If you are pregnant, NICE want you to given a carbon monoxide test. This test is to see if you smoke. But look at the flowchart on page 11- you are to have this test even if you say you don’t smoke, and even if you say you do.

I don’t think this is conducive to a  trusting relationship. Being bulldozed into tests isn’t ethical, apart from anything else – no matter if the midwife has good intentions or not, competent adults are allowed to do legal things, and to refuse tests – even if you as a healthcare provider don’t like them.

Apart from anything else, the test is not foolproof – passive smokers, or people living near busy roads can elevate the test to ‘smoking’ levels even in non smokers. If you do smoke – a confession that is clearly to be extracted from you no matter what – you will be referred to stop smoking counselling, even if you don’t want to go. (The issue of false positive tests is jollied along by NICE, who say ‘it is best to use a low cut-off point to avoid missing someone who may need help to quit’. They don’t say much about  the falsely accused woman.)

The evidence around treating addictions is firm about one thing: the person themselves has to be motivated to stop. I am especially concerned about this guidance as there is a clear relationship between lower social class and smoking. There is an argument that poverty is more damaging to the developing child than exposure to smoke in utero. And what about the unintended adverse effects this intiative will have? Will the smoking woman avoid disclosing other concerns or worries about her pregnancy in the context of a clinical relationship which, first of all, essentially asked her if she was lying?

For what it’s worth, I am a non smoker and would have  refused any such carbon monoxide test in pregnancy. I would love someone to tell me that I’m wrong, but there are 30 people listed as being on the advisory committee to NICE’s recommendations, 2 of whom are GPs and one of whom is a psychologist. I can find no midwives at all, and the majority of members are from public health backgrounds where I would not expect them to have direct experience of consulting individually with patients.

It’s this disregard for the consultation that I find most disturbing. The very essence of what goes on is based on trust, and this recommendation is a retrograde step.