Rapid 1/3 fall in smoking during pregnancy in North East

NEW figures show the North East has seen a rapid fall in smoking in pregnancy thanks to a major four year initiative involving midwives to embed best practice in maternity services.

County Durham and Darlington NHS Foundation Trust is proud to be part of the initiative which means that every woman in the North East still smoking when they see a midwife is now given information about risks to their unborn baby and put in contact with support to quit - resulting in rates falling by nearly a third over the last six years.

Regional Smoking at the Time of Delivery (SATOD) rates are now at their lowest level on record, having fallen from 22.2% of women smoking at the time they gave birth in 2009-10 down to 15.6% in 2016.

The North East has taken a regional approach to reducing smoking during pregnancy and embedding National Institute for Health and Care Excellence (NICE) guidance using the babyClear approach developed by the Tobacco Control Collaborating Centre. This was rolled out in the North East by Fresh with all of the North East's hospital foundation trusts and Stop Smoking Services.

The national NICE guidance recommends that midwives raise smoking as an issue, use carbon monoxide monitoring to check high levels of exposure to tobacco smoke; and refer all smokers to local stop smoking services.

babyClear has worked in two ways to embed and go further than the NICE guidance:

•Women receive carbon monoxide (CO) monitoring as part of the routine tests during their booking appointment at around 8 weeks into the pregnancy. All high CO readings are routinely referred to Stop Smoking Services within 24 hours where they can get friendly, supportive help to stop.

•Women still smoking at their 12 week dating scan are talked through a more hard hitting and factual discussion on the harms of smoking with their midwife, using software to show the potential harm being done when an unborn baby is exposed to smoke.

Smoking during pregnancy can increase the risks of miscarriage and stillbirth, or having a premature baby who needs lots of medical attention.

Grace Wali, Public Health Improvement Manager for County Durham's stop smoking service, Solutions4 Health, said: "We are seeing more women who have taken the decision to quit smoking for their unborn baby. That has been as a direct result of this being raised as an important issue by their midwife.

"Women are now coming into the stop smoking service for help and support more informed and more motivated to stop, and many have already started to make really important changes.

"The bond between mum and midwife is a really important one and midwives are probably the most trusted source of health information for women during those months when they are carrying the baby. Women also find regular CO monitoring very motivational in seeing how far they have made progress."

Ailsa Rutter, Director of Fresh, said: "Most women who smoke will have started in their teens or younger, and it is an addiction that is not always easy to quit. Stop smoking services offer friendly support and understanding to make quitting that bit easier. Having support at home from their partner and grandparents can also really help.

"Monitoring carbon monoxide is now done quickly and simply alongside all the other routine screening tests carried out at the booking appointment to identify and address any health concerns to the baby and mum-to-be.

"Women need the facts but also to know there is excellent free support to quit smoking where they will be supported and helped, not have the finger wagged at them. Some women can find the facts quite shocking - but most are very glad they have been told and come to expect this as part of their anti-natal care.

"The North East has seen the largest falls in smoking in England and we still have lots to do before we are down to the national average or lower for pregnancy, but we are moving in the right direction."

Following babyClear's launch in 2012, around 450 midwifery staff and 150 Stop Smoking Service advisers have received skills training to discuss the issues with women in a factual, blame-free way, as well as being provided with equipment to deliver interventions.

When a smoker inhales, the 5000 chemicals in smoke, such as arsenic, benzene and formaldehyde, are absorbed through the lungs and move into the bloodstream. In pregnant women, these chemicals are passed to the unborn baby, depriving them of vital oxygen. Exposure to CO may cause harm to an unborn child, including low birth weight, perinatal death (stillborn and deaths within the first four weeks of birth), and behavioural problems.

A report by the Royal College of Physicians in 2011 found maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths (stillbirths and sudden infant deaths within the first four weeks of birth) and 2,200 premature births a year nationwide. In the North East that breaks down to 360 miscarriages, 22 perinatal deaths (stillbirths and sudden infant deaths with the first four weeks of birth) and 160 premature births.

In 2013 the national Smoking in Pregnancy Challenge Group - including ASH, the Royal College of Midwives, Tommy's and the Lullaby Trust published a report which called for more action to further reduce smoking in pregnancy and for the NICE guidance to be properly implemented.

It called for all midwives to be provided with carbon monoxide monitors to enable them to check all pregnant women for harmful levels of CO throughout their pregnancy, and for all NHS professionals to be able to raise awareness about the harm of smoking during pregnancy and the benefits of stopping. A review of the progress made was published in 2015.

Research with midwives by NHS North East and Newcastle University in 2010 found not all midwives felt confident or equipped to raise smoking during pregnancy, with many wanting more training and resources such as CO monitors.

Feedback from wards has also found women come to expect smoking being raised as an issue, and does not affect the positive relationship they have with their midwife.

Pictured: Trust matron for midwifery and ante-natal care, Allison Metters is interviewed by BBC Look North on the initiative's success.

Published: 16 September 2016