Quitting smoking in
pregnancy and following
childbirth
Implementing NICE guidance
2010
NICE public health guidance 26
What this presentation covers
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Background
•
Recommendations
•
Costs and savings
•
Discussion
•
Find out more
Background
• Smoking in pregnancy can cause serious health
problems for mother and baby
• Nearly a third of mothers in England smoke in
the 12 months before or during pregnancy
Recommendations
The guidance makes 8 recommendations on:
•
identifying pregnant women who smoke
•
referring them for help
•
providing support
•
training for professionals
Identification and referral:
action for midwives
• Assess the woman’s exposure to tobacco
smoke through discussion and use of a CO test
• Provide information on the risks of smoking and
health benefits of stopping
• Advise pregnant women to stop smoking – not
just cut down
• Refer them for help to quit and explain that it is
normal practice to do this
Identification and referral:
action for others
• Use any appointment or meeting as an
opportunity to ask women if they smoke
• Offer those who want to stop a referral to
NHS Stop Smoking Services
• Those with specialist training should provide
information on the risks of smoking and health
benefits of stopping
Recommendations for
NHS Stop Smoking Services
These are aimed at specialist advisers and cover the
following areas:
-
Contacting referrals
Providing support
The use of NRT and other pharmacological support
Working with other agencies
Disadvantaged pregnant women who smoke
Partners and others in the household who smoke
Contacting referrals
• Telephone all women who are referred for help
• Try and see those who cannot be contacted by phone
during a routine antenatal care visit
• Send information on smoking and pregnancy to those
who decline the offer of help
Providing support
• Provide information on the risks of smoking and
health benefits of stopping
• Provide intensive and ongoing support throughout
pregnancy and beyond
• Biochemically validate that the woman has quit on
the date she set and 4 weeks after
• Establish links with other organisations
NRT & other drugs
• Only prescribe NRT for 2 weeks once women
have stopped smoking
• Only prescribe more NRT to women who have
demonstrated that they are still not smoking
• Do not offer varenicline or bupropion to
pregnant or breastfeeding women
Helping those who are
disadvantaged
• Ensure services are delivered in an impartial,
client-centred manner
• Ensure services meet individual needs
• Involve women in service planning and
development
• Work with agencies that support women who
have complex social and emotional needs
Helping partners and other
household members
• Offer partners who smoke help to stop, using a
multi-component intervention
• Provide clear advice about the dangers of
second-hand smoke
• Recommend not smoking around a pregnant
woman, mother or baby
Training
• Midwives delivering intensive stop-smoking
interventions should be trained to the same
standard as NHS stop smoking advisers
• Non-specialist midwives should be trained to
assess smoking status and refer people for help
• Other relevant professionals should be trained to
the same standard as non-specialist midwives
Costs and savings
Recommendations on the following may result in
additional costs or savings:
• Identifying and referring pregnant women who smoke
to NHS Stop Smoking Services
• Contacting pregnant women who smoke and providing
them with help to quit
• Helping pregnant women to stop smoking to help
mother and baby avoid health complications
Discussion
• What training is available to ensure local midwives
can help pregnant women to quit smoking?
• What specialist support is available from local
NHS Stop Smoking Services for pregnant women
who smoke?
• How is smoking status currently validated?
Find out more
Visit www.nice.org.uk/PH26 for the:
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Guidance
quick reference guide
costing report and local template
baseline assessment tool for local planning
commissioning guide (from late 2010)