The Risk of Smoking during Pregnancy - Essay Example

What role do midwives play in supporting and advising women about the risk of smoking during pregnancy General Introduction: The importance of midwives can not be neglected, especially if you talk about their role in United Kingdom. In fact, midwifery is one of the leading professions in UK and you can find a midwife to be present at the time of birth in more than 75% of cases. Their assistance is helpful for women to make specific decisions during the pregnancy. They don't only make a positive contribution to the health of a woman but to the wellbeing of his child as well. Therefore, it is considered to be a highly privileged and highly skilled profession in UK (Midwifery). Though it is supposed that the role of midwives is limited to child birth but this modern world has changed the role and responsibilities of midwives all over the UK. For instance, many of the midwives are now actively playing their role in health promotion. In fact, midwives are now taking health promotion more seriously as along with managing ill health and disease they also inform women about the ways to keep them healthy. Though the midwife has always been playing an important role in public health but now it is important for them to divert their attention to teenage pregnancy, drug awareness, domestic violence and smoking cessation (Beldon et al, 2005). Here, you can easily see that the role of midwives is quite extensive but the help these midwives provide pertaining to smoking recession is remarkable. It is well known fact that smoking is injurious to health and no one can deny this reality. But, the health implications of smoking can be even critical during the pregnancy. The worst thing is that smoking can not only hurt a pregnant women but it is also perilous to the health of unborn baby. Actually, it is said that baby smokes when a pregnant woman does that. As she inhales carbon monoxide and nicotine during smoking, the growing baby suffers as these substances are nothing less than poison. It doesn't allow a baby to get enough oxygen or food. Smoking for pregnant women increases the chance of miscarriage. In addition to this, the chances of a baby coming into this world too soon will also be there. In this situation, the weight of a baby will always be on the lower side, giving rise to a lot of health issues. For these children, it becomes difficult to stay away from asthma or lung problem as they grow old (Smoking During Pregnancy). These are few of the issues associated with the smoking during pregnancy but it is a fact that lots of women don't become able to quit smoking during pregnancy, even if they want to do so. It is only because of the lack of motivation and will power that they find no way to overcome their desire to inhale nicotine. That's exactly the point where midwives come into the picture to help these women find a way to quit smoking for good. It is however found in many studies that midwives try to implement different methods and techniques to keep women away from smoking during the pregnancy. But, midwives have to ensure that they don't make a wrong use of a new practice as it can create adverse effects. They first have to identify a problem and discover a solution after thorough analysis (Beldon et al, 2005). This study is all about checking those specific practices adopted by midwives in supporting and advising women about the risk of smoking during pregnancy. Sometime midwives use motivational techniques and sometimes let women know about the threats associated with smoking. But, different pregnant women react differently to different methods and learning those responses can be helpful for new midwives to avoid negative impacts. This study will delve into the details available in previously conducted researches to compare it to new results found during the research process. Also, it was found in previous researches that the basic emphasis of midwives is to ensure the health of the fetus. It means that most of the techniques used by midwives are not women-centered. The results found through this study will also be compared to this particular statement made in previous researches to give better recommendations and suggestions so that midwives may become able to change the lives of pregnant smokers in a better way. Literature Review: The health implications of cigarette smoking are recognized by the general public and the medical community. The healthcare providers including the midwives have always been encouraged to deal with smoking cessation as the foremost issue (West et al). Lots of efforts have been made by different organizations to stop women from smoking during pregnancy. To achieve this goal different types of strategies are developed by many organizations. For instance, it is announced by NHS that pregnant women will get 20 if they will stay away from cigarettes for one week. This amount will get doubled if they stay away from smoking for a month. Another 40 will be added to the amount if expectant mothers say goodbye to smoking for a whole year. According to NHS, the money will be given to buy something other than alcohol and tobacco (Levy). Many other examples can also be found in this regard but it is a fact that no one can influence the life of a pregnant smoker better than a midwife. The role of a midwife is extremely important in UK. Although the basic duty of midwives is to provide prenatal care to pregnant women but their role is changing and that's the reason why they can affect the life of a pregnant smoker in the best possible way. Apart from advising women, they can also let them know about "Give it up" schemes like the one mentioned above. For instance, a Give It Up For Baby (GIUFB) scheme has been operating in different parts of Perth City and Rattray since 2007. The major aim of this scheme is to provide practical advice and support to someone interested in leaving cigarettes. The help is to be given by this scheme after checking the eligibility of women through midwives (Give It Up For Baby scheme helps pregnant smokers). With the help of midwives, these schemes can be utilized to quit smoking as nicotine replacement therapy is also provided in some of the schemes. While it is a fact that midwives can help women in smoking cessation, it is also true that no two women react in a same way to the techniques used by midwives. Following box (McCurry et al, 2002) shows the basic nine step approach used by most midwives. This nine-step approach shows that midwives don't only have to advise pregnant women but their partners and family members as well. But, one thing is quite evident in this particular approach and that is about letting women know about the dangers of smoking. This is one of the methods used by almost all midwives but it is not extremely beneficial because most women already know a lot about it. In these circumstances, it becomes important to understand the success ratio of using this method along with mixing it with other strategies. That's why a more comprehensive study is required to get to some conclusion. Furthermore, this basic approach makes it pretty clear that older approaches and smoking cessation programs have not considered the relation between the self-medication facet of smoking and the stressing factors in a woman's life. The factors can create more problems for a pregnant woman to quit smoking as compared to a non-pregnant smoker. Leaving cigarette is tough but it becomes tougher during pregnancy. It is only due to this fact that despite the steps being taken by midwives for smoking cessation, there is no real improvement in the cessation rate. Little or no improvement in smoking cessation is discouraging, especially after considering the fact that intensity of smoking cessation advice has increased over the past two decades (Lumley et al, 2004). The distressing fact is that most midwives don't understand that leaving cigarette is tough in pregnancy; hence don't become able to help women at all. It is also quite significant to mention that the basic focus of most of the midwives is on helping women in smoking cessation by telling them about the negative impact of smoking on the health of fetus (Lumely et al, 2004; Haug et al, 2000; Secker-Walker et al, 2003). This has been found in previous researches but that was the time when most of the midwives were not properly trained and educated. Things have now changed a lot and that's the reason why new strategies are being used by midwives to deal with pregnant smokers. New studies have to be conducted in order to learn more about the latest procedures used by midwives. But, one thing is for sure that there is an inherent relationship between smoking cessation advice and stress. One of the objectives of this study is to find the impact of the quit smoking advice on pregnant women. Here, it is crucial to mention that in many recent studies it was supposed that midwives advice to stop smoking might be stressful for pregnant women. Although there are no evidences of randomized controlled trials pertaining to this issue but some connections between smoking, social disadvantage, and stress are found in recent researches. Also, it is common for pregnant women to say that they smoke to relieve stress. In fact, many women believe that leaving cigarettes can be more harmful than continuing with it. They believe it to be a source of ensuring their own mental health (Irwin et al, 2005; Pletsch et al, 2003). That's the reason why Oliver comments, "it seems irrational to try to take away a coping mechanism [by advising pregnant smokers to quit] and not look for any social and emotional consequences" (Oliver, 1997). Also, it is relevant to mention that though most women take smoking as a way to deal with their stressors but they also feel embarrassment about their act of smoking during pregnancy (Irwin et al, 2005). Many women don't let their midwife know about their smoking habit. It is so because the negative feelings associated with the act of smoking during pregnancy stop them to call in a midwife for help. They believe that asking for smoking cessation advice would expose them and people with hate them (Aveyyard et al, 2004). Moreover, it is found in a new research that one in 10 pregnant women smokes but most of them do so to deal with their depression. This situation makes it even complicated for them to leave this bad habit for good. But, most midwives often try to help these women by giving a simplistic message that smoking is bad for their baby and that's not a the best way to achieve the task (USA: Pregnant Smokers May Suffer Depression). The fact is that women take the dangers of smoking in a different way as compared to the perception of a health professional or midwife and that has to be taken into consideration (Cameron et al, 2006). So, social and emotional consequences will always be associated with smoking cessation advice offered by midwives but the extent of those consequences needs to be evaluated by conducting a study. Here, it is important to point out the results of a study that was conducted in 2004 to judge the impact of quit smoking advice on pregnant women. It was found that women receiving more intensive advice for smoking cessation were not likely to face stress in postpartum period or late pregnancy. Also, there were women who tried to leave smoking to please their midwife but they were not under stress while doing so. Moreover, there were women who received intensive advice but relapsed. There was no clear evidence that they were under stress because of intensive advice (Aveyyard et al, 2004). Though it is evident from this study that no real impact was created by intensive advice on women but the basic approach used in this situation was the older one. The fact of the matter is that recent studies have found nothing more than the basic methods and strategies being used by midwives. But, it is understandable that the impact of those old methods is not really encouraging which means that midwives may be using some different techniques according to the situation at hand. Knowledge about those methods used by midwives in different situations along with the knowledge about the effectiveness of those methods can really help new entrants to handle things in a much better way and that's one of the major emphases of conducting this particular study. Also, most midwives have been using the simple approach of informing women about the dangers of smoking which is not a result oriented approach. In this approach, nothing is done to cope with other factors like stress, poverty, lack of control over life circumstances and low self esteem. A new and more detailed study is required to see if midwives are still using the same tactics or they have made some changes to yield better results. If this study shows that midwives are still persisting with old technique by not taking several stressors into account, this can be deduced that encouraging results are not obtained only because of the inefficient techniques. Though some midwives now try to make use of Nicotine replacement (NRT) patch, nicotine gum, nicotine microlab, nicotine lozenges, and other techniques like hypnosis, acupuncture, etc, but study needs to be conducted to find effectiveness of these methods so the right method may be highlighted. So, this study can help changing the entire outlook of midwives pertaining to smoking cessation. Aim of the Study: The aim of this study is to delve more into the details related to the duties of midwives along with figuring out their role in helping future moms to quit smoking during their pregnancy. This topic is important because it will help new entrants expecting to start a midwifery job to understand what they can do and what they should not do to help pregnant women in smoking cessation. This will also help pregnant women in understanding what should be expected from a good midwife, especially in relation to smoking cessation. The major objectives of the study are; 1. Identify the basic roles of midwives 2. Identify the key problems associated with smoking during pregnancy 3. Recognize the methods used by midwives to inspire women to quit smoking during pregnancy 4. Find out if new and advanced methods are used by midwives or they are sticking to the older techniques 5. Identify the impact of those methods and practices used by midwives 6. Recommend few of the tried and tested ways for new midwives to help pregnant women with smoking cessation Research Design: The basic approach used in this research will be Evaluative. The use of evaluative research approach is appropriate because it helps in getting information about midwives general role along with checking their impact on smoking cessation during the pregnancy. It also helps in describing the ways used by midwives along with the effectiveness of those ways. Though explanatory research approach can also be used to compare literature review with new findings but evaluative approach is better because it assists in touching different aspects of this particular topic. Data Collection Method: Most part of the literature review for proposed study will be secondary data. It means that data will be collected from journal articles, magazines, books, newspaper, reports, conference papers, archives, internet and electronic databases. For evaluative research method, data can be collected in two ways, i.e. Qualitative and Quantitative. Both of the data collection methods will be used in conducting this research as literary search from books, online journals, articles, notes and websites will act as qualitative part, whereas, questionnaire analysis through statistical methods will form quantitative part of this evaluative study. For quantitative part, three types of research methods can be used; case study, explicatory and survey. For case study, it is important to conduct an extensive research and as a full time student it is not possible to conduct a research of this sophisticated level. So, it is not preferred for this study. Explicatory research is based on personal views of researchers and involves a variety of complicated procedures, which can be time consuming. So, it is not used for this study. Survey method is the most appropriate method to conduct research on this particular topic. It is also best suited for evaluative researches as a specific group of people is used to get their opinions and thoughts about a specific question. It is also a relatively cheaper method and allows people to take liberty to answer the questions at their leisure. That's the reason why Questionnaires are used to conduct research. Simple questionnaire will be used to conduct a research. The design of questionnaire will be to get more information about the role of midwives along with understanding if midwives are performing their role in the right way. This will be done by handing out a questionnaire to a number of pregnant ladies. Here, a variety of questions will be used to discover the ways and procedures used by midwives for smoking cessation. A separate questionnaire will also be given to midwives to judge how often they have become able to influence a future mom to quit smoking and what ways they have used for it. Also, a set of questions will be used to judge the effectiveness of each method used by midwives to convince pregnant smokers to leave cigarettes for good. Analysis of Data and Interpretation of Findings: As questionnaires will be used to conduct a research, the best way to analyze data and interpret findings is by using statistical methods. Simple statistical methods like percentage, average, frequency, etc, will be used to evaluate the results of the questionnaires. Results will be discussed in percentage in relation to the findings obtained in literature review section. Validity of the facts found in literature review will be judged by taking questionnaire results into consideration. Findings will be critically analyzed so that the difference between results found in old and new research may be highlighted. By comparing the results of questionnaire and the literature review, it will be found to what extent midwives have been able to influence a woman during his pregnancy to stop smoking. Also, the most effective ways and strategies to achieve this goal will also be identified through literature review and questionnaire results. Ethical Issues: Certain types of ethical issues get involved in community-based research. Since the data will be collected directly from pregnant women and midwives, these women bound to have some considerations pertaining to undesirable exposure. Also, smoking women don't like to expose them for the fear of getting embarrassed in front of others. But data will only be collected to judge the role and efficiency of midwives so that some recommendations may be made to discover a better method or plan for smoking cessation. Special attention will be paid to the storage of data until some results are found by using data analysis methods. Proposed Research Time Table: May 2009 - June 2009: Literature Review June 2009 - July 2009: Design the Questionnaire; Collection of Statistics July 2009 - August 2009: Field Work - 1st Session of forwarding questionnaire to pregnant women August 2009 - September 2009: Field Work - 2nd session of forwarding questionnaire to midwives September 2009 - October 2009: Analysis of the data collected through fieldwork October 2009 -December 2009: Thesis Resources: Internet access will be required on regular basis for the collection of national statistics pertaining to smoking cessation efforts made by midwives. Also, the literature review will be based on newspapers, online journals and books, so regular visits to libraries will also be required. The cost will get incurred while printing and photocopying questionnaires. Transportation cost will also be there while handing over these questionnaires. Some questionnaires will be sent to participants by post and this will also add to the total cost of conducting the entire study. References: Andrew Levy. NHS Offers Pregnant Smokers 100 to Quit. Jan 23. 2009. Mail Online. http://www.dailymail.co.uk/health/article-1126653/NHS-offers-pregnant-smokers-100-quit.html Aveyard P, Lawrence T, Croghan E, Evants O, Cheng K (2004). Is advice to stop smoking from a midwife stressful for pregnant women who smoke Data from a randomized controlled trial. Preventive Medicine. Beldon A, Crozier S. Health promotion in pregnancy: the role of the midwife. The Journal of the Royal Society for the Promotion of Health 2005; 125; 216 Cameron J, David E (2006) Risk Perception Analysis in Australia. In: Symon A eds. Risk and Choice in Maternity Care an International Perspective. Churchill Livingstone Elsevier, Edinburgh: 123-37 "Give It Up For Baby scheme helps pregnant smokers" 2008. http://www.pkc.gov.uk/Council+and+government/Council+information+performance+and+statistics/Media+area/Council+releases/2008+Releases/February+2008/Give+It+Up+For+Baby+scheme+helps+pregnant+smokers.htm Haug K, Irgens L, Skjaerven R, Markestad T, Baste V, Schreuder P (2000) Maternal smoking and birthweight: effect modification of period, maternal age and paternal smoking. Acta Obstetricia et Gynecologica Scandinavica 79: 485-9 Irwin L, Johnson J, Bottorff J (2005) Mothers Who Smoke: Confessions and Justifications. Health Care for Women International 26: 577-90 Lumley J, Oliver S, Chamberlain C, Oakley L (2004) Interventions for promoting smoking cessation during pregnancy. Cochrane Library Issue 2, 2004 McCurry N, Thompson K, Parahoo K, O'Doherty E, Doherty A. Pregnant women's perception of the implementation of smoking cessation advice. Health Education Journal 2002; 61; 20 "Midwifery". University of Wolverhampton. Website: http://www.wlv.ac.uk/Default.aspxpage=7498 Oliver S. Exploring lay perceptions on questions of effectiveness. In: Maynard A, Chalmers I, editors. Non-random reflections on health services research. On the 25th anniversary of Archie Cochrane's Effectiveness and Efficiency. London7 BMJ Publishing Group, 1997. p. 272- 91. Pletsch P, Morgan S, Pieper A (2003) Context and Beliefs About Smoking and Smoking Cessation. MCN, American Journal of Maternal Child Nursing 28: 320-5 Secker-Walker R, Vacek P (2003) Relationships between cigarette smoking during pregnancy, gestational age, maternal weight gain, and infant birth weight. Addictive Behaviors 28: 55-66 "Smoking During Pregnancy". American Lung Association.http://www.lungusa.org/site/c.dvLUK9O0E/b.3121325/k.7AA8/Smoking_During_Pregnancy.htm USA: Pregnant Smokers May Suffer Depression (2007). 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