon monoxide and other poisons contained in tobacco smoke. County Durham and Darlington NHS Foundation Trust has been the first trust to implement this intervention in the North East, with 90% of women receiving it in the first few weeks going on to take the first steps towards quitting. Work is now on-going to support rollout of this in other trusts across the region.
  • Around 400 midwives and over 100 stop smoking service advisers have received skills training and equipment to support implementation of this system.

When a smoker inhales, the 4000 chemicals in tobacco are absorbed through the lungs and move into the bloodstream. In pregnant women, the chemicals are passed to the baby via the placenta, depriving the unborn infant of vital oxygen.

A report by the Royal College of Physicians found maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births a year nationwide. In the North East that breaks down to 360 miscarriages, 22 perinatal deaths and 160 premature births.

Ailsa Rutter, director of Fresh, said: “Smoking during pregnancy is an issue the North East needs to collectively tackle together, and Babyclear is a national first to embed best practice within every maternity service across the whole region.

“Midwives are best placed to relay vital information to women and their partners to give them the best chance of having a healthy baby. They can fully explain the problems caused by smoking.

“The initial results from Durham and Darlington suggest this more factual, honest approach is already making an impact. Women need to know there is effective support to quit where they will be helped, not judged.”

Kay Branch, midwife consultant at South Tees Hospitals NHS Foundation Trust, said: “Smoking is one of the biggest risks to the health of the unborn baby. It increases the chances of losing the baby but also of giving birth prematurely to a baby that is more likely to suffer from frequent illness, is more irritable and not able to settle and sleep well.

“In Middlesbrough, Redcar and Cleveland, CO monitoring at booking appointment is now standard practice and we are working to embed the risk perception element at time of the dating scan to ensure every woman smoking during pregnancy gets the full facts and support they deserve. The risk perception resource provides visual information to women at the time of their scan that demonstrates the effect that smoking has on their unborn infant.

“After CO monitoring, we found many women were shocked and had not previously fully understood the process of how poisonous chemicals reach the baby and deprive them of oxygen.

“A premature birth increases the chances of the infant spending their first few months of life backwards and forwards to hospital.

“Women smoke during pregnancy for a number of reasons. A person is more likely to smoke if they have grown up in a household where other family members smoke. If their partner smokes that can make quitting more difficult as well, so we’re urging partners to quit too.

“It is important that pregnant women should be empowered with the full facts about smoking so that they fully understand what is happening inside their own body, without judgement or blame. We can help put them in contact with the best available support to help them to quit.”

Over 1,400 women quit smoking during pregnancy with the help of NHS stop smoking services in the North East between 2011-13.

Joan Chapman, manager of Middlesbrough, Redcar and Cleveland NHS stop smoking service, said: “We understand it can be hard, but stop smoking services offer free, effective support to pregnant women that really boosts their chances of quitting successfully. We’re not there to wag the finger, just to help.

“The good news is that it’s never too late to benefit from quitting smoking. Most of the harmful effects of smoking during pregnancy happen in the second and third trimester, so stopping in the first three months of pregnancy reduces your risk of having a low birth weight baby to that of a non-smoker.”

Eugene Milne, director, adult health and wellbeing at Public Health England, said: “Helping mothers not to smoke is hugely important for the future health of the whole family. Despite making great strides in recent years, the region has historically had England’s worst figures for smoking in pregnancy. So it is terrific to see services getting to grips with the problem and offering practical help and support. The Babyclear programme looks a good bet for helping more mothers to quit, and Public Health England will be watching with keen interest to see if the North East can again lead the way.”

Anyone wanting to quit smoking can contact the Middlesbrough, Redcar and Cleveland NHS Stop Smoking Service on 01287 284487.

The evaluation is one of the first funded by the National Institute for Health Research’s School for Public Health Research (NIHR SPHR) as part of its recently launched Public Health Practice Evaluation Scheme (PHPES). The scheme enables those delivering innovative public health initiatives to work in partnership with SPHR to conduct rigorous evaluations of their cost effectiveness.

Smoking and pregnancySmoking during pregnancy

Smokers have a greater risk of having a premature baby or cot death. Premature babies are more likely to suffer from severe illness and respiratory infections, be more restless, sleepless and irritable, and need regular hospital attention in their early years.

Smoking during pregnancy increases the chance of a baby being born with missing or deformed limbs and cleft lip or palate.

Studies show smoking during pregnancy may significantly increase the risk of having a child with behavioural problems.

A report was published in June 2013 by the national Smoking in Pregnancy Challenge Group – a coalition of baby charities, campaigners, leading academics and health experts including the Royal College of Midwives, Royal College of Nursing, ASH and Fresh. The group also raised concern over the training of healthcare workers and midwives to offer support to mothers who smoke, meaning that smokers do not always know the consequences of smoking and that professionals are not always equipped to provide the necessary motivation required.