By Maeve O’Connell RGN/ RM & Dr. Maria Duaso Midwives experience of using the Carbon Monoxide Breath Test for smoking cessation in Pregnancy By Maeve O’Connell RGN/ RM & Dr. Maria Duaso

Maeve O’ Connell Current Role: Midwife High Risk Team (Thames Team) St. Thomas Hospital Background: Diploma in Nursing, University College Cork (UCC), Ireland in 2004 BSc (Hons) in Nursing, UCC in 2005 PG Dip in Midwifery, UCC in 2008

Smoking Cessation The midwife is in an excellent position to provide health protection during the antenatal period by providing advice/ support to help women to make lifestyle changes to benefit their health and that of their baby, (Crafter, 1997; Dunkley, 2000). Pregnancy may be the only time in their lives that women are in regular contact with health professionals and women see midwives as a major source of information and advice about health behaviour in pregnancy.

The detrimental effects of smoking in pregnancy have been widely documented, (Royal College Physicians (RCP), 2010). It is linked to tobacco-induced abortions, ectopic pregnancy, stillbirth, neonatal death, Sudden Infant Death Syndrome, Intra- Uterine Growth Restriction, and pregnancy complications such as premature labour, premature rupture of membranes, placenta praevia, and abruptio placenta (Baxter, Messina and Goyder, 2010; Lumley, Chamberlain, Dowswell, Oliver, Oakley and Watson, 2009; Edwards and King, 2007; Dunkley, 2000).

The Carbon Monoxide Breath Test CO is a toxic chemical, which is a waste product of cigarette smoking. The CO breath test is mainly used in three ways: as a motivation tool for smokers on a quit attempt, to detect smokers and to detect possible exposure to CO in the home environment, (O’Gorman, 2011).

Self-reporting of smoking status is unreliable due to the addiction and the shame and guilt associated with smoking in pregnancy, as women know the effects of smoking on the pregnancy but struggle to quit (NICE, 2010; King et al, 2009). CO testing is recommended as it is thought to be more objective than the use of questionnaires in determining levels of smoking in pregnant women, (King et al, 2009). A positive breath test allows the opportunity to discuss smoking cessation with the pregnant woman and the midwife relates the CO level to the consequential lower level of oxygen in the foetus, (Cope, 2011). This can be a good motivational tool to help women quit.

In 2010, the National Institute for Health and Clinical Excellence (NICE) advised the use of Carbon Monoxide screening by midwives as part of routine antenatal care for all pregnant women. However, it seems this strategy has not been widely implemented nor always well received (Cope, 2011; O’Malley, 2010; Clift-Matthews, 2010[MD1] ).

This study aimed to explore the lived experience of midwives that use Carbon Monoxide (CO) monitoring for smoking cessation in pregnancy and to investigate midwives attitudes to the use of CO Monitoring as part of routine antenatal care for pregnant women. A qualitative approach based on a descriptive phenomenology was employed. Ten midwives in the UK that use or have used the carbon monoxide breath test for smoking cessation at booking took part in the study. Their work experience ranged from one to over twenty years.

Themes Barriers to the implementation of CO monitoring in practice Facilitators to the implementation of CO monitoring in practice Women’s Reactions to the breath test Conclusion/ Recommendations: Regular mandatory updates Clear Referral Pathway & Support Network Support of Auxiliary Staff Further Research

Challenges Successes Time Recruitment to the study R&D/ Ethics Approval/ Site Specific Approval ‘Bracketing’ Successes Gained support from the midwives- ‘snowballing’ Target Sample met led to adequate study size

Findings disseminated Individually to participants by leaflet as requested Publishing an article in a journal Presenting at conferences

Support Network Masters Supervisor=key Site Supervisor Participants in the study Colleagues at work Fellow students Family & Friends

What would I do differently next time? Preparation Apply early for R&D and Site Specific Approval Look broadly at the use of CO Monitoring for smoking cessation (Auxilliary staff included in study) Carry out the study in an area with higher smoking prevalence

Thank you Any Questions?