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Smokefree Skills: a review of maternity workforce training is published by ASH on behalf of the Smoking in Pregnancy Challenge Group

The report has been published by Action on Smoking and Health (ASH) on behalf of the Smoking in Pregnancy Challenge Group (founded in 2012 in response to a challenge by the then Public Health Minister to identify means to reduce rates of smoking in pregnancy) and launched in Parliament today (18th July) at a joint event between the APPG on Baby Loss and the APPG on Smoking and Health.

The report provides an analysis of the training that midwives and obstetricians receive to address smoking in pregnant women, and what further training is needed. Smoking is a major cause of stillbirth and sudden infant death, and also leads to more babies being born with health problems and with a low birth weight.

Evidence shows that short and straightforward conversations with midwives and doctors can increase the chances of a woman accessing services that will help her to quit. Smoking rates among pregnant women in the North East have fallen by almost a third from 22.2% in 2009/10 down to 16% in 2016.  Behind the fall is a major programme to embed NICE guidance to help midwives raise the issue and refer women to stop smoking services through the babyClear initiative which has doubled quitting rates and received national acclaim.

However, while staff are being taught about the harms from smoking in pregnancy, training on how to communicate this to women, how to use basic equipment such as carbon monoxide monitors, and how to provide short effective advice to women is not being provided consistently around the country.

Ailsa Rutter, Director of Fresh, said: “The work in the North East has already demonstrated the dramatic reduction the NHS can play by raising smoking as a serious issue, and either prescribing treatment or referring patients to stop smoking support.

“In the North East, we found women expected this issue to be raised by their health professional, and referrals to stop smoking support increased every time midwives received extra training in how to raise this issue and use CO monitors. It is vital that this is sustained across all localities in the North East and is part of routine clinical practise in all maternity services as it works, is highly cost effective and can save lives.

Report author Dr Misha Moore, a doctor in both Public Health and Obstetrics, who wrote the report for ASH, said: “Throughout this process, people would tell me the importance of reducing smoking in pregnancy ‘goes without saying’. But leaving things unsaid appears to be just the problem. The majority of staff are clear on the risks of smoking, but not all are quite so clear on how they could help women to stop. Simple, low cost, training delivered by every Trust in the country could go a long way to addressing this issue.”

Francine Bates, Chief Executive of the Lullaby Trust and co-chair of the Smoking in Pregnancy Challenge Group said: “Tragically smoking causes ill health and death among babies in this country every day. We know that pregnant women listen to their midwife and their obstetrician. With the right training, they could make a big difference to the number of women smoking in pregnancy.”

Will Quince MP, co-chair of the APPG on Baby Loss, said: “Undergraduates must not leave midwifery and medical schools simply with knowledge on harms from smoking. They need practical skills so their interaction with a woman who smokes actually helps her to quit. These must not only be taught but be tested too.”

Antoinette Sandbach MP, co-chair of the APPG on Baby Loss, said: “Smoking is an addiction and it can be very hard to give up without the right support. Health professionals need to be sensitive and non-judgemental in the ways they encourage women to give up smoking. Building this into training and professional development is vital.”

The report also highlights that training of maternity staff is not enough on its own. There has to be co-ordination with the local services that help women to quit smoking.

Bob Blackman MP, Chair of the APPG on Smoking and Health said: “Stop smoking support is incredibly cost effective. Every local area needs to find a way of maintaining these vital services, particularly for pregnant women.”

For more information on babyClear click here

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