Doctors, butt out of pregnant women’s lives

The chief executive of Public Health England (PHE), Duncan Selbie, has called for pregnant women to have their carbon monoxide (CO) levels monitored at antenatal appointments to find out whether they smoke. The Royal College of Midwives (RCM) has supported the initiative, provided the tests remain voluntary.

While no one believes that smoking during pregnancy is healthy, PHE’s suggestion is alarming. What exactly does Selbie propose should happen to women who smoke during pregnancy? He points out that PHE’s plans ‘[aren’t] about scaring or hectoring people’. But arguing that women should be subject to blood tests suggests that women can’t be trusted to tell doctors the truth about their health during pregnancy. This so-called health initiative is more about vilifying women for their behaviour than improving health.

The National Institute for Health Care and Excellence (NICE) claims that the measures are a helpful way of showing women that smoking during pregnancy has a harmful effect on the health of their unborn children. Yet, while the majority of women who are planning to have a child will do everything they can to ensure they have a healthy pregnancy, women who do continue to smoke while pregnant know the potential consequences of their actions already. What good will showing women their CO levels do?

These measures are said to be a way of helping women who don’t feel comfortable telling their doctors that they’re struggling to quit smoking. But, voluntary or not, testing pregnant women for smoking will only foster a climate of mistrust. And alienating pregnant women from their doctors by making them feel like they’re being policed will do nothing to help their health.

Besides, it is worth noting that there is a lack of consensus on the effectiveness of such tests. NICE, which has been calling for CO screening of pregnant women since 2010, has admitted that there is no clear cut-off point in CO levels that would definitively determine smoker status. CO levels are an unreliable measure by which to assess whether a patient smokes in the first place. This means that women could potentially be reprimanded for smoking habits they don’t even have.

PHE needs to realise that in order for women to trust their midwives and doctors, the healthcare system needs to demonstrate trust in them. Women must also be trusted to make their own lifestyle choices, which includes the freedom to smoke during their pregnancy. Subjecting women to these screenings will do little to foster the sense of mutual trust and respect necessary for a meaningful doctor-patient relationship, and will only serve to make women feel like they’re being watched, not helped.

Patients – pregnant or not – make bad health choices. The role of healthcare professionals is not to police patients, but to offer them support when they ask for it. We need a healthcare system that focuses less on controlling the behaviour of its patients and more on treating those that need treatment. It’s not news to anyone that smoking during pregnancy is unhealthy. But let’s treat women as adults who can make their own choices, rather than investing in invasive and ineffective measures that will do little to improve their actual health.

Milja Kljajic is a writer based in London.