Published on July 24th, 2018 | by Deb Wolf0
The Risks of Smoking During Pregnancy, and Solutions for Quitting
Current prEvents – July 19, 2018 – The Times Argus
Editor’s note: Current PrEvents is produced by the Central Vermont New Directions Coalition as part of the Regional Prevention Partnership grant from the Vermont Department of Health.
By ANGELA SHEA
For many expectant mothers, pregnancy is a transformative process that can be beautiful and lead to important reflection — but it’s not all rainbows and ponies. It can be stressful. When smoking is used as an outlet for stress reduction, pregnancy can be a particularly confusing and difficult experience. Mothers want what’s best for their babies and a pregnancy that carries stress can hinder attempts to quit smoking, a habit that we know is harmful for both mother and child.
Smoking while pregnant increases the risks for several adverse birth outcomes. Nicotine can greatly reduce the baby’s supply of oxygen by narrowing or tightening blood vessels in the body. This includes the blood and oxygen supply to the placenta, the baby’s “lifeline” to the mother. Smoking during pregnancy often leads to low birth weight, can inhibit newborn weight gain and adversely affect the baby’s body temperature or ability to ward off infection. For children whose mothers smoke, there is an increased risk of birth defects, premature birth, miscarriage and even stillbirth.
The smoking rate for expectant mothers in Vermont is consistently twice the national average. While this trend is troubling, there has been a statistically significant decrease in maternal smoking rates between 2013, when it was 18.3 percent, and 2014, when it dropped to 16.8 percent (National Vital Statistics 2014). When we break down the numbers of pregnant patients in Washington County who quit smoking, we see the number has increased from 13.8 percent in 2013 to 28.8 percent in 2016 (Vermont Department of Health). This increase tells us some interventions may be working to help women quit. While we are making progress, there’s still much more work to do.
Turning the curve
While quitting smoking at any time is an uphill battle, the women’s health team at the University of Vermont Health Network – Central Vermont Medical Center provides non-judgmental support and offers a variety of tools to help patients successfully address their tobacco addiction. Counselors, using motivational interviewing, explore patients’ internal motivators for wanting to stop and can also guide patients in finding a “replacement” for harmful habits. For example, if someone typically smokes on their drive home, we can suggest other options such as walking, getting a ride with a non-smoker or taking a bus. They also offer general tobacco education and help patients explore relaxation and mindfulness techniques. By using a carbon monoxide (CO) monitor, counselors can measure the amount of carbon monoxide in a patient’s and fetus’ lungs by having the patient blow into the device. This visual indicator of a baby’s health is a powerful motivator for tobacco reduction and cessation. It provides encouragement to patients who decrease their tobacco consumption week after week as they watch the CO number drop.
Tools for quitting
A number of proven strategies and resources are available for expectant mothers who wish to reduce or quit tobacco. A variety of nicotine replacement therapies (NRT) are available including nicotine lozenges, patches, mouth spray, gum or inhalers. While NRT has proven safe and effective for pregnant mothers, one should always consult with their primary care provider to determine the appropriate approach.
Your primary care provider, in some practices, can make a referral for an SBIRT clinician (Screening Brief Intervention Referral to Treatment) and free smoking cessation groups are available at Central Vermont Medical Center.
Additional strategies and support are available through the toll-free Vermont quit line at 1-800-QUIT-NOW (800-784-8669). There is a special program for new and expecting mothers to work with a supportive personal Pregnancy Quit Coach during and after pregnancy. Pregnant and post-partum moms may receive free NRT and can earn gift card rewards while trying to quit. Women can put the Quitline number into their cellphones so they recognize the coach when he or she calls back. Complete information is available at 802quits.org/baby/
Hate smoke, not smokers
The most important factor in mitigating parental smoking during pregnancy is to foster a culture of compassion for those struggling with nicotine addiction. As a clinician, I rarely meet a pregnant mother who doesn’t want to stop smoking. By stigmatizing behavior, we can inadvertently contribute to a cycle of addiction. I have heard a mom-to-be explain, “I feel bad about my smoking and therefore will have another cigarette in order to avoid this pain.” Shaming pregnant women just makes the challenge more insurmountable. By showing empathy and reminding patients of the resources available, we can make a positive impact and effect the changes in behavior that will pay off both for baby and for mom.
We know that smoking during pregnancy is dangerous and leads to chronic poor health. But with a compassionate approach, combined with easy access to resources, pregnant women can ensure a positive outcome for their newborns and give them the start in life they deserve.
Angela Shea is a behavioral health clinician with the University of Vermont Health Network – Central Vermont Medical Center’s women’s health team.