Based at Tommy’s Maternal and Fetal Health Research Centre at the University of Manchester, Suzanne is a small for gestational age specialist midwife and Saving Babies Lives lead midwife and knows that smoking is a major factor in babies being born early, unwell or in the worst cases stillborn:
As a specialist midwife, I support women who are at risk of having a baby with a low birth weight due to being diagnosed with Fetal Growth Restriction (FGR). There are several things that can increase the risk of FGR and smoking is one of them.
Smoking in pregnancy is the single biggest risk factor for adverse outcomes in pregnancy, including complications during labour, increased risk of miscarriage, premature birth, low birth weight and stillbirth.
However, it is a modifiable risk factor which means something can be done about it, so that’s why it is incredibly important we offer support to pregnant women to help them quit smoking. As a midwife we are often the first point of contact and it is a routine part of our practice to talk about smoking and stillbirth prevention.
Pregnant women are screened for carbon monoxide levels early in their pregnancy, regardless of smoking status. If levels are raised, we explain that it can be caused by cigarette smoke, environmental factors such as pollution from car exhaust fumes, faulty gas appliances and second-hand tobacco smoke and that it is dangerous to them and their baby. Breathing in carbon monoxide can slow a baby’s development and increase the risk of birth defects.
It’s important not to be judgemental. Every parent wants the best for their children, but quitting smoking is not easy and it is a serious addiction, not a lifestyle choice. When a woman lets us know that they smoke, or has a high carbon monoxide reading, we refer them to a specialist stop smoking service and they are assigned a maternity support worker who provides support to help them to quit.
Midwives play an important role in supporting pregnant women throughout their pregnancy and beyond, and for many of them the parents are not just patients, they are friends. Suzanne believes building a trusted relationship is key to help women enjoy a healthier future for them, their baby and the rest of the family:
As midwives we know pregnancy can be a very stressful time. While most women decide to quit as soon as they find out they are pregnant, not everyone is ready to commit to stop smoking and many will need support to stop. Many women have smoked for years and are addicted to smoking so we need to put them in direct contact with specialist advisors who can help. They put a lot of trust in healthcare professionals, so it is important we spend the time to get to know the women who use our services and develop a relationship with them.
We recognise the need for women to feel safe and know that we are here to help even in difficult circumstances. With complicated pregnancies consistency is important, and in my role as a specialist midwife, I am fortunate to be able to spend time each woman, which is particularly important for the women who have sadly experienced stillbirth.
There is a lot of sadness involved in our roles at the centre, but it motivates us on to prevent other families from going through the devastation of pregnancy loss. When I started training to be a midwife twenty years ago, I never thought I would end up being a specialist midwife working to reduce the risk of stillbirth, but I absolutely love my job and feel privileged to do it.
We are incredibly lucky to have the Greater Manchester Smokefree Pregnancy Programme, as it has enabled midwives across the boroughs to help hundreds of families become smokefree. When we identify a pregnant smoker, we refer them to a specialist stop smoking service and they are assigned a maternity support worker who provides support to help them to quit, including free nicotine replacement therapy.
However, it is not just about providing support to pregnant women, as if their partners or family members smoke we offer to help them too. This is equally as important, as unfortunately the risks from smoking don’t end after birth. Sadly, babies in homes where someone smokes are more likely to die from cot death or sudden infant death syndrome.
For Suzanne and her midwifery colleagues, the COVID-19 pandemic has been a challenging time, but they have continued to support women and their families through life-changing experiences:
The pandemic has had a huge impact on the NHS and all services, but for us it has been businesses as usual. During the first wave we had to temporarily suspend CO monitoring tests. This did impact the specialist stop smoking service, but our midwives and midwifery support workers continued to provide support and guidance over the phone.
As the pandemic continued, the specialist stop smoking service provided women with individual carbon monoxide monitors which link to smartphones and enable people to complete screenings at home and feedback to the specialist midwives to track their quit journey.
My advice to women who smoke is please speak to your midwife, there is absolutely no judgement and we want to reassure people that we are here to help. We have adapted our working practices in response to the pandemic, but our wide programme of support is always available to help you quit smoking and protect you and your baby.