Smoking in pregnancy
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2188 (Published 22 June 2009) Cite this as: BMJ 2009;338:b2188
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Dear Editor,
The thoroughly researched and documented effect(s) of tobacco-smoking
during pregnancy on the unborn fetus is an area of vital importance and I
thank you for bringing it to the fore once again. Despite the numerous
interventions and media campaigns, obstetricians and midwives world-wide
continue to focus their efforts on encouraging pregnant women to stop
smoking. Is it that we underestimate the complex issues behind the choice
to persist smoking in the face of gentle prodding, sound advice or
forceful evidence?
Research has suggested that factors such as age of the expectant
mother, education, poverty, whether her partner smokes and having the
“addictive” gene that predisposes some people to heavy smoking all affect
a woman’s ability to quit smoking during pregnancy. These are multifaceted
issues which in my opinion, are difficult to address during regular
antenatal visits with providers of prenatal care.
I note the findings from the systematic review quoted in your
editorial and disagree with the notion that the ineffectiveness of mid-
wife led interventions to reduce maternal smoking could be due to
reservations about addressing the issue while attempting to build rapour
with clients early in their pregnancy. It borders on suggesting that
midwives rank the importance of good client relations above the health of
both the mother and unborn child. There is a distinct difference between
the midwifery and medical (obstetric) models of care, with the former
being traditionally more relationship-intensive than the latter.
Midwives pay keen attention to the process and experience of
pregnancy and its impact on the fetus, labour, delivery, and maternal
development. As such, they invest time to help and support a mother to
recognize and change aspects of their lifestyle that are detrimental to
the health of their unborn baby. An article in the Journal of Midwifery
and Women’s Health (1999) highlights the difference in the approach of
obstetricians who mainly focus on the fetus and screening for pathology.
A study by Aaronson (1987) concluded the opposite of the one cited in
your editorial. It stated that women who had obtained prenatal care at a
facility by either midwives or obstetricians, felt that their midwife care
providers held significantly stronger opinions about the importance
of health-promotion behaviors, including abstinence from smoking, and
offered more support to help the women conform to those behaviors, as
compared to the women who obtained their prenatal care from obstetricians.
But this commentary is not seeking to prove whether midwives or
obstetricians obtain a better success rate in smoking cessation. Rather, I
agree that strategies to address this behavior early in pregnancy and
beyond childbirth need to be intensified to lower the burden of
preventable conditions on health systems and government budgets.
Perhaps incorporating psychologists and social workers as part of the
interventions could result in more favorable outcomes.
Uki. A. Atkinson
Competing interests:
None declared
Competing interests: No competing interests
Smoking in Pregnancy
Thanks for this write up. I believe it is time smoking effects be
limited to the perpetrators of this dangerous practice and that the future
generation (innocent unborn and newborns)be free from this maternal short
coming.
Of utmost concern is the suggestion that cluster randomized trials of
midwives fail to show that their intervention in pregnancy can reduce
maternal smoking. Midwives' precedence in health care has never been to
build relationships alone, but preference is always given to the well-
being of the mother and infant. I suggest that if interventions are well
focused, the window period of stopping smoking for the benefit of the
fetus could be utilized for antenatal clients to completely stop smoking.
These interventions should not only focus on the immediate need to
stop smoking, but look at more long-term efforts to encourage and convince
mothers of the benefits of stopping the habit for life – their own and
that of their children.
It is high time that the dialogue and debate about this issue yield
better results and interventions.
Ekaete Francis Asuquo
Competing interests:
None declared
Competing interests: No competing interests