Reflection On Smoking Cessation

Reflection on Smoking Cessation 1

REFLECTION ON SMOKING CESSATION

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Reflection on Smoking Cessation 2

Reflection on smoking cessation

The reflecting covers my experience as a student midwife in a healthcare facility. The

paper critically evaluates the process and obstacles to smoking cessation in pregnant women.

Further, the paper is arranged in a sequential manner assessing the situation, factors and issues

surrounding the issue and finally the recommendations and action plan that can be taken to

improve the rate of smoking cessation in women. Among the things extensively explored include

the carbon monoxide testing provided to pregnant women. Through my experience, current

literature, and clinical knowledge I will evaluate ways of improving my services and impact on

pregnant women to help them quit smoking. I will use Rolfe’s (2001) reflective model, as it

provides an easy approach which I have found beneficial to me in the previous assignments

(Rolfe, Freshwater, and Jasper 2001, p.4).

What?

Smoking cessation in pregnant women is not an easy task to pursue. My role as a

midwife in the first year was to provide the necessary guidance for pregnant women in the habit

of smoking to quit smoking. Smoking is an addiction like any other, and hence most people find

it difficult to quit (Allen, Oncken and Hatsukami 2014, p.58). This is something which I have

observed on the first occasions during antenatal appointments. There is a big problem given that

it is not an easy task to take an addicted person away from their addiction. Evidence reveals that

there are adverse effects on children born to mothers who are in the habit of smoking

(Greenaway, Mogg and Bradley 2012, p.1025). Most of the children born to smokers suffer from

respiratory diseases immediately from birth making their parents spend longer times in the

hospitals even after they give birth (Greenaway, Mogg and Bradley 2012, p.1025). For such

Reflection on Smoking Cessation 3

incidences to be avoided, as a student midwife I must help smoking women in their pregnancy

quit which has not been a straightforward task.

So what?

The main reason behind resistance to smoking cessation in pregnant women is social

contentment and satisfaction. During my interactions with these women, I have found out that

different issues need to be dealt with from personal to family level. According to self-efficacy

theory, family and friends make it hard for people to quit their addictions (Bandura 2003, p.39).

Pregnant women are very ignorant to the reality of the effects on their babies, and therefore I

have found taking them through the effects of smoking on their babies as the only way to present

reality of the situation (Coleman et al. 2013, p.373). , I have noted that depending on the method

I adopt in engaging the women on smoking cessation determines whether the patient will make

an effort to quit smoking or the effort they will put towards quitting (NHS 2017, n.p.).Thus,

having the necessary skills and adequate training plays a prominent role for a person in my

position.

My main strategy in taking pregnant women through smoking cessation activities is

through engaging them in dialogue. This appears to be the only best method of understanding

smoking from their perspective. It also helped me understand why most women start smoking

during their pregnancy even when they were not smoking initially. This effectively took place

when I was not restricted to the cessation procedures, deviation from the normal cessation

procedures helped the women to be free and open in our conversation (Oaks 2012, p.124).

Immediately a woman decides to quit smoking, discussion and prescription of the right

medication took place according to the patient’s smoking and medical records (NHS 2017, n.p.).

Reflection on Smoking Cessation 4

I found that to be very useful in making fact-based and informed decisions thus enhancing the

cessation process.

Smoking cessation is difficult for women who have been smoking even during their

earlier pregnancies and gave birth to healthy babies. These are some of the factors that made my

role as a student midwife less effective since they are not easily convinced of the reality of the

effects likely to befall their babies (Oaks 2012, p.86). Unfortunately, I came to learn that some of

the children born to these mothers after their first pregnancy were adversely affected. Some

justified themselves by claiming that they had been smoking for longer times and quitting during

pregnancy could make no difference (Meernik and Goldstein 2015, n.p.). Finally, the main

reason for smoking by pregnant women is the belief that they get relaxed when they smoke. The

stressful events may have contributed to this during their pregnancies and high rates of idleness

and inactivity.

Presentation of facts about smoking sometimes hits a dead end when it comes to pregnant

women. For example, as a student midwife, I continually reminded the women of the cause and

effect of smoking to the health and well-being of the baby. Smoking results in high blood

pressure in the patient thus speeding up the heartbeat. This results into lesser blood getting

supplied to the fetus reducing the supply of oxygen due to high volumes of carbon (II) oxide in

the blood of the mother (Greenaway, Mogg and Bradley 2012, p.1026). The NICE program has

continually made campaigns against women smoking particularly during and immediately after

pregnancy (Grant et al. 2014, p.142). Even with these facts, the women are still resistant to

smoke cessation some even opt to take fewer cigarettes assuming that it makes a difference;

Reflection on Smoking Cessation 5

however given that tobacco has no safety zones, their efforts are worthless (Allen, Oncken and

Hatsukami 2014, p.56). The effects on the babies still manifest even after their resistance and

ignorance.

The carbon monoxide test has proven to be among the most effective indicators of

women exposed to smoking and those who haven’t. The results of such tests have indicated that

smoking cessation has beneficial effects on both the mother and the fetus at different stages of

the pregnancy (National Institute for Health and Care Excellence, 2010). However it is very

motivating to see the acceptability of the carbon monoxide testing by patients. To me, this

indicates a sense of hope in accepting the guidance and smoking cessation in the same way.

Now what?

Given a chance to serve as a student midwife again, I am well equipped with new ways

and techniques in facilitating smoking cessation in pregnant women. I will incorporate both

behavioral support and appropriate medication to ensure that all patients recover and give birth to

healthy babies (Allen, Oncken and Hatsukami 2014, p.54). With the knowledge I have obtained

on nicotine therapy, I will ensure that the patients get a better and thorough understanding of

how to effectively use it for their benefit. Besides, I would encourage utilization of the available

local facilities to help them reduce the relapse rate (Oaks 2012, p.35). Further, I will make it a

personal priority to congratulate patients who have made efforts in smoking cessation. In that

case, the pregnant women will have their motivation to quit smoking lifted hence attempt abrupt

cessation as a goal (Meernik and Goldstein 2015). Lastly, keeping a record of all the

conversations with the women and further direct them to other relevant help if need be will also

help them greatly.

Reflection on Smoking Cessation 6

Patients need to be presented with real-life scenarios and statistics of women who smoke

and the health states of their babies. For example, such babies are associated with chronic

hypertensive disorders, low birth weight infants, sudden infant death syndrome, increased

childhood respiratory illnesses, and placental problems during and after pregnancy (Greenaway,

Mogg and Bradley 2012, p.1027). This will maybe make a more compelling and convincing

case to women as an encouragement to quit smoking. As presented NICE and the NHS women

need advice and emotional support throughout pregnancy and early stages after delivery, and

thus I will make it my responsibility to do so.

In addition to performing carbon monoxide tests, I will prioritize educating the women

on the significance of these tests and their implication to both the mother and the fetus.

Additively, the use of the Five As’; Ask, Advise, Assess, Assist, and Arrange I will make the

cessation activity procedural and sequential so that patients can quit their addictions smoothly

(Fahy et al. 2014, p.107). First I will assess the willingness of the patient to quit and provide the

necessary supporting help to help them do so. Otherwise, outlining the effects of smoking will

form the greatest part of cessation procedures (National Institute of Health Care Excellence

2010, n.p.). Lastly, I will make follow-ups to all patients to ensure that their efforts are rewarding

and successful.

Reflection on Smoking Cessation 7

References

Allen, A., Oncken, C. and Hatsukami, D. (2014). Women and Smoking: The Effect of Gender on

the Epidemiology, Health Effects, and Cessation of Smoking. Current Addiction Reports,

1(1), pp.53-60. Retrieved from http://www.nhs.uk/conditions/pregnancy-and-

baby/pages/smoking-pregnant.aspx [Accessed 14 September 2017].

Bandura, A., 2003. Self-Efficacy: The Exercise of Control. 6th ed. Johanneshov: MTM:

W.H.Freeman and Company.

Coleman, T., Chamberlain, C., Davey, M.A., Cooper, S.E. and Leonardi‐Bee, J., 2013. Efficacy

of nicotine replacement therapy in pregnancy. RCOG: An International Journal of

Obstetrics & Gynaecology, 120(3), pp.373-374.

Fahy, S.J., Cooper, S., Coleman, T., Naughton, F. and Bauld, L., 2014. Provision of smoking

cessation support for pregnant women in England: results from an online survey of NHS

stop smoking services for pregnant women. BMC health services research, 14(1), p.107.

Grant, A., Lewis, R., Jones, S., and Paranjothy, S., 2014. PMM. 58 Who should support pregnant

women to quit smoking? Early findings from a quasi-experiment building upon NICE

guidance: Models for Access to Maternal Smoking Cessation Support (MAMSS).

Archives of Disease in Childhood-Fetal and Neonatal Edition, 99(Suppl 1), p. 142.

Greenaway, R., Mogg, K. and Bradley, B. (2012). Attentional bias for smoking-related

information in pregnant women: Relationships with smoking experience, smoking

attitudes and perceived harm to foetus. Addictive Behaviors, 37(9), pp.1025-1028.

Reflection on Smoking Cessation 8

Meernik, C. and Goldstein, A.O., 2015. A critical review of smoking, cessation, relapse and

emerging research in pregnancy and post-partum. British medical bulletin, 114(1).

National Institute of Health Care Excellence, 2010. Smoking: stopping in pregnancy and after

childbirth. [Online] Available at: https://www.nice.org.uk/guidance/ph26 [Accessed 14

September 2017].

NHS, 2017. Stop smoking in pregnancy. [Online] Available

Oaks, L. (2012). Smoking and pregnancy. New Brunswick, NJ: Rutgers University Press.

Rolfe, G., Freshwater, D., Jasper, M. (2001) Critical reflection in nursing and the helping

professions: a user’s guide. Basingstoke: Palgrave Macmillan

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