Pregnant Women to be Tested for Smoking

The National Institute for Clinical Excellent (NICE) has issued guidance advising that, given the risks, pregnant women ought to be tested for smoking. …Yes. You read that correctly. NICE advise that all pregnant women should be given breath tests that can detect elevated levels of carbon monoxide, which will show the midwife/doctor that the pregnant woman either smokes, or is regularly exposed to second-hand smoke.

And I suppose this makes sense, given most pregnant women lack the capacity for language-use; so it would be terribly difficult to ask them whether they smoke. op! What’s that you say? They don’t? Pregnant women can usually both speak and understand some natural language or other?

Last I checked, smoking is harmful to lots of creatures–not just fetuses. In fact, I’m pretty sure that all mammals are negatively affected by carbon monoxide. Do we need to test *everyone*? No? Why is that? Here are some theories I’ve come up with:

  • Those pesky pregnant women lie more than other patients.
  • The health of other human creatures doesn’t matter as much as the health of fetuses.
  • Pregnant women speak too slowly for information on their smoking status to be acquired in a timely fashion verbally.
  • It’s a known fact that most pregnant women are out to harm their fetuses and need to be blocked from doing so.
  • Health practitioners are barred by law from asking the husbands/partners medical questions about the women, which precludes the possibility of acquiring accurate information about the woman (since, really, the head of the household is the only one in the family who isn’t a silly little thing).
  • Pregnant women have no right to privacy.

Have I missed any? OH wait. Silly me. (see? my husband should be writing this.) I forgot the most obvious one:

  • Pregnant women are simply the devious chunks of flesh wrapped around the real patient.

more from the BBC here.

22 thoughts on “Pregnant Women to be Tested for Smoking

  1. I think the last one is the best one….

    I smoke, and I hope I will be able to stop smoking should I ever decide to spawn but what worries me is the reasoning behind these smoke tests – that they want to do it so they can find out who smokes then support the woman to stop.

    I dont buy that halo of light.

    First of all, it is only women who want to stop that will take the offer of help – pregnant or not, smoke test or not.
    Should they refuse the help then what happens? do the NHS then have the right to blackmail/bully the woman into stopping/witholding any treatment present/future for the baby and mother – such as holding permenant records that she denied help for smoking and as such face the consequences of that.

    Secondly, a woman who wants to stop will go voluntarily to a support area or quit by herself without any need to be tested. So its really a waste of money doing these, quite redundant.

    What brought this on? Why are they targetting pregnant women (I would imagine it is to cut future NHS costs with the child growing up) but at the same time ‘allowing’ their staff to smoke without getting the same tests? In fact, if it is for a “we are supporting you” reason then why arent we all being subjected to smoke tests when we visit our GP (oh thats right, we get asked….pregnant women clearly lose their honesty)

    So, what ulterior motive is lurking here……

  2. good point, vibes01!: the women who are lying about smoking probably aren’t the ones who would take the help! i hadn’t thought of that.
    the thing i’ve been thinking just now is that it seems like exactly the sort of thing that’s going to put vulnerable women off going in for antenatal care. if they know they’re going to be basically drugs-tested, they’re not going want to go in to begin with.
    i have no idea what’s brought it on. i was bored and reading the internet this morning & found it. and yes, it would be interesting to know why this why now.

  3. Of course, they could just give everybody the sniff test for proximity to tobacco smoke. And then pregnancy tests to all who fail. And then just lock ’em up till they deliver…

  4. why would you trust a woman w a baby if you can’t even trust her to make appropriate choices wrt her antenatal care?

  5. yes! passive smoking can be hugely damaging to growing children. we ought to smoke test all mothers. (not the fathers, of course: what do they have to do with it? and anyway, if they’re smoking, it’ll show up in the mothers’ tests.)

  6. I’m a bit unclear about why everyone is getting so worked up. The proposal is that:

    “One of our recommendations is for midwives to encourage all pregnant women to have their carbon monoxide levels tested and discuss the results with them.”

    I take this to mean that pregnant women whether they smoke or not will be advised to have a test. This may be important in households where others smoke or where the woman feels that she does not smoke very much and is unsure about whether this safe.

    Now, while it may be true that some women may not want to give up smoking, the test is merely advisory and the proposal suggests that the results would help women make a more informed choice about whether or not to continue smoking.

    I think that it is easy to think that all women have access to information about the risks of smoking whilst pregnant but this is probably too optimistic. I suspect that there are many women who smoke while pregnant and do not have access to this information. Moreover, while women may have access to the information, the advice is likely to be undermined if they happen to have many peers who also smoke while pregnant.

    Importantly, this does not seem to be a proposal aimed at identifying and stigmatizing women who smoke while pregnant, but one which endeavours to ensure that women are as informed as possible about the potential risks of smoking while pregnant.

  7. but fr, why not, then, simply *inform them*?

    and again, smoking is harmful to everyone; why are pregnant women being singled out for testing?

  8. Granted smoking isn’t great for anyone, but its consequences on development may be radical and basically irreversible. I abhor the notion that “the real patient” is the fetus. But as someone with various enduring and “atypical” (to put it almost neutrally) traits highly correlated with gestational exposure to smoking (and whose mother smoked throughout pregnancy), I suspect that a single nine-month interval of smoking continues to contribute to my daily challenges 30+ years later. (I have never smoked myself).

    Meanwhile the impact of *that* nine-month interval of smoking is now negligible on my mother. Alas, she has not quit, and so we’re talking about the impact of decades’ worth of smoke on her now. Still, I think a preventive system of healthcare *does* have very good reason to focus disproportionately on developmental risks.

    The pity here is that a piece of equipment (carbon-monoxide breathalyzer) may be substituting for the *communication skills* that should allow a healthcare provider to approach the problem sanely *with* patients, rather than “at” them. A heavy-handed style precludes constructive discussion of the discomfort and fear and anxiety and isolation associated with trying to quit an addiction. Indeed, communication is undermined by anything that adds to the sense that one is *not* taken to be trustworthy.

    That said, I can imagine lots of women who are exposed to domestic *second-hand* smoke who would be gratefully curious for an objective confirmation of their suspicion that smoke levels at home do register in their bodies. Being able to point to such a “result” may provide leverage in discussions between pregnant women and their partners (again, only if *that* conversation is approached constructively!).

  9. Making pregnancy even more a site for objective tests by medical personnel gives them more control. With any luck, from their point of view, the whole idea that pregnancy is somehow natural or normal is just about dead.

  10. ELP – Perhaps it is felt that merely providing information is not enough in some cases. If you happen to live in an area where many of your peers smoke while preganant the risks may not be apparent to you regardless of the information available: ‘why should I worry about what these doctors tell me when many of the women I know smoked while pregnant and it didn’t hurt them or their babies’. Having a test which will show what an individual’s carbon monoxide levels are, and how those levels may affect a foetus, may be more compelling.

    Re: singling out pregnant women: The test may be beneficial to all smokers in the respect that it could show how an individual’s carbon monoxide levels are affecting their health, and perhaps the test will eventually be advised to all smokers. However, given limited resources one might think that pregnant women are more deserving of this testing than say women who are not pregnant (and perhaps women with asthma will be more deserving than women without) because many women probably don’t want to risk harming their potential child because of a lack of accurate information. I don’t think this is that outlandish since most women would like to be informed about the risks of eating certain foods during pregnancy – that is not to say that this information has always been accurate or that women must always follow such advice.

  11. Though the balance of my intuitions is quite strongly pro-choice when it comes to a woman’s right to have an abortion, my intuitions definitely shift in this context when it’s a matter of a fetus whose bearer intends it to eventually become what is uncontroversially considered a person. Once set on that trajectory by the mother’s decision, it seems to me she’s thereby invested the fetus with an interest that’s in some nontrivial sense independent of hers, such that I can’t immediately dismiss this screening proposal as absurd or outrageous.

  12. Rob, I think I share the utter annoyance, expressed by some here, with the proposal; but at the same time see the force of some of your claims.
    I wonder if the following thoughts are coherent:

    that it is morally wrong to smoke whilst pregnant (in a way that I don’t think it morally wrong to abort (although perhaps I can think of some very unusual examples in which it might be morally wrong to do so)).

    But just because it is morally wrong, doesn’t mean that arms of the state (in this case, medical personnel) can wade in and coercively test or tick smoking mothers off for their moral wrongs (and indeed, there are many moral wrongs that it would be wholly inappropriate for the state to interfere in).

    But, on the other hand, if we’re talking about moral wrongs that involve physical harm to other persons, it sometimes is appropriate for the state to intervene. So should the state in this case?

    It seems to me that there are strong reasons against endorsing this particular intervention, even though it involves imposing harms upon other potential and intended persons (I won’t pursue that side of the discussion here), such as:
    i) avoiding the perpetuation of problematic and objectifying assumptions about pregnant women;
    ii) respecting pregnant women as persons, who can reliably report their smoking habits,
    iii) and not deterring them from seeking antenatal care;
    iv) the costs (a midwives association on the radio noted that equipping all/many midwives with such devices would be expensive, and that money could be better spent elsewhere).

    When I was writing this, I also wanted to put high on the list:
    v) the unequal treatment,
    -as elp rightly points out that if we’re concerned with the harms of smoking, we’d need to be testing more than just pregnant women.

    Supporters of the intervention might claim that it is not unequal treatment, and that all people who a) directly and negatively impact on the health of others who b) cannot avoid this harm, should be subject to such testing. But that would require a committment to testing *parents* who smoke (given the harms of second hand smoke on children). So unless they advocate this they would be advocating unequal treatment (which fails to respect women, perpeutates objectifying norms and so on).

    So it seems to me there are two considerations of principle (respect, equal treatment) that speak against intervention, and three considerations concerning consequences and practical constraints.

    (I’m tired, so I’m not sure I haven’t just confused myself here…)

  13. stoat: your position is well-stated and seems quite reasonable to me. However, the unequal treatment argument still give me pause because a fetus is not equally vulnerable to the possible effects of its co-creators’ smoking; and I am assuming, perhaps wrongly, that the prenatal risks associated with smoking are more acute than the postnatal ones both parents have equal opportunity to inflict upon their kids.

  14. Hi Rob. Yes, that may be. In which case the question would be whether the other considerations outweigh the case for unequal treatment. I think they do outweigh.

    I have to say that amongst the strongest reasons here, it seems to me (with respect to this particular case), are the pragmatic ones; that is just isn’t likely to be the most helpful way of ensuring pregnant women (and thereby their respective foetuses) get good healthcare. I’m somewhat uncomfortable with practical considerations playing such a great role. (It is fortunate that in this case they are in step with respect for women.)

  15. I should add: I said that I think it is morally wrong to smoke whilst pregnant, but thinking about it now, that doesn’t strike me as so obvious.

    We’d have to accept something like the following (taking into account your mention, Rob, of the issues pertaining to women who intend that their foetus will become a person, and granting for present purposes that (at least some of) those interests are independent of the woman’s):

    (W) it is morally wrong for A to act in a way that damages the interests of P, when one has undertaken a project involving the protection and fostering of the interests of P (or where there is independent obligation not to harm P’s interests).

    It seems to me that we shouldn’t always accept (W):
    -In cases where the interests are damaged only slightly, or where the risk of harm to interests is only slightly raised, it might not be morally wrong to do so.
    -In cases where it is very difficult to avoid damaging the interests of P, it might not be morally wrong to do so.
    -In cases where the damage to the interests is not something (entirely) within A’s control, it may be inappropriate to see A’s action as morally wrong (or we might think that A is not wholly responsible or blameworthy for any such damage to P’s interests).

    So whether it is morally wrong to smoke whilst pregnant will depend on all sorts of things, such as how hard it is to give up, the extent to which one is addicted to smoking.

    So perhaps there isn’t a straightforward answer to whether it is morally wrong – it will depend on other considerations such as those above. (I feel a little uncomfortable with such claims, given the way that moral judgements often slide into (I’m thinking BBC Radio 4 programmes here) moralising legitimations of intereference, but I hope it is clear that I am keeping these issues separate here.)

  16. Hell, there’s probably a Knobe effect at work on both my (perhaps punitive?) reluctance to accept mitigating considerations on behalf of (some) pregnant smokers and my initial receptiveness to the screening proposal, since I’m disposed towards anti-natalism, and so tend to feel that a harm has already occurred (or has begun to occur) at the point at which a fetus becomes sentient.

  17. Have any of you ever read Rebecca Kukla’s fine book, Mass Hysteria? It lays out in a lovely way the history, over the last couple hundred years, of the enormous amounts of policing to which pregnant and lactating women are subjected. It’s in the context of all that policing, in which the woman’s body isn’t her own but belongs to (a) the state and (b) the fetus, that the NICE guidelines become extremely objectionable.

  18. I hate that pregnant women are considered subversive – there’s a degree of moral panic assocaited to a pregnant women who asserts herself – oppression at its finest.

  19. Measures like this are always about somebody’s bottom line and/or somebody’s reputation among social conservatives. If it were happening here, I’d say it’s just another excuse to call in the child protection people for the sake of messing with women’s housing and gvt. benefits and/or health care.

    Even if a woman is working, married, etc. if anything at all goes wrong with her child’s development, they always blame it on the smoking. It doesn’t matter if she has Homer freaking Simpson’s job. If she’s been around some Chernobyl type meltdown the same month she walks past a smoker on her way to wherever, dontcha know the insurance companies will blame the kid’s extra limbs on that one whiff of second hand smoke? This type of blame also prevents researchers from looking into other causes for birth defects. Imagine a nicotine panic like this 40 years ago when thalidomide wreaked its havoc.

    I’m not sure how healthcare works in the UK, but I’m confident that conservative rhetoric is the same in all English speaking countries. It’s always about finding an excuse to stigmatize people to justify cutting costs.

    Now, let me fill you in on what it’s like to quit smoking. At my worst, I smoked between 15&20 strongish cigarettes a day. Player’s, which are on par with Winstons or Rothman’s blue, not quite as strong as Pall Malls, but close. Over a period of years I cut back to extra lights. Lighter than Virginia Slims. I don’t think there’s an equivalent in the rest of the world, so I’ll just call them Butterfly Farts. I also cut back to 5 on a good day, 9 or 10 when I’m stressed. That’s 2 pks/wk. $75/month or 1/3 of my personal food budget, which I can cut back on (read: go without food if the gvt’s messing with my benefits) as long as I have my smokes. That’s not dissonance. It’s physiology. Cigarettes supress the appetite. Yeah, yeah, so does rat poison but rat poison kills quickly.

    You psych people might be interested in what the withdrawal feels like. Check this out: Have you ever tried to highlight your own hair without help, using one of those annoying little plastic caps with the crochet hook thingie? Remember what it was like to use 2 mirrors to try to get at those hairs at the back of your head, reversing left&right a la Alice in Wonderland, and the hairs keep slipping and the whole process is so tedious it’s now 3am AND you’re sleep deprived too? Every second-by-second decision, every step, every corner-turn, word formation, reaction to the outside world is like trying to grab that stupid tiny hair in that bass-ackwards mirror through a fog of angry sleepiness. That’s what nicotine withdrawal is like. It also messes with something in my pain/fullness receptors. I get bruises everywhere when I try to quit. And my belly doesn’t tell me when it’s time to stop eating. I have to rely on what my eyes tell me about portion sizes, which isn’t much better with my cognition going all bass-ackwards. I quit for 5 weeks once, and the messed up perceptions did not change. I gained 14 kilos. And I was angry all the time.

    My daughter asked me to PLEASE start smoking again. No way, no how would I attempt that with a fetus in my belly, extra hormones bouncing around everything and another child in the house. Better a 1 in 5 risk of an asthmatic child or, what is it? a 1 in 1000? risk of more serious birth defects than a 90% risk of an assault charge or a strong likelihood that my messed up perceptions will lead to a terrible act of clumsiness resulting in horrible injury or death. And don’t even get me started on the obesity trade-off. 14 kilos every 5 weeks would be the weight of just slightly more than 2 extra me’s added to my 167 cm frame within a year. I think I’d prefer the rat poison.

    The never-picked-up-a-cigarette moral right just doesn’t get this. I’m really skeptical about those stories about people who quit cold turkey after a 30 year, 3pk/day habit. Not unless they were hospitalized for something, or had a spouse or parent that took care of everything else while they locked themselves in the attic.

    If governments want to force people to quit, they should treat it like a heroin addiction. Give us a place to “dry out” for a month or 2 so we don’t endanger ourselves or our families while we come clean.

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