Midwives thoughts on smoking in pregnancy

[ruralnurs]

i am an rn in a tiny rural hospital where i do everything (er, icu, m/s, peds, and ob). we deliver less than 60 babies per year and are in a small, poverty stricken county. i completed my fnp but am still working as an rn for various reasons.

i tell you this for two reasons, one i did my final year and a half preceptorship with one of our fp mds that does ob so was involved in many, many prenatal exams and two, i did my master’s thesis on how to support pregnant women to quit smoking.

just recently i had a situation that blew my mind, so much so that i did not say anything to the md at the time which is very uncharacteristic of me (i used to be a psych nurse and am very good at advocating for myself and others). i helped to deliver the second pregnancy of a young woman at our hospital with one of our mds.

she had given birth to twins (not with us, we don’t do “high risk”) about 2 years prior. after the birth and the paperwork the md came back down to the room and handed me a one page informational paper on sids. he told me her story. she had lost one of her twins to sids at 5 months of age and then said, “i don’t know if she is till smoking or not but being a smoker and having a previous sids baby really increases this one’s risk, can you talk to her?” after i got over the shock i wished i had said, “you have been seeing her for how many months and had the opportunity to assess and educate her and now you are putting this on me?”

i hoped that it was because i have been a psych nurse and was able to gently and without blame, explain to her the risks of her smoking (and “yes” she was still smoking and “no” nobody had ever told her that smoking was that bad). so not only does this doc not talk to pregnant moms, the other fp i worked with really minimized it too. even when we have classic cases like babies born weeks early, sga, being readmitted in less than a month for various reasons, etc. it seems like i am the only one here that thinks it is an issue. i don’t believe we need to berate these women, but in my research i found that if you can help a woman to stop with the first pregnancy she will unlikely smoke with future pregnancies. and i see health care providers as people with special knowledge, we have secrets if you will) that we are obliged by ethics to share, and one of those is the detriment of smoking in pregnancy. yes that mom would have felt bad if after her baby died someone spoke to her about sids, but will she feel worse if she loses another baby to sids?

so i guess my question is, do midwives see smoking as an issue, do you try to get women to stop, do you educated them on the hazards, is it mostly mds that don’t want to bother or is it my workplace that seems to not want to bother? any thoughts?

[LydiaNN]

What the heck happened here? Does everyone else see the bracketed font info before every sentence?

[ruralnurs]

I typed this in a word document then tried to copy and paste. I tried to edit it after I saw the problem but it olnly lets you edit for 5 minutes and it took longer than that and it did not let me fix it. Then I treid to resend it and it mesed up again. Sorry, don't know if anyone can even read it.

[LydiaNN]

No problem, I just thought maybe something was amiss with my computer.