Babies who are forced to smoke

"BABIES die because their mothers smoke. That is a reality in my day-to-day life," says North-East hospital consultant Dr Shonag McKenzie. And it's not just the babies who are under threat: one pregnant woman Dr McKenzie treated smoked 40 cigarettes a day, leading to a heart attack at the shockingly young age of 23.

The obstetrician, who runs a busy clinic at the Wansbeck Hospital in Ashington, was one of the main speakers at the regional summit on smoking and pregnancy called by the group campaigning for a Smoke Free North East - Fresh - and held earlier this week at Wynyard Park House near Billingham.

She speaks passionately about the need to curb smoking levels in pregnant women in the region and gives delegates a shocking insight into the impact smoking has on mothers and babies. And while the emphasis tends to be on the health of babies, the consultant says we shouldn't forget how smoking affects mothers too.

"I had three women in intensive care with smokingrelated pneumonia after they had their babies," says Dr McKenzie, who works for the Northumbria Healthcare NHS Trust. "One of them could have died, the other two were very seriously ill and had to be ventilated for days."

During her talk she flashes up a grainy image of an abdominal scan illustrating the effects of smoking on pregnancy.

She points out the areas which have been affected by bleeds and other smoking-related complications. "This lady is a mother-of-two who was smoking 50 a day. Her baby is very tiny and severely at risk. She gave me permission to show you this image. She has got a copy of this on her fridge. She asked me to do this to motivate her.

"The same woman has managed to reduce her smoking to ten a day but that is still ten too many. She is desperate to give up smoking and we can't underestimate how hard it is," the consultant adds, pointing out that the woman's home circumstances are difficult, with a partner recently receiving a suspended prison sentence.

Her patient is using nicotine replacement therapy and is in touch with specially trained stop smoking advisors, who are giving her a lot of support, the doctor adds. "It is important that we recognise cigarette smoking is highly addictive but it is also important to let people know they don't have to rely on cold turkey' to give up."

Getting pregnant mums to enrol on a stop smoking scheme and use nicotine replacement therapies such as patches, gum and inhalers is vital, the consultant argues. What annoys Dr McKenzie is when women who lose babies say they wished they had known of the risks. "I get very upset when people say that. I talk to them about smoking and miscarriages, smoking and still births. I also talk about smoking when babies have died. Not doing it is not an option.

It is not about our comfort We have to give women this message."

For Dr McKenzie the key messages to get across are that smoking does kill babies, that nicotine replacement therapy does help smokers give up and that every health professional working in the region has a duty to discuss smoking behaviour with patients.

But the consultant is concerned that the NHS does not devote enough resources to identify women who are at risk through smoking during pregnancy. She believes all smokers who are booked in to have a baby should treated as high risk cases and given extra ultrasound scans.

Smoking is strongly related to a whole host of problems from low-weight babies to increased risk of stillbirth, neonatal death and even cot death. Identifying women early and helping them to give up smoking by enrolling them on a stop smoking course and getting them on nicotine replacement therapy could increase the number of healthy births and reduce complications and difficult deliveries.

"All smokers should get growth scans so we can pick up the small, at-risk babies. At the moment we miss half of all small babies," says Dr McKenzie.

The problem comes down to resources: there are simply not enough funds to provide early scans for smokers as well as for women who are medical high-risks.

"The good news is that if you stop smoking at any point, it reduces the risk to your baby. And if you stay stopped, it helps prevent childhood illness," says Dr McKenzie.

Health professionals also need to provide accurate information.

"It is not about telling them you are killing your baby' but saying it is very dangerous for your baby'."

Above all, she adds, doctors, nurses, midwives and health visitors need to understand the lives of women who are often in far from ideal circumstances. "I see women with extreme drug and alcohol problems, partners in prison, bringing up six children on their own. Smoking can be the only thing keeping them sane. Unless you understand that and where they are coming from, you will have no impact at all."

One of the basic messages Dr McKenzie tries to get across to pregnant women is that cigarette smoke contains 4,000 chemicals including cancer-causing substances and carbon monoxide, the gas that is pushed out of car exhausts. "I tell them that they are breathing in the same as car fumes and that it affects the baby by displacing oxygen," she says.

It is also vital to counter an idea which seems prevalent among North-East teenage girls that smoking helps to ensure an easy birth because the baby tends to be smaller. The reverse is actually true, with smaller babies being linked to increased risk and complications.

Dr Alex Bobak, a London GP who is an expert on smoking cessation, illustrates the hold that nicotine has over smokers by showing a grisly image of a women smoking through a tube through her throat after an operation to remove her cancerous larynx.

"Women keep smoking during pregnancy because of addiction. It makes you go into denial and lie to yourself,"

says Dr Bobak.

Former smoker and mother-of-nine Jane Cairns, from the Byker district of Newcastle, successfully quit during her most recent pregnancy after signing up with a smoking cessation advisor, who made home visits and prescribed nicotine patches.

"The patches did the job. They really helped me," she says. "The great thing is I can ring them up any time. I think it has a lot to do with them coming to the house. The bairns are over the moon that I have stopped smoking."

*For information on the work of Fresh: Smoke-Free North East and links to stop smoking sites visit www.freshne.com