Reaching out to pregnant smokers

Supporting pregnant women to give up smoking for the sake of their baby is no easy task. Pregnancy can be a stressful time and the thought of kicking the habit can be daunting for mums-to-be. We met a midwife who works with pregnant smokers to find out what is being done to help them to quit. 

Having seen first hand the effects of smoking in pregnancy, midwife Sarah James is on a mission to encourage more expectant mums to kick the habit.

She is the Substance Misuse Specialist Midwife for Cardiff and Vale University Health Board and works tirelessly to spread the message about the harmful effects of smoking in pregnancy.

Fear of being judged or given a ‘telling off’ by their midwife puts many pregnant women off admitting they smoke, she says, however she is keen to stress that won’t happen: “Some women won’t admit they smoke because there is a stigma around smoking and pregnancy. We’re not here to judge or to tell anyone off. We’re just here to promote healthier pregnancies and to provide support,” she said.

According to Sarah, although there is plenty of information available about the damage that smoking can do during pregnancy, for some women it is still a socially acceptable practice, particularly those surrounded by others who have done the same: “For lots of women I see, smoking in pregnancy is socially acceptable. They have seen their mothers and sisters do it and for them it’s just the norm.” The stark reality, however, is that smoking does very real damage both to babies, and in extreme cases to the mother too, as Sarah has witnessed:

“Smoking affects the flow of blood and oxygen to the placenta and when the baby is born the placenta has a gritty feel and is black and discoloured.

“The placenta effectively acts as the baby’s lungs so if you smoke you are preventing enough oxygen from reaching the baby. This affects the baby’s growth and in the worst-case scenario can cause placental abruption where the placenta becomes detached from the wall of the womb and the oxygen supply to the baby is cut off. It can trigger a massive haemorrhage which can also be life threatening to the baby. Women need to know the risks. One in every 200 babies are stillborn. We must not shy away from using the word stillbirth.”

Getting the message across to pregnant smokers can be a challenge. Today all pregnant women in Wales are offered the opportunity to blow into a carbon monoxide monitor at their initial booking appointment at eight weeks at their GP Surgery and at their 16-week appointment with the midwife.
Many also have their carbon monoxide levels monitored at their 12-week scan. Carbon monoxide is a poisonous gas contained in cigarette smoke which reduces the ability of the red blood cells in the body to carry oxygen. Having high carbon monoxide levels in the body is particularly dangerous for pregnant women because it affects the baby’s access to oxygen.

If the woman is a smoker and would like to find out more about how to quit, the midwives can use an electronic referral system to refer the woman to the Help Me Quit smoking cessation service. She is then contacted and offered the opportunity to receive smoking cessation support, either from a pharmacist, as part of a group or on a one-to-one basis.

Last year, on average, around 35 pregnant women were referred to Help Me Quit every month and Sarah’s team is hoping to establish a feedback loop to find out the outcome of the referrals.

She says that most women are happy to use the CO monitor – particularly after a recent occasion where the high levels of carbon monoxide in a non smoking pregnant women’s lungs led to her discovering that there was in fact a carbon monoxide leak in her home.

“The ones that decline to use the CO monitor are few and far between, particularly since the story about the woman with carbon monoxide in her house came out,” said Sarah.

Where women do decline, or won’t disclose whether they smoke, the midwives will try again at their next appointment. Using every opportunity to speak to pregnant women about smoking is key, said Sarah, whose team believes in an ‘every contact counts’ approach.

“The first time you ask a woman to use the CO monitor, they may be going through a stressful period in their lives and it may not be the best time. At the 16-week appointment things may have settled down for them and you could try again. As midwives we are in the brilliant position of being able to see these women regularly. Our community midwives have the chance to build up trust and a rapport with these women. Some of the women may never have been unwell so they have never been seen by a midwife. Pregnancy is a golden window of opportunity to reach those women and get the message through to them about smoking.”

Sarah is keen to stress that it’s never too late to reach pregnant smokers, recounting a success story that shows the huge benefits to baby if mum stops smoking:

“I had one lady in and the growth of the baby was very small. She went into hospital for two weeks and during that time she couldn’t smoke. We rescanned her and the baby had crossed several centiles and was growing properly. Once she could see the changes that were taking place she was motivated to stop smoking for good.”

And with as many as 16 per cent of women in Wales continuing to smoke throughout their pregnancy and 11,864 unborn babies exposed to tobacco each year, it’s this sort of story that Sarah hopes will be repeated.

If you are a smoker who would like to find out more about how to give up, Help Me Quit is run by NHS Wales and will help you to find the stop smoking service that best suits you. Contact them on 0800 085 2219 or visit www.helpmequit.wales.

Smoking and mental health – the hidden cost of lighting up

The harmful effects of smoking on physical health are well publicised but people are less aware of the impact smoking can have on mental health.

Many smokers use cigarettes to relieve stress, and do not know the damage their habit could be doing to their mental health and wellbeing. They believe so strongly that smoking aids relaxation that it prevents them from successfully quitting, however, smoking can exacerbate symptoms of stress, anxiety and even depression. Currently 36% of those with a mental health illness smoke compared to just 19% of the general population across Wales. To mark World Mental Health Day, we’ve taken a look at the relationship between smoking and mental health.

A short term fix

Regular smoking leads to changes in the brain which trigger nicotine withdrawal symptoms in the gaps between cigarettes. When a smoker lights up, the rush of nicotine temporarily improves their mood, lowers their stress levels and relaxes their muscles. The feeling of relaxation they get is because they have fed their nicotine addiction, not because nicotine is helping to deal with the underlying causes of their anxiety.

The stress cycle

For smokers, anxiety will kick in again once they start to experience the next cycle of nicotine withdrawal symptoms, which usually begin within a few hours after their last cigarette. If they did not smoke they would not experience this spike in anxiety as the effects of the nicotine wear off.

Depression

According to a booklet produced by the Mental Health Foundation (MHF) –  there could be a relationship between smoking and depression, though it is not clear whether smoking leads to depression or depression encourages people to start smoking, and/or discourages people to quit. The MHF states that most people start to smoke before they develop symptoms of depression.

Nicotine stimulates the release of dopamine in the brain which is the chemical that triggers positive feelings. Smoking encourages the brain to switch off its own mechanism for making dopamine, leading the supply to decrease and encouraging people to smoke more. Supplies of dopamine are often low in people who suffer with depression which could lead them to use smoking to increase their dopamine supply.

Other side effects

Smoking is an expensive habit that can contribute to debt and limit lifestyle choices. With cigarettes costing around £250 a month on average for smokers, it’s a pricey habit to feed, and that financial pressure alone can cause stress levels to rocket.

The constant worry about the toll on physical health is also stressful, particularly if others around the smoker are urging them to quit. Giving up smoking can remove these added pressures and have a significant impact on a person’s wellbeing.

Why quit

For those who use smoking as a crutch to support themselves through stressful situations, the thought of quitting can be daunting. However, the long-term benefits to mental health include reduced anxiety, depression and stress levels, a better quality of life and more positive moods.

Surviving nicotine cravings

We asked Steve Clarke, clinical and therapy services manager for The Priory Group, about coping with nicotine withdrawal and its short terms effects on mental health. Here is his advice.[/vc_column_text][mk_blockquote font_family=”none”]“Smokers who attempt to quit might want to be prepared for managing some anxiety that is created by cravings. Cravings are likely to happen as the body withdraws from its reliance on nicotine. These cravings may feel intense at first, however they will significantly recede within a short space of time. Cravings are often triggered by a cue or stimuli such as having dinner or drinks, or break-times at work. These urges to smoke will decrease as time passes; however, their intensity often remains strong for a reasonable period of time as we associate these events with smoking. In time, the association will completely diminish.”

“Cravings are natural. It’s a way of understanding that behaviours are changing. When we experience cravings and they are intense, it can be a good tactic to remind ourselves of the consequences if we pick up a cigarette once more. One good way to support this may be to make two lists:

1 – What will life be like 5 years from now if I continue to smoke – maybe include “I’ll be less fit, I’ll have more health issues, I’ll have less money…”

2 – What will life be like in 5 years if I stop smoking? – maybe include “I’ll be healthier, I’ll be fitter, I’ll have more money, my clothes will be fresher…”

Getting started

Going ‘cold turkey’ is the least effective way to quit smoking, but thankfully you don’t have to go solo. There is plenty of help available through NHS Wales, including nicotine replacement therapy and support from a smoking cessation advisor in a one-to-one or group setting. Everybody is different and there is no one size fits all solution to quitting smoking. Help Me Quit is run by NHS Wales and will help you to find the stop smoking service that best suits you. Contact them on 0800 085 2219 or visit www.helpmequit.wales.

Be the best quit smoking wingman

If a friend or loved one is giving up smoking this Stoptober then the chances are that you’ll be going on that journey with them. And it won’t be an easy ride. The highs and lows of quitting can send smokers on a rollercoaster ride of emotions with the urge to cave in lurking around every bend. You can’t control their cravings however, you can play a big part in helping them to stay on track. From moral support to stern reminders, quitters need others on their side. Here are some top tips on how to play your part:

Lend an ear 

You may find that your most important role is simply to be a good listener. Giving up smoking is tough and while some may withdraw into themselves, others will need to vent. If so let them talk and try not to interrupt with your own comments. Resist the urge to tell them to stop complaining, however unsympathetic you may be feeling. Instead make encouraging comments about the great progress they are making and show empathy by acknowledging that it is not an easy process. Encourage them to express their feelings and make it clear that you will be there to lend an ear whenever they need to let rip or simply to have a good cry.

Create a diversion 

Cigarette cravings are powerful and the urge to cave in will be strong. Perhaps ask your quitter to let you know when they feel a craving coming on so that you can distract them. The longing for a cigarette can last as little as two minutes so even creating a brief temporary distraction can work wonders. Suggest going for a walk or a jog and getting some fresh air. Turn on the radio. Get them talking about a subject that interests them. Show them an amusing photograph on your phone. Anything to take their mind off nicotine. If they are really suffering with withdrawal symptoms suggest a day trip for a change of scene, going for a meal or to the cinema. You could even encourage them to take up a new hobby – something that keeps their hands busy will be particularly helpful.

Timely reminders 

There are a multitude of reasons why people decide to stop smoking – from improving their health to saving money. If your quitter looks as though they are starting to lose motivation, then remind them why they decided to give up in the first place. You could even write down the reasons on posters and stick them around the house or the office, accompanied by photographs of anybody they are quitting for.

Minimise stress 

Many people smoke as a way to relieve stress and anxiety. And for long term smokers, lighting up can become an automatic response to any stressful situation. You can’t shield your quitter from every source of stress. However, striving to create as relaxing an environment as possible will minimise the triggers that could set them back on the smoking path. If it is a partner or loved one who is giving up, try to avoid initiating any conflict or making stressful life decisions during this time. Identify the situations that stress them out and think about how you can take on some of the burden or provide them with extra support.

Be positive

If your quitter caves in then don’t berate them. They will feel bad enough without you adding to their feelings of inadequacy. Instead praise them for having lasted that long and tell them that just because they’ve slipped up this time then there’s nothing to stop them from trying again. They will succeed – eventually. Even if it will take several attempts. The most important thing is never to give up.

If you are a smoker who would like to find out more about how to give up, Help Me Quit is run by NHS Wales and will help you to find the stop smoking service that best suits you. Contact them on 0800 085 2219 or visit www.helpmequit.wales.

Expert’s guide to surviving nicotine withdrawal

Steve Clarke is clinical and therapy services manager for The Priory Group which provides specialist mental health services across Wales, and has more than 400 facilities in the UK. Here are his top tips on coping with the temporary impact on mental health of nicotine withdrawal

“Smokers who attempt to quit might want to be prepared for managing some anxiety that is created by cravings. Cravings are likely to happen as the body withdraws from its reliance on nicotine. These cravings may feel intense at first, however they will significantly recede within a short space of time.”[

“Cravings are often triggered by a cue or stimuli such as having dinner or drinks, or break-times at work. These urges to smoke will decrease as time passes; however, their intensity often remains strong for a reasonable period of time as we associate these events with smoking. In time, the association will completely diminish.”

“Cravings are natural. It’s a way of understanding that behaviours are changing.

“When we experience cravings and they are intense, it can be a good tactic to remind ourselves of the consequences if we pick up a cigarette once more. One good way to support this may to make two lists.
1 – What will life be like 5 years from now if I continue to smoke – maybe include “I’ll be less fit, I’ll have more health issues, I’ll have less money…”
2 – What will life be like in 5 years if I stop smoking? – maybe include “I’ll be healthier, I’ll be fitter, I’ll have more money, my clothes will be fresher…”

Top tips on how to quit from the UK’s first GP to specialise in smoking cessation

To help smokers quit during Stoptober we asked stop smoking experts for their top tips on how to give up

Dr Alex Bobak is the first GP in the UK to specialise in smoking cessation and is a passionate campaigner on the dangers of smoking. He has carried out extensive research into treatments for smoking cessation and now teaches the subject to other health professionals around the world. He currently works as a senior partner of a General Practice in Wandsworth, South London. He spoke to ASH Wales about will power, addiction and how to cope with cigarette cravings.

What first inspired you to specialise in smoking cessation?

My first job as a junior doctor in the 1980s was working under a Welsh chest physician called Stephen Williams at Stoke Mandeville Hospital. Most of the patients on the ward had one thing in common, they were smokers, more often than not dying from smoking related diseases such as COPD or lung cancer. My job was to tell them the bad news about their diagnosis and prognosis and I just thought how completely unnecessary all the suffering was. That inspired me to work on ways to help smokers to beat their addiction.

Can smokers kick the habit using will power alone?

Will power alone is definitely not the easiest way to stop. In fact, research has shown that it’s up to ten times more difficult for smokers to kick the habit if they use will power alone. Smoking is a powerful addiction, as or more powerful than, heroin or cocaine addiction. If you have been smoking for a while your brain changes so that it needs nicotine and continues to demand it even when you can’t afford it anymore or when people around you want to you stop. That is because smokers have three or four times more nicotine receptors in their brains than they were born with, all of which demand feeding.

Would you advise those hoping to stop smoking to seek help from their GP?

Smoking is a powerful addiction so why not get medical help. I don’t see any difference between smoking addiction and a physical illness. If you had diabetes for instance you would think nothing of seeking medical help. There is plenty of support out there so why make life difficult for yourself when giving up smoking is the most important thing you can do for your health.

What treatments are available to help smokers give up?

There are tablets called Champix that are designed to stop cravings by blocking the release of dopamine when you smoke. This takes away the pleasurable aspect of smoking. Also nicotine replacement therapy (NRT) can be highly effective and products range from patches, gum and lozenges to nasal and oral sprays. It is usually better to use two different types of NRT at the same time as one often isn’t enough.
And we know that all treatments to stop smoking work much better with support so the best first step is to contact your local stop smoking service or general practice who can go through all the treatment and support options with you.

What advice would you give on dealing with nicotine cravings?

As well as using NRT, my other advice is to use a displacement activity, such as going for a run or eating a healthy snack. Cravings don’t usually last more than two minutes but they can be very powerful. So doing an activity to distract yourself during that time can really help. Withdrawal symptoms can be horrendous but one way to deal with that is to up your dose of NRT. A lot of people under-use these products so they become less effective. It’s important to keep seeking advice and support if you feel the NRT you are using is not helping you to deal with your cravings.

10 Ways to Quit Smoking

Do you know your options for quitting?

Ranging from nicotine replacement therapy (NRT) products to e-cigarettes, there are plenty of options available to help you quit for good.  It has also been proven using them in combination with support from stop smoking services means you have an even greater chance of success.  Here is our guide to ten stop smoking aids that will help you to achieve a smoke-free life.

 1.Will power 

Going cold turkey works for some smokers. However, many find the urge for a cigarette too overpowering. Indeed, NHS research shows that only 3 in every 100 smokers manages to stop permanently using will power alone.  If you do plan to quit by going cold turkey it may help to enlist the support of family and friends to keep you on track and to avoid stressful situations while you are withdrawing from nicotine.

2. Nicotine patches

Patches release nicotine directly into the bloodstream through the skin and help to relieve cravings and withdrawal symptoms. They can be worn for 24 hours or just while you’re awake, for 16 hours and are available in different strengths. The 24-hour patches are particularly good for those who crave cigarettes when they wake up in the morning.  Some people find that the patches irritate their skin.

3.Nicotine inhalers

Nicotine inhalers release nicotine vapour that is absorbed into the mouth and throat. Using an inhaler mimics the motion of smoking which some find helpful. Smokers feel the effects of the inhaler more quickly than gum or lozenges and it can be used to relieve sudden strong cravings.

4.Nicotine nasal spray

This is the strongest form of NRT.  It delivers a swift and effective dose of nicotine through the lining of the nose that is equivalent of smoking one cigarette. Some people do experience side effects while using a nicotine nasal spray, such as coughing and watering eyes.

5.Nicotine lozenges

These work best for delivering a short burst of nicotine to relieve cravings. They dissolve slowly in the mouth, taking up to 30 minutes.  People suck the lozenges to release the nicotine then suck again to release more when needed.

6. Nicotine chewing gum

Chewing nicotine gum delivers similar effects to lozenges. The gum comes in either 2mg or 4mg strengths. The downsides are that not everybody likes the taste and some people don’t like the sensation of keeping the gum in their mouth.

7. Nicotine microtabs

Nicotine microtabs deliver a small amount of nicotine when needed. They dissolve quickly under the tongue and are more discreet than gum or lozenges, albeit not as strong.

8. E-cigarettes

Experts estimate that e-cigarettes are at least 95 per cent less harmful than cigarettes. They allow smokers to inhale nicotine in a vapour rather than smoke and do not burn tobacco. The e-cigarettes work by heating a solution that usually contains nicotine, propylene glycol and/or vegetable glycerine and flavourings.  They come in different models and rechargeable e-cigarettes with a refillable tank deliver nicotine more effectively than a disposable model.

9. Champix (Varenicline)

This prescription tablet can be taken by smokers up to two weeks before they decide to stop smoking and for around 12 weeks in total.  The tablets are designed to reduce cravings for cigarettes and to reduce the effects of smoking. You cannot take them if you are pregnant, have some pre-existing conditions or if you are under 18-years

10. Zyban (Bupropion)

Like Champix, Zyban can be taken up to two weeks before you stop smoking and for eight weeks in total.  The tablets reduce the craving for a cigarette and won’t be prescribed if you are pregnant or under 18-years-old.

It is important to remember you are 4x more likely to quit successfully with help from stop smoking services. NHS Help Me Quit is the national stop smoking service in Wales and is just a click away.