published

Smoking in Pregnancy Project Report: June 2012
3.1.4.2 Existing practice for identifying and referring pregnant women
Staff interviewed were asked to describe how they, or their team, would identify and refer
pregnant smokers in their current practice, prior to the implementation of any changes
introduced by the pilot. All members of staff described what they saw as relatively robust
systems that were already in place.
These systems included community midwives asking all women for their smoking status at
the booking appointment and carrying out a CO test, with six parts per million as the cut
off for active smoking. Those women who were identified as smokers would be given brief
advice by the community midwife and then asked if they wished to be referred for further
support. A referral letter, found in the women’s hand held notes would then be either sent
to the specialist stop smoking service midwife directly (in Macclesfield) or sent to the office
of the local stop smoking service (in Leighton), this difference was site dependent.
What we do currently is we already CO monitor at booking, so what happens is when the
woman gets booked with the midwife, the midwife does a CO test, it’s part of the computer
system, it prompts them to ask the question. Every single woman whether they’re a smoker
or not everyone has the test. If that then shows that they are a smoker they do an automatic
referral, which is located in their care plan, the handheld notes (P3)
Women would be asked again throughout their pregnancy, most probably by the community
midwives, whether they were a smoker. It was stated that there was space in the hand held
notes to record the women’s smoking status at these subsequent appointments. In Macclesfield
midwives had been recording smoking status as routine practice for approximately six years,
with routine CO monitoring being in place for approximately two years. It was not known
how long the system in Leighton had been in place for.
It was discussed that it was mandatory for community midwives to ask smoking related
questions, however any HCP could discuss the women’s smoking status with her, and thus
in theory, anyone could carry out the referral.
Other systems were also discussed, including health visitors routinely asking the woman her
smoking status at their initial postnatal visit; however a CO test would not necessarily be
carried out at this point. Health visitors would offer the woman information about the
dangers of smoking, discuss second hand smoke and how to avoid exposure for the baby,
however a specific referral process did not seem to be in place at this stage, at either site.
It was suggested that the woman may be directed to their GP or a pharmacist for support.
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