Smoking in pregnancy and childbirth health and social care essay

Harmonizing to Fink ( 1998, pp. 3 ) the literature reappraisal procedure can be termed as “ a systematic method for placing, measuring and construing the work produced by research workers, bookmans and practicians ” .

Government Policy on smoke in gestation and after childbearing:

There are three of import policies made by the British authorities in related tosmokingin gestation foremost is kids ‘s wellness and good being, than malignant neoplastic disease bar and the decrease of wellness inequalities. To back up this policies there are assorted different policy paperss like Every Child Matter ( HM Government, 2004 ) , Maternity Matters: Choice, entree and continuity of attention in a safe service ( DH, 2007a ) , the Cancer Reform Strategy ( DH, 2007b ) , HealthInequalities: advancement and following stairss ( DH, 2008 ) , Smoking Kills ( DH, 1998 ) and the Implementation Plan for cut downing wellness inequalities in infant mortality: a good pattern usher ( DH, 2007c ) .

In add-on to damaging the wellness of the female parent, antenatal smoke is associated systematically with a figure of complications during gestation ( Castles et al, 1999 ) and several possible conditions impacting the baby ( Cnattingius, 2004 ) . Smoking rate among pregnant adult females in the UK was 23 % in the twelvemonth of 1995, it declined to 19 % in 2000 and farther declined to 17 % in 2005 ( Baxter et al, 2005 ) . But RCM has noted an addition in gestation smoke rates since 2005 ( Baxter et al, 2009 ) . It is estimated that around 17 % and 23 % of pregnant adult females are estimated to smoke throughout gestation in the United Kingdome ( Owen et al, 1998 ) . It is of import that cost effectual intercessions are developed and disseminated so that smoking-related wellness complications can be avoided.

While face to confront smoking surcease behavioral support is by and large available for pregnant tobacco users, attending rates are really low ( Taylor et al, 2001 ) . In instance when the pregnant adult females are non able to go to face to confront smoking surcease behavioral support the option is self aid intercessions ( Ussher et al, 2005 ) . Self aid intercessions are peculiarly of import due to their low cost and they can make wider group of population. Giving pregnant adult females brochures incorporating information of jeopardies of smoke is one of the common signifier, but they can besides include picture, telephone and computing machine based systems.

A recent Cochrane reappraisal concluded that, compared with having no stuffs, self help stuffs on their ain addition surcease rates merely marginally among non pregnant tobacco users ( Lancaster and Stead, 2005 ) . Tailored ego aid stuffs were found to be increasing the quitting rates compared to standard stuffs used for intercession ( Lumley et al, 2004 ) . Tailoring is the usage of participant features to individualize intercession stuffs and is believed to be effectual because it increases the relevancy of the information to the person and heed to the message ( Dijkstra and De Vries, 1999 ) .

Self aid stuffs are common constituents in behaviour intercessions for pregnant tobacco users and are considered to be of import to cessation reding aid to pregnant adult females tobacco users to discontinue smoke ( Ussher et al, 2004 ) . However it is ill-defined whether ego aid intercessions on their ain can increase discontinuing among pregnant tobacco users.

Several reappraisals have confirmed that intercessions promotion smoking surcease during gestation can cut down smoking rates significantly ( Kelley et al, 2001 ; Lumley et Al, 2004 ; Mullen et Al, 1999 ) . Lumbley et Al ‘s ( 2005 ) reappraisal largest in this country to day of the month included tests supplying a assortment of surcease intercessions, including self aid stuffs, reding techniques, fiscal inducements and nicotine replacing therapy. Lumbley et Al ‘s ( 2004 ) indicated that hazard of smoking in late gestation was lower among intercession groups than usual attention groups. They besides found that intercessions of greater denseness determined by personal contact, added small benefit. Kelley et Al ( 2001 ) reported that the degree of reding provided within an intercession was non associated with efficaciousness.

Sing the possible benefits of ego aid intercessions it is of import to find whether they can be effectual on their ain in mark group.


As an ethical bookman my inclusion and exclusion standards explains my attack towards choosing a proper literature for my attack. As a pupil of Northumbria University my first attack was to travel through the diaries available on NORA. There was plenty data available on NORA for research articles related to my subject. I besides tried to get quality resources from other hunt engines every bit good. I searched through Cochrane library to acquire good reappraisal articles on my research subject.

Search Engine

I used Nora, Wiley Inter scientific discipline, The Cochrane library, British diary ofPsychology, Official site of Elsevier publication which enabled me to entree articles through scientific discipline direct, PubMed, CINAHL etc. I used my university login wherever required for the entree of articles. This hunt engines are choice assured and supply entree to high quality of international resources.

Search footings

Four chief databases were searched through MEDLINE, EMBASE, PubMed, ScienceDirect. Sear was done utilizing combination of keywords like ‘smok* ‘ , ‘tobacco ‘ , ‘pregn* ‘ , ‘cessation ‘ , ‘self help intercessions ‘ , ‘quit* ‘ and other proper equivalent word.

A computerized electronic hunt was performed to place relevant articles. The hunt was conducted on Medline [ Jan 1997 to November 2010 ] , Embase [ Jan 1997 to November 2010 ] , CINAHL [ Jan 1997 to November 2010 ] , ScienceDirect [ Jan 1997 to November 2010 ] and PubMed [ Jan 1997 to November 2010 ] . PICO method was used to seek cardinal words to govern out the articles in each database. PICO is a method of hunt scheme that allows taking a more grounds based attack to literature seeking in database like CINAHL, ScienceDirect, etc ( Schardt et al. , 2007 ) .

Electronic seeking yielded 1010 relevant articles of which 725 were extras and after testing of the commendation or mention 285 articles were published one. Based on the survey criteria 11 articles were related to self aid intercessions. 3 articles were eliminated due to type of qualitative or prospective survey. 4 articles were good, they were run intoing my inclusion exclusion standards but I was non able to entree them as they were paid articles. Finally, 8 to the full published articles were included in this assessment.

PICO Method

Population: Pregnant adult females smoking during gestation

Intervention: Tests were considered if at least one of the experimental weaponries met the ego aid definition. The definition used based on Lancaster & A ; Stead ‘s ( 2005 ) defines self aid as the proviso of structured stuffs that assist the person in doing quit effort and prolonging abstention without important aid from a wellness professional or group support.

Comparison: Comparison was done between different intercessions. Usual attention given to pregnant tobacco users during their ante natal attention was compared with ego aid intercessions. Besides usual attention was compared with picture based and brochures intercession.

Result: Smoke results were accessed either in 2nd or during the 3rd trimester. The tests besides determined the smoke position either during late gestation or postpartum ( Moore et Al, 2002 ) .

Arm 1: Standard obstetrics advice to halt smoke and a self-help cusp appropriate for adult females in the readying phase. Midwifes received no extra preparation except in survey protocol.

Arm Two: TTM based arm. Woman were been seen by accoucheuses with 2. 5 yearss specialist preparation, 2 of these yearss on TTM. Women received a TTM based self-help brochure and received four Sessionss of behavioral reding from the accoucheuses ( three during gestation and one 10 years post partum )

Arm Three: TTM based arm. Woman were been seen by accoucheuses with 2. 5 yearss developing as in arm 1. Intervention was the same as arm two, with the add-on of a computing machine based surcease intercession used on the four juncture ‘s of the accoucheuses visit.

Pregnant adult females in weaponries two and three ( TTM- based ) were significantly more likely to travel frontward in phase of alteration than adult females in the control arm.

Overall, the TTM-based intercession produced some motion in adult females ‘s preparedness to discontinue but it was hard to construe this determination as the TTM intercessions were besides more intensive. The writers concluded that TTM had small cogency in explicating smoking surcease behavior during gestation.

Participant, Recruitment and Sampling Methodology

A sum of 146 adult females were screened for the survey. Sixty four adult females failed to run into the inclusion standards for the test ( & gt ; 18 old ages of age, smoke & gt ; 3 coffin nails per twenty-four hours, less than 30 hebdomads pregnant, have a on the job VCR, be willing to put a quit day of the month within two hebdomads of showing, and non involved in any other formal smoke surcease plan ) .

82 adult females participants were indiscriminately assigned.

Usual attention ( UC ) ( N= 40 ) and UC plus picture ( UCV ) ( N= 42 ) groups. All participants continued to have the usual prenatal attention provided by their primarydoctor, plus survey stuffs as described below. All intercession stuffs were provided through the mail, after participants had undergone a telephone testing for inclusion. All follow ups were besides conducted by telephone.

Abstinence was observed between the two groups. Abstinence studies were measured by salivary cotinine values.

Seven twenty-four hours point prevalence abstention informations did non demo any significance consequences. At the terminal of quit day of the month the abstention rate was 10 % in control group and 3 % in experimental group. At the terminal of intervention the abstention rate was 12 % in control group and 7. 5 % in experimental group.

The present sample size may be unequal to pull any i¬? rm decisions sing the differential effectivity of the picture intercession.

The effectivity of low-priced smoke intercessions targeted to pregnant adult females has been demonstrated, although few additions in absolute surcease rates have been reported in the past decennary. Under conditions of typical clinical pattern, this survey examined whether results achieved with brief reding from antenatal attention suppliers and a self-help brochure could be improved by adding more resource-intensive cognitive-behavioural plans.

Study Design

Randomised Controlled Trial

Participant, Recruitment and Sampling Methodology

Womans 18 old ages of age or older who self-reported to be active tobacco users at their initial antenatal assignment. 131 adult females were randomised.

Control group: 111 participants.

Experimental Group: 120 participants.


Participants were randomized to one of three groups:

  • ( a self-help brochure tailored smoke forms, phase of alteration, and life style of pregnant tobacco users ;
  • the brochure plus entree to a computerized telephone surcease plan based on synergistic voice response engineering ;
  • or  the brochure plus proactive telephone reding from nurse pedagogues utilizing motivational interviewing techniques and schemes.

Biochemically conirmed abstention measured by degree of cotinine in urine samples obtained during a everyday antenatal visit at about the 34th hebdomad of gestation.

Twenty per centum of participants were conirmed as abstainer with no signiicant differences found between intercession groups. Cessation rates in heavy tobacco users were less in all intercession groups.

Neither a computerized telephone surcease plan nor systematic proviso of motivational guidance improved surcease rates over a trim self-help brochure delivered within the context of brief advice from antenatal suppliers.

Experimental group received usual information with a prenatal and station partum information. Control group received merely usual information. The intercession consisted of single accomplishments direction and guidance by a equal wellness counselor on the usage of a self-help surcease usher and everyday clinic support.

It was measured by smoking surcease confirmed by cotinine measuring. Significant decrease in smoke was besides considered as an result step. Smoking forms were besides considered

Among the Experimental group ( n = 193 ) , 6. 2 % were cotinine confirmed quitters at 3rd trimester and among the C group ( n = 198 ) the quit rate was 5. 6 % .

No important differences were found in the two groups.

To measure the effectivity in assisting pregnant adult females stop smoke of two intercessions ( Pro-Change for a healthy gestation ) based on the Trans theoretical theoretical account of behaviour alteration ( TTM ) compared to current criterion attention

Study Design

Cluster randomised survey.

Participant, Recruitment and Sampling Methodology

494 pregnant tobacco users participated.

Control group: 243 participants.

Experimental group: 251 participants.

Arm 1 for standard attention.

Second arm for TTM based ego aid manuals.

Third arm for TTM based ego aid manuals plus session with an synergistic computing machine plan giving individualized smoke surcease advice.

Biochemically confirmed smoke surcease for 10 hebdomads and point prevalence abstention, both measured at 30 hebdomads of gestation and 10 years after bringing.

There were little differences between the TTM weaponries. Uniting the two weaponries, the odds ratios at 30 hebdomads were 2. 09 ( 95 % assurance interval ( CI ) 0. 90 to 4. 85 ) for 10 hebdomad sustained abstention and 2. 92 ( 95 % CI 1. 42 to 6. 03 ) for point prevalence abstention relation to controls. At 10 yearss after bringing, the odds ratios were 2. 81 ( 95 % CI 1. 11 to 7. 13 ) and 1. 85 ( 95 % CI 1. 00 to 3. 41 ) for 10 hebdomad and point prevalence abstention severally.

Borderline important addition in discontinuing in the combined intercession weaponries.

Smoking surcease rates were low when cotinine measuring was done. The rates were 18. 8 % in intercession group and 20. 7 % in normal attention group.

Self reported smoking surcease rates were high. The rates were 29. 1 % in intercession group and 25. 6 % in Normal attention group.

Self Help Intervention was utile but non so effectual during prenatal attention. There needs to a more intensive and tailored made intercession be made for good consequences.

88 topics were enrolled as experimental topics, they received trim smoke surcease messages through mail, one after each antenatal visit. 85 topics in control group received a quit smoke brochure and no other stuffs.

The experimental group was given trim messages after each antenatal visit. They were given manus held computing machine and were advised to make full up abruptly follow upinterview. Urine samples were collected at the pre natal visits. The control group were merely given merely discontinue smoking brochures.

It was measured by the interview signifiers filled by the pregnant adult females.

Rate of surcease in control group was 14 % as compared to experimental group was 15 % . There was no important difference in smoking surcease rates.

Tailored message produced no alterations in the smoke behavior of the topics.