Smoking While Pregnant? Maybe Not In Britain

Britain’s National Institute for Health and Clinical Excellence (a truly wonderful title) has suggested that all pregnant women be given an pre-natal carbon monoxide test to see if they persist in smoking during pregnancy.  The smokers would then be given advice on how to quit.  The organization claimed that the move was not intended to “penalize” smokers; rather, it would provide ways to protect the health of the woman and the unborn child.

The suggestion was met with criticism from the Royal College of Midwives, whose main worry centered around the guilt that could be imposed on pregnant women by these requirements.  They agreed in principle with the idea that pregnant women should be discouraged from smoking, but pointed out that the effect might be to make women feel that they aren’t trusted to be honest with their doctors about their health.

Certainly, smoking is one of the most dangerous practices during pregnancy; although eating sushi and having a glass of wine don’t have the devastating impact that most pregnancy advice books claim, smoking is much riskier.  In his book, The Panic-Free Pregnancy, Dr. Michael Broder writes that smoking can raise the risk of miscarriage and inhibit fetal growth.  “Do not smoke,” he advises bluntly.

But while the intentions of the National Institute for Health and Clinical Excellence seem good, I agree with the midwives that testing pregnant women is not the way to go.  I’m also interested by the fact that a carbon monoxide test may pick up the effects of living in a large city – blogger Ceridwen points out on Babble that living in polluted areas can have the same negative impacts as smoking, but what’s the solution, forcing pregnant women to move?  I also agree with Jessica on Feministing, who writes that this doesn’t just make women feel guilty, it assumes that they are guilty, and doesn’t give them the agency to control their own bodies, even if they’re making potentially unhealthy decisions.

All of this boils down to the complicated relationship that American society has with pregnant women, who are often caught in a double bind.  Given enormous responsibility for carrying a healthy child, they’re also denied the right to make fundamental decisions about their own health and well-being.  One of the most interesting examples is the debate over whether pregnant mothers should take anti-depressants; although we’re unsure of the impact on the fetus, some argue that this is a place where the health of the mother means better health for the fetus, because depressed women may have more trouble maintaining a healthy pregnancy.  The relationship between mother and fetus is often framed in terms of the “maternal-fetal conflict,” where women are told to deny and control themselves for the good of the fetus, rather than showing women that what is good for their bodies is ultimately good for their child as well.

The bottom line, for me, is that while doctors should do everything they can to encourage women to give up smoking during pregnancy, the choice ultimately belongs to the mother, and tests like these will only increase the lack of control that many women feel during their pregnancies.  And all of this feels like a slippery slope – if women can be tested for carbon monoxide, that opens the floodgates for all kinds of monitoring.  This is an important issue, but NICE’s approach will only limit pregnant women’s rights, which are already fragile.

Photo from Flickr.


Harriet J. B.
Harriet B2 years ago

I smoked while I was pregnant. I told my doctor about it. He said, "as long as you get and keep your weight down. That was 50 years ago.

Lynne A.
Lynne A.6 years ago

Here's another instance where the doctor might know about his patient and use the test to help. Across the board is overboard.

Cindy C.
Cindy C7 years ago

@DH. F. - I see your point. Cigarette smoke may not be the most dangerous type of smoke...smokers are pumping it into their bloodstream several times a day. But pregnant women smoking are exposing unborns to it regularly. Eliminating cigarette smoke from a pregnant woman's bloodstream is taking a giant step toward cleaning up the blood going to the unborn baby.

Cindy C.
Cindy C7 years ago

Quitting isn't hard. Stop buying cigarettes and drink a lot more fluids. You see, if you throw your cigarettes away (outside), get rid of all ashtrays, wash the walls down, open windows and air out the house, get rid of old clothes that smell like cigarettes.....those people who are insisting that quitting is hard really don't want to. Now go ahead and get mad at me for saying it's so easy to quit. If you really want to...get rid of all reminders. Put a couple of new plants in the house. Get busy. It CAN be done. Today.

Helen Le
Helen Le7 years ago

This is a smart idea, I've volunteered at Sick Kids before and seen those poor little premature babies barely breathing at birth :(
Please help out these women and sign this petition, we all need to live in a world without domestic violence and a world where everyone has human rights!

Andrea M.
Andrea M7 years ago

If someone is highly addicted to smoking and becomes pregnant, she should care enough about herself and her unborn child to do anything she could to stop smoking immediately. She owes her child at least that much.

Lynn C.
Lynn C7 years ago

Are the Brits learning from us or have we learned from to be in-your-face-tell-you-what-why-when-where-to live your life...Bah! Humbug!

Lika S.
Lika P7 years ago

I realize that smoking while pregnant is a health hazard. I also know that it's not easy to quit. I've smoked over 20 years, and I also did while I was pregnant. Bad, I know, and my child is healthy. But to criminalize a mother for smoking isn't doing anyone favors either.

I think the efforts should go to try to prevent start up, and have more available to quit smoking rather than to force the issue and shake a finger at someone.

Eva T.
Eva T7 years ago

I believe this is a good idea for the sake of the unborn babies who cannot speak for themselves. If you want to have a baby, do so when you have quit smoking and if you want to smoke, do so while you are not getting pregnant. What may be equally as bad, if not worse is parents smoking in the house with children present forcing them to breathe in disgusting and unhealthful 2nd hand cigarette smoke. Nothing is more disgusting to me having been a victim of this and as a result suffered with health problems for years. I would not ever subject an animal much less a human to 2nd hand smoke. One's addiction should never impact anyone else's right to breathe what we have left of clean air or be given every chance at having the best health possible.

Amanda Griffin
Amanda G7 years ago

@Karen. Think before you judge - I find your attitude to be frightening. I believe all women want what is best for their children and most mothers to be do there very best. When you are dealing with addictions and mental health sometimes the road is bumpy. This is not a question of will - this is a question of capability. Attitudes that lack compassion and empathy are likely more dangerous for a woman struggling to quite smoking or anything else - because this raises the stress and induces more of a desire to smoke. No, smoking is not healthy during pregnancy - but ultimately the decision to quit smoking can only be in the hands of the woman herself. Harm reduction is the key that often ends up helping a woman to let go of her addiction. Please - think before you judge. Thank you.