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Working with pregnant smokers
Tim Coleman and Carmel O'Gorman
Abstracts
Tim Coleman:
Treating pregnant smokers: the evidence base
Aim: To provide practitioners with an awareness of the
evidence base underpinning delivery of smoking cessation
interventions in pregnancy.
Background: Maternal smoking in pregnancy remains a significant
public health problem causing an increased risk
of miscarriage, low birth weight, pre-term birth and still
birth. Children of mothers who smoke whilst pregnant are
more likely to suffer from neo-natal mortality, sudden
infant death syndrome and asthma. Maternal smoking whilst
pregnant is also associated with an increased risk of
attention deficit and learning problems in childhood.
Content of presentation: This talk will briefly summarise
the impact that maternal smoking in pregnancy has upon
the fetus and infant and will assess the likelihood that
this harm is caused by nicotine. Recent trends in the
prevalence of smoking during pregnancy will be discussed
and the characteristics of women who continue to smoke
throughout pregnancy will be highlighted. Finally, evidence
for the effectiveness of smoking cessation interventions
in pregnancy including nicotine replacement therapy, will
be highlighted.
Carmel O'Gorman:
The North Staffordshire 'You Two Can Quit' programme
was identified by the HDA as best practice. Many existing
services encompass the key elements for a successful service.
Strategies to promote the pregnancy smoking cessation
service have included regular presentations and reports
to staff, community education via the mass media with
articles published in local newspapers and information
on display boards in hospital and community settings.
Referrals are from GP's, Health Visitors and Sure Start,
though the majority are from midwives. There are also
a number of referrals that are via 'word of mouth.' Experience
in North Birmingham has shown that referral rate tends
to increase following multidisciplinary training sessions.
Quality service standards exist for the management of
referrals. Experience has shown that initial telephone
contact provides an opportunity to establish a rapport
with the woman, offer further information and assess readiness
to quit. Training enables of midwives has enabled staff
to effectively determine a woman's readiness to quit smoking
and make more appropriate referrals.
Generally one-to-one support is offered mainly in the
clients own home. Treatment involves multi-session support
and depending on individual needs regular telephone and
text-messaging support is available. Women are assisted
in making an informed decision about using NRT. Local
GPs are progressive with the majority prescribing it.
The length of time that the products are used varies between
four to twelve weeks.
Some women use it albeit infrequently for longer than
this. Engagement is with partners/family members wherever
possible and access to support is facilitated for them
too.
The profile of smoking cessation in pregnancy has risen
greatly since the government targets were set and yet
pregnant women who smoke bring particular challenges.
In light of this a West Midlands network has been established
to offer a forum for practitioners in the field to access
information, share experiences and good practice. As the
network coordinator on-going support from the WM HDA and
the WM Perinatal Institute is important.
Biographies
Tim Coleman:
Tim Coleman works as a senior lecturer at the University
of Nottingham and as a salaried general practitioner (GP).
He qualified as a doctor from Leeds University in 1988
and trained as a general practitioner in Bradford, West
Yorkshire. He became an academic GP in 1993 and in 1998
was awarded an MD degree for his research into general
practitioners' anti-smoking advice given during their
routine consultations. He is keen to improve the primary
care management of smoking cessation and most of his research
has been into this area. Before taking up his current
post, Tim worked in the Leicester Warwick Medical School
and acted as medical advisor to RESOLUTION (Leicestershire's
Smoking Cessation Service).
He is a member of the Department of Health funded research
team evaluating the implementation of the English NHS
Stop Smoking Services. More recently, Tim's research has
focused on the use on the use of nicotine replacement
therapies (NRT) and he is the chief investigator for a
£1.1 million, MRC funded trial investigating the
safety and effectiveness of NRT in pregnancy.
Tim Coleman
Director of General Practice Undergraduate Education Unit
and Senior Lecturer in General Practice, School of Community
Sciences, Division of Primary Care, University Hospital,
Queen's Medical Centre
tim.coleman@nottingham.ac.uk
Carmel O'Gorman:
Carmel O'Gorman began her professional career as a
nurse and midwife, having worked mainly in the North of
England, but more recently in the West Midlands Region.
Her current post is as the Midwifery Lead for Smoking
Cessation in Pregnancy at Good Hope NHS Trust Hospital
in Sutton Coldfield, Birmingham.
A challenging and rewarding aspect of this post has been
successfully implementing and developing an integrated
service between Good Hope maternity services and North
Birmingham PCT stop smoking service. It is a 'quality'
service, which supports pregnant women to improve their
own health and give their babies a smoke-free start in
life.
A women's health advocate with a particular interest
in the tobacco problem and the special concerns about
women smoking, she is also a graduate in Women's Health
studies at the University of Central England in Birmingham.
Instrumental in addressing the need for smoking cessation
training, she has delivered multi-disciplinary pregnancy-specific
training locally and also enjoys lecturing on the impact
of tobacco on women's health at the UCE in Birmingham
too.
Carmel facilitates the West Midlands Regional Smoking
Cessation in Pregnancy Network, which began in September
2003. The network meetings provide an opportunity for
practitioners to discuss related resource, research, and
policy requirements and share good practice. A key feature
of the network is also to regularly review and present
pertinent research findings to inform the development
of effective cessation support. It is very pleasing to
note that the network has developed into a committed and
involved group with a desire to influence continuing change
for the benefit of this client group and their families.
As well as having a developmental role, importantly her
role is as a 'front line' practitioner too. Though helping
pregnant women to quit can be difficult and frustrating
at times - immense job satisfaction is gained from helping
women to stop and stay stopped. As one of her successful
mum's stated, "Carmel worked positively and supportively
with me and helped me to give my baby daughter the best
gift I ever could - a healthy start in life."
Carmel O'Gorman
Midwifery Lead Smoking Cessation in Pregnancy/coordinator
WM SCIP network, Good Hope Hospital NHS Trust/North Birmingham
PCT
carmel.o'gorman@goodhope.nhs.uk
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