A MAJOR initiative to protect thousands of unborn babies from the harm caused by smoking and tackle the worst rates of smoking during pregnancy in the country is being rolled out across the North East.
babyClear, led by Fresh and the Tobacco Control Collaborating Centre, is a UK first aimed at reducing premature births, stillbirths, miscarriages and complications after labour due to smoking.
The project is supported by all eight of the North East's Foundation Trusts, Heads of Midwifery and NHS Stop Smoking Services to ensure every woman smoking during pregnancy is given full, frank and factual information from a trained health professional about the harmful effects of carbon monoxide (CO), and encouraged to quit.
Although the North East has seen large drops in smoking over the last decade, the region still has the worst rates of smoking in pregnancy in England. Smoking at the Time of Delivery (SATOD) statistics show nearly one in five (19%) women are smoking compared to around one in eight (12%) nationally.
• Midwives in every North East trust are now including systematic carbon monoxide testing as part of the routine tests all women receive at first booking appointment, which is part of national NICE guidance. Raised CO readings can indicate smoking but also second-hand smoke exposure, inhalation of fumes from faulty exhausts, or poorly ventilated cooking or heating appliances. All high readings will be referred to NHS Stop Smoking Services within 48 hours as a matter of concern.
• At the time of the dating scan, any women who are still smoking will be given a more detailed explanation of the potential harm to the foetus, from being exposed to carbon monoxide and other poisons contained in tobacco smoke. County Durham and Darlington NHS Foundation Trust has been the first trust to implement this intervention in the North East, with 90% of women receiving it in the first few weeks going on to take the first steps towards quitting, Work is now ongoing to support rollout of this in other trusts across the region.
• Around 400 midwives and over 100 Stop Smoking Service advisers have received skills training and equipment to support implementation of this system.
When a smoker inhales, the 4000 chemicals in tobacco are absorbed through the lungs and move into the bloodstream. In pregnant women, the chemicals are passed to the baby via the placenta, depriving the unborn infant of vital oxygen.
A report by the Royal College of Physicians found maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births a year nationwide. In the North East that breaks down to 360 miscarriages, 22 perinatal deaths and 160 premature births.
Ailsa Rutter, Director of Fresh, said: "Smoking during pregnancy is an issue the North East needs to collectively tackle together, and babyClear is a national first to embed best practice within every maternity service across the whole region.
"Midwives are best placed to relay vital information to women and their partners to give them the best chance of having a healthy baby. They can fully explain the problems caused by smoking.
"The initial results from Durham and Darlington suggest this more factual, honest approach is already making an impact. Women need to know there is effective support to quit where they will be helped, not judged.”
Anne Holt, Head of Midwifery at County Durham and Darlington NHS Foundation Trust, which was the first NHS trust to fully embed both babyClear interventions, said: "Smoking is one of the biggest risks to the health of the unborn baby. It increases the chances of losing the baby but also of giving birth prematurely to an unhealthy, more irritable infant.
“A premature birth increases the chances of the infant spending their first few months of life backwards and forwards to hospital.
"Women smoke during pregnancy for a number of reasons, but most probably started as teenagers and are addicted. If their partner smokes that can make quitting more difficult as well, so we’re urging partners to quit too.
"After embedding babyClear, we found many women were shocked and had not previously fully understood the process of how poisonous chemicals reach the baby and deprive them of oxygen.
“It is fair to say there was some initial reservations from some midwives, but the reaction from most women has been overwhelmingly positive. They are also offered quitting support there and then.
"It is important that pregnant women should be empowered with the full facts about smoking so that they fully understand what is happening inside their own body, without judgement or blame. We can help put them in contact with the best available support to help them to quit."
Eugene Milne, Director, Adult Health & Wellbeing at Public Health England, said: “Helping mothers not to smoke is hugely important for the future health of the whole family. Despite making great strides in recent years, the North East has historically had England's worst figures for smoking in pregnancy. The babyClear programme looks a good bet for helping more mothers to quit, with important implications for reducing inequalities in health across the country and has the full backing of Public Health England.”
Over 1,400 women quit smoking during pregnancy with the help of NHS Stop Smoking Services in the North East between 2011-13.
Joanna Feeney, specialist advisor for County Durham and Darlington NHS Stop Smoking Service Secondary Care Team, said: "We understand it can be hard, but Stop Smoking Services offer free, effective support and Nicotine Replacement Therapy to pregnant women that really boosts their chances of quitting successfully. We're not there to wag the finger, just to help.
"The good news is that it’s never too late to benefit from quitting smoking. Most of the harmful effects of smoking during pregnancy happen in the second and third trimester, so stopping in the first three months of pregnancy reduces your risk of having a low birth weight baby to that of a non smoker."
An in-depth evaluation led by Newcastle University working with Teesside University as members of Fuse, the Centre for Translational Research in Public Health (http://www.fuse.ac.uk/) will track around 30,000 pregnancies in the North East, and assess the impact of this concerted approach on birth outcomes.
The evaluation is one of the first funded by the National Institute for Health Research’s School for Public Health Research (NIHR SPHR) as part of its recently launched Public Health Practice Evaluation Scheme (PHPES). The scheme enables those delivering innovative public health initiatives to work in partnership with SPHR to conduct rigorous evaluations of their cost effectiveness (http://sphr.nihr.ac.uk/in-partnership-with-practice/phpes/).