Smoke free pregnancy

The tobacco dependency service

Everyone in the care of our service who smoke, or use an e-cigarette or vape, are referred to our in-house, specialist tobacco dependency service.

At your first appointment with your midwife, you will be asked whether you smoke. Your midwife will then ask you about your tobacco dependency; how often you smoke and how much tobacco you smoke per day. You will also be advised around the risks of secondhand (passive) smoking.

Once referred to our service, a maternity tobacco dependency advisor (TDA) will contact you to offer support and advice on stopping smoking during your pregnancy.

Your midwife will also ask whether any other members of the household smoke to see if they would like support to stop smoking as soon as possible.

Stopping smoking during pregnancy

There are no safe levels of smoking, either for you or your baby. Reducing the number of cigarettes, you smoke is a positive step in your journey, although there is no evidence that smoking fewer cigarettes is better for your baby.

Protecting your baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life. Whilst it can be difficult to stop smoking, it is the most important thing you can do to improve your baby’s health, growth and development. It is never too late to treat your tobacco dependency.

Benefits of stopping smoking

When you stop smoking:

• You are more likely to have a healthier pregnancy and a healthier baby.
• You will reduce the risk of a miscarriage, or your baby dying before it is born (stillbirth)
• You will reduce the risk of a premature birth (when your baby is born before 37 weeks).
• You will reduce the risks of your baby having birth defects, such as a cleft lip and palate.

For more information, please watch the video below about the effects of smoking on your baby: 

Carbon monoxide levels in pregnancy

One of the thousands of harmful chemicals in tobacco smoke is carbon monoxide (CO). Pregnant women have higher levels of CO than those that do not, and those who smoke have even higher levels of CO. Exposure to CO restricts the amount of oxygen getting to your baby, which can lead to:

• reduced birthweight
• increased risk of your baby being sickly and unwell
• increased the risk of sudden infant death syndrome (SIDS), also known as “cot death”.

CO monitoring during pregnancy

Your midwife will offer CO monitoring at your first booking appointment and will ask you to do a breath test, which will measure the level of CO in your system. This will be repeated at all antenatal appointments throughout your pregnancy.

Anyone who is pregnant is advised to have a CO test whether they smoke or not, as faulty gas appliances at home can mean you are exposed to higher levels of CO.

If you are not a smoker or you have not been exposed to tobacco smoke and your CO reading is high, you should contact the free Health and Safety Executive gas safety advice line: 0800 300 363.

They will advise you on how you can have your gas appliances checked within your home.

The effects of second-hand (passive) smoke

Second-hand smoke is the smoke exhaled by someone when they are smoking, and the smoke from the end of the cigarette (or cigar). Breathing in second hand smoke, or ‘passive smoking’, can affect you and your baby before and after giving birth.

Exposure to second-hand smoke can:

• reduce your baby’s birthweight
• increase the risk of your baby being sickly and unwell
• increase the risk of sudden infant death syndrome (SIDS)
• increase the chance of your baby having long term health issues, especially during their first year.

Living with someone who smokes can also make it difficult for you to stop smoking. If someone in the household does not want to give up smoking, we recommend that they do not smoke indoors. They should shut all windows and doors and take at least five steps outside the door before smoking.

What support is available?

Once referred to the tobacco dependency service, your TDA will contact you by telephone to offer you some advice and talk to you about what the service can offer you.

The service offers 12 weeks of support to help you stop smoking. If you choose to accept the referral, your first four meetings with the TDA will be face-to-face. In these appointments, the TDA will monitor your CO levels with a breath test.

Your first pre-quit meeting

The TDA will offer you behaviour therapy support and nicotine replacement therapy (NRT). You can discuss your tobacco dependency and your expectations for stopping smoking.

The TDA will advise you to follow the ‘No Puff rule’: once you make your quit attempt, you do not have a drag of another cigarette going forward.

You can choose the type of NRT you use during your pregnancy from the products we supply. You can read more about NRT below.

You will set your quit date which is the date you will no longer continue smoke.

Further appointments

Your follow-up appointments in weeks three to 12 will be a mixture of face-to-face and over the phone appointments. The TDA will discuss with you any challenging situations you may be facing, celebrate any successes and continue to monitor your CO levels.

Your TDA will meet with you face-to-face a few days after your quit date to see how you are getting on. The TDA will want to make sure you have enough NRT supply and to carry out your CO testing.

Nicotine replacement therapy

You are twice as more likely to be successful at quitting if you get some support from a trained advisor and use NRT.

NRT contains a pure dose of nicotine, which means it does not have any of the harmful chemicals found in cigarettes and so is a much better option that continuing to smoke. NRT is available as patches, gums, inhalator, nasal spray, mouth spray, lozenges. They come in different strengths depending on how much you smoke.

You can safely use NRT during your pregnancy if it will help you on your quit journey, however it is not recommended that you take Champix or Zyban.

You can be prescribed NRT during your pregnancy by talking to the smoking cessation midwife or a TDA. You can also buy it over the counter without prescription from a pharmacy.

Your TDA can offer you support on what is the best NRT to suit your lifestyle. It is recommended that you use two different NRT products on your quit journey: a slow-acting one like a patch that will deliver nicotine into your system throughout the day, and a fastacting NRT like a gum. The fast-acting NRT will help with your immediate withdrawals, symptoms and urges to smoke.

NRT is not a magic cure to your tobacco dependency, but it does help take the edge of your urges to smoke. By getting this specialist advice, you can be sure that you are doing the best for you and your baby.

E-cigarettes and vaping in pregnancy

E-cigarettes and vaping are new, and we do not know the long-term effects they will have on the body. However, current evidence suggests they have less risks than smoking.

E-cigarettes and vapes do not produce tar or CO, which are some of the main chemicals we worry about when smoking cigarettes as they are harmful for developing babies. The vapour from an e-cigarette or vape does contain some potentially harmful chemicals, but at much lower levels than cigarette smoke.

Although not risk-free, if using e-cigarettes or vapes helps you to stop smoking, it is much safer for you and your baby than continuing to smoke. If you want to use e-cigarettes or vapes as a tool to quit smoking, you can still get specialist support from your TDA.

Unlike NRT such as patches or gums, e-cigarettes and vape are not available on an NHS prescription.