As a Tobacco Dependence and Treatment Practitioner within Maternity Services at Kingsmill Hospital, Amy is on the frontline within the NHS, supporting pregnant women to quit smoking.
She describes the service offered, her thoughts on the drivers and barriers to quitting and advice she gives to those thinking about quitting.
Cessation Service
The service offers treatment to smoking mums-to-be at every point of contact from the initial maternity booking. Mums can take part in an incentive scheme where they receive Love2Shop vouchers if they can stay smoke-free at certain milestones throughout the pregnancy. The service can also provide nicotine replacement therapies and a long-term series of consultations, up to 6 weeks after the baby is born.
Women are also made aware of the risks of smoking in pregnancy, some of which Amy witnesses first hand. She refers to this as “one of the rough parts of the job – seeing pre-term babies born, or pregnancies end”. Whatever happens, she prioritises supporting families in a completely non-judgemental way. Amy is of the opinion that smoking should be treated with an absence of blame – the idea that smoking is an addiction and not a lifestyle choice.
She likes to get to know her patients – to build a rapport and some level of trust before the quit smoking plans are put in place. Amy becomes someone mothers trust and feel supported by, regularly opening up to her about other struggles in their lives.
The incentives are good for women – they give up so much in pregnancy that it’s quite nice for somebody to say ‘Well done – you’ve stuck it out’. It’s an acknowledgment that they’ve achieved it. And if they’re hitting a tough point, maybe it’s the thing that keeps them going.
Things like miscarriage, stillbirth and interventions in pregnancy – instrumental deliveries, all are more common if you smoke. Your healing postnatally isn’t going to be as simple either and it can also impact the development of the baby. There’s also things like cot death which are more common. It’s all quite grim. Sometimes with women we say it’s a bit like ‘Russian Roulette’ – your last pregnancy may have been completely fine, and you had no problems, and baby’s fine, your fine. I can’t tell you that it will be the same again…
Insight into Smoking in Pregnancy
Many of Amy’s patients are ready for a new start and actually wish they never started smoking in the first place. However, Amy sees a lot of patients who talk about ‘relieving stress’ as one of the main reasons for smoking. The fear of losing that ‘5 minutes peace’ within a stressful day is a definite barrier to quitting amongst the women she works with. Amy explains that smoking can actually be a cause of stress – and that in fact, escaping the vicious cycle caused by smoking is likely to improve stress levels.
Another challenge for mothers can be when partners also smoke – it can be hard to quit on your own. Amy tries to encourage both partners to try and quit together, and makes sure she communicates the risks of passive smoking on expectant mothers and their babies.
Now more than ever, Amy sees many families in desperate financial situations, who end up spending hundreds of pounds on cigarettes every month. Linked to this, she hears more women saying they use illicit tobacco as a way to save money. Amy witnesses the ways in which quitting can really change lives, financially – especially for growing families.
The financial impact on a couple can be huge - hundreds and hundreds of pounds a month. We know cigarettes are expensive, but people are more and more being pushed towards black market cigarettes and tobacco because they can’t afford it, but struggle to give it up because they’re addicted.
It's just a big cycle - symptoms of stress and anxiety are really similar to withdrawal, so it’s about helping people recognise that what they’re feeling is not necessarily stress, it's withdrawal because they’ve not smoked. That's why, when they smoke, they feel better. Women can use nicotine replacement during pregnancy (under supervised use) to make things easier, but it’s not going to cover everything - there are mental cravings as well as physical ones. It’s about finding different coping strategies – for someone who started smoking at 11 – smoking has been their coping mechanism for their entire adult life!
What advice would I give to other smokers?
If you’re thinking about it - give it a go. Every quit is different. You may have tried before, it might not have worked – try something different. Life changes – we change as people.