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The Sheep Sheep Song

Smoking during pregnancy is a controversial issue that gets anti-smoking puritans frothing at the mouth. In Blackpool they are taking a proactive stance by screening mothers-to-be for carbon monoxide in their blood. I’ll let Emma Harris of the Evening Gazette take up the narrative.

WOMEN are now being screened for signs of a deadly chemical as part of Blackpool’s bid to cut the number of mums-to-be smoking.

The resort still has the highest rate in the country of pregnant women who light up – at 29 per cent.

I hope these chemical checks are being performed with the permission of the women concerned. After all, according to the statistics, more than 70% of pregnant women in Blackpool don’t smoke making nearly three quarters of the tests redundant and a waste of resources if the screening is involuntary. Unfortunately Ms Harris doesn’t elucidate.

But health bosses say this is the first time the figure has been below 30 per cent since records began.

Nor does Ms Harris expand on when records began so we have no idea what percentage of pregnant women smoked prior to this. The percentage of so called deprived families increased when local housing associations started accepting hell knows how many problem families from other deprived parts of Lancashire, especially Liverpool and Manchester. There is also a growing East European migrant population that appears to enjoy smoking. It seems the figures don’t discriminate between locals and incomers. For all I know the local born smokers could be trending towards the national average.

Smoking while pregnant poses a higher risk of serious health problems to the unborn child, including low birth weight, pre-term birth, placental complications and even still-birth.

Presumably Blackpool health bosses have strong evidence to support this higher risk claim of serious anti and post natal health problems due to women smoking during pregnancy. Stronger than the weasel word poses that is. Let’s see the statistics of birth complications linked directly to smoking. Blackpool, with nearly a third of pregnant women sucking on cancer sticks, should be bursting at the seams with neo-natal victims and smoking induced maternity misery. It isn’t.

Nationally, the average rate of women who admitted smoking during pregnancy during 2011/12 was 13 per cent.

[Insert sound of gramophone needle being clumsily and noisily removed from record track]

What about the women who didn’t admit to smoking whilst pregnant? Having seen how women like Stacey Solomon suffer public demonisation by the Witchfinders General anti-smoking puritans for indulging in a habit that is legal, how many pregnant women are willing to admit they smoke? The average rate of women who admit to smoking during pregnancy, in a nation where the government and media actively collude to discriminate against smokers, is only as good as the honesty of the women who were polled. Unless of course we are to believe that pregnant women are somehow incapable of lying to protect themselves from the baying, finger-pointing, Cromwellian masses.

Fran Frankland, lead for reducing tobacco use in pregnancy with NHS Blackpool, said measures had been taken to try to tackle the problem.

Fran Frankland’s time would be better spent reducing drug abuse during pregnancy which is a far greater concern in Blackpool than lighting up a fag.

Blackpool, which has high levels of deprivation, has a high rate of smokers across the general population.

Obviously not so deprived they can’t afford to smoke…

She said a new scheme started in October which saw midwives trained to screen women for carbon monoxide – a poisonous gas in cigarette smoke, which takes the place of oxygen in the blood and causes damage to the body.

There is a national shortage of midwives in the NHS which is said to be at crisis point yet their precious time can be co-opted to assuage the demands of the anti-smoking lobby?

She said: “If they test positive, they are automatically referred to our specialist stop smoking service for support.

If they test positive? So they are wasting vital resources testing non-smokers then?

They can opt out of this at any time of course, but the door is always left open for them to come back at any time.

But can they opt out of the initial screening if they don’t want it? Once a smoker’s guilty secret is out how hard are they pressured into taking up this optional specialist service? Are they supplied with a pamphlet stuffed with tactically ambiguous ifs, coulds and mights so that they can make up their own minds?

They are given information on the risks of smoking during pregnancy, so if a woman does choose to opt out, it’s not because she doesn’t know or isn’t aware of the issues. It’s for some other reason.

That other reason being – mind your own damned business? People are sick and tired of being lectured and harangued by self-righteous busybodies. Are you even listening Fran Frankland?

This has been really useful for us to identify women who are smoking.

So they don’t take a woman’s word for it unless it comes disguised as the national average. Does this mean the test on Blackpool women is involuntary? Who the hell do these people think they are?

We don’t have a specialist midwife here in Blackpool purely for women who smoke during pregnancy, because of the large numbers, but we do have a specialist stop smoking clinic.

Does any hospital have a midwife purely for women who smoke during pregnancy? And why does Blackpool need a “specialist” stop smoking clinic? One that seemingly approves the implementation of involuntary medical procedures on pregnant women to justify what? Jobs for the girls and boys? At what cost? And on who’s say so? What ever happened to the much cheaper GP’s advice to not smoke during pregnancy and let the patient make up her own mind?

I think sometimes for some women, it’s a bit like the chances of winning the Lottery – they just don’t think it will happen to them.

What won’t happen to them? Giving birth to an underweight or premature baby? Because it never happens to non-smoking mothers? Ever?

It’s trying to help them understand it may not have happened to their mum, or in their previous pregnancy, but it could still happen.

Of course it could still happen. It can happen to anyone- smoker and non-smoker. So the point being made here is…?

It costs more than £10,000 to deliver what is termed as a complicated birth – in women who smoke during pregnancy, the placenta can be broken down, causing birth complications.

More weasel words. So let’s see the figures on difficult births. How many can be directly attributed to smoking?

As the rate of women smoking in pregnancy has dropped by 3.5 per cent – that’s roughly a decrease of 48 women – there has been a potential saving of close to £500,000.

So how much extra did the remaining 96.5% of smokers cost in real terms? Since only the potential saving was quoted I’m going to hazard a guess and say the actual additional cost of whelping a smoker in Blackpool is close to a big fat zero. If it was otherwise the health officials wouldn’t be scraping the bottom of the reality barrel in order to brag about apocryphal savings.

Ms Frankland added: “That’s without the emotional cost of babies having to be rushed off into neo-natal care.

Maybe Ms Frankland should refrain from adding the emotional cost of alarmism to the stress of pregnancy in order to justify her salary.

“The work we’ve been doing is starting to have an effect so hopefully it will now grow.”

The numbers of women smoking during pregnancy has fallen dramatically over several decades. However, Ms Frankland feels duty bound to justify the expansion of her “specialist” service. I prefer to call it rent seeking.

Dr Arif Rajpura, director of public health, added: “We have been working very hard on this for several years now.

“It is very gratifying to see the downward trend as this means far more babies get a healthy start in life.”

Having a statistic that is more than double the (questionable) national average is something to be gratified about, I can see that now. As for more babies getting a healthy start in life – says who? There are no end of strapping lads and lasses born into families who smoke. There are sick children born into families who do not smoke, drink or abuse drugs. Are the lifestyles of non-smokers blamed for their afflicted newborns? Or is it that filthy smokers offend the senses of the puritans and must be punished and vilified at every level of society? The most reviled of all being the consenting adult female who indulges a certain legal habit during pregnancy.

The days of trust me, I’m a doctor are long gone because the profession has lost all credibility through empty alarmism and sanctimonious nannyism. So let’s see the evidence, medical profession. Crusading rhetoric isn’t proof. Neither is spinning non-existant potential savings. I sure hope doctors and other clinical staff are not advocating the non-consensual testing of pregnant women for CO at the behest of government sponsored pressure groups even if it’s for the perceived own good of patients. Health fascism and political correctness have no place in medicine. The NHS exists to try and heal people, not to crush freedom of choice beneath its dictatorial heel. So please do stop singing your imperious, we-know-best song because people, whether you like it or not, are not the sheep you want them to be.

22 Comments

  1. I was born in 1951. My mum smoked 20 a day throughout her pregnancy with me, as she did with my two brothers. And she had a drink every day as well. We three brothers are all fit as fiddles for our ages, and in that we are between 6 foot and six foot six, have clearly not been shrunk by Mum’s smoking.

    As you were…

  2. There IS strong evidence of links between smoking and a range of complications during pregnancy – low birth weight being one. Note that is birth weight, not adult height/weight. Low birth weight causes all sorts of other further complications in childhood.

    Birth weight is generally lower in ‘deprived’ families anyway – low income, poor housing, poor environment, even poor education all seem to be expressed in this way. In many cases the mechanism is unclear, but for smoking it is well understood.

    Pregnant women who smoke and drink heavily are not just exercising personal choice – they are inflicting their choices onto their unborn child. I’m not suggesting women should be forbidden to smoke or drink while pregnant, but it isn’t unreasonable to take steps to make sure they know the implications and to offer support in stopping. This IS a health issue.

    Even so there are always exceptions and variations – this is the nature of the human species. That aside perhaps your rather hysterical post would be better directed at the crap that passes for local journalism.

  3. Lynne says:

    Ian, the Blackpool initiative does not discriminate between light, moderate or heavy smokers. Or even non-smokers judging by what has been said. While I am aware that heavy smoking can cause complications you have said yourself that there are other contributing factors involved. Where is the initiative to combat these? Drug abuse (which is rife in Blackpool) and poor or little nutrition are far greater threats to the unborn child than smoking a pack a day.

    Besides, you have missed the point of the post – testing for carboxyhaemoglobin in pregnant women is an invasive procedure. They appear to be testing everyone. That’s 71% of pregnant Blackpool non-smokers subjected to what amounts to be a lie test by syringe. If this takes off across the UK and the national statistics are to be believed, that figure rises to 87% unnecessarily tested. Or are you advocating that involuntary, mass medical screening, whether warranted or not, should be the norm? This is a rather nasty aspect of nanny statism.

    Am I hysterical? No, just bloody angry!

  4. Mac the knife says:

    What pervades my mind when I read this stuff is a sort of sense of surreal amazement.

    The medical profession has spent four-hundred years, give or take, making themselves possibly the most exalted of professions in the world. Yet they have abandoned hard medicine, science and objectivity in favour of epidemiological trickery; and blinkered predjudice.

    Empathy and understanding of simple human fallibility are still there, but diminishing daily.

    How can it be that people of supposed high intelligence. with a vital reputation to protect have found themselves in bed with professional lie factories like ASH and CRUK?

    Unless some sanity is restored at the top of the BMA, this once great profession may find that they sat down to sup with a spoon that was way, way too short.

  5. JuliaM says:

    Bravo! Excellent post!

  6. JuliaM says:

    “I’m not suggesting women should be forbidden to smoke or drink while pregnant, but it isn’t unreasonable to take steps to make sure they know the implications…”

    I don’t smoke myself, but I know what the packets look like. They are plastered with all sorts of dire health warnings, doctor’s surgeries and NHS clinics are festooned with educational posters, as Lynne points out, The Solomon Affair made all the papers…

    Just how much more information could they need?

  7. NickM says:

    “How can it be that people of supposed high intelligence.”

    I have lived with medical students.

    This is practically verbatim…

    (You have to appreciate A was a final year medical student and that his slang of choice for penis was “chopper”). E was another medical student.

    A: “It was so sad today going round the wards and seeing all those sick choppers!”

    E: “But you were on gynaecology rotation!”

    A – last heard from -A is a urologist, E is a gynaecologist.

    Gawd bless the NHS!

  8. Pregnant women are no different to anyone else – any treatment, blood test or other intervention requires prior consent. Hell, when I was in hospital a couple of weeks ago putting on a blood pressure cuff required my explicit consent – even at 2 bloody AM!

    I don’t know how levels of carboxyhaemoglobin are tested for. I’m guessing (based on this: http://clinicalevidence.bmj.com/x/systematic-review/2103/overview.html) that it is via a blood test, in which case it isn’t especially invasive. Blood tests are a standard part of clinical management in many conditions. Blood and urine tests are pretty much ubiquitous in pregnancy with any risk of complications. Adding a test for carboxyhaemoglobin to the others already being carried out isn’t physically invasive, but may still be invasive if you think that each and every test on the blood sample needs separate and distinct consent. (I don’t)

    As for education, just because a packet says, even in a variety of ways that smoking is harmful, that doesn’t mean that each and every possible effect is made known or assimilated. Provision of accurate information is not intrusive or invasive.

  9. Mac the knife says:

    Thanks Nick, I’m still in the clutches of these fucks… :)

  10. Roue le Jour says:

    First class fisking.

    “I don’t smoke myself, but I know what the packets look like.”

    Given choice between the ones that say “Smoking makes your willie drop off” and the ones that say “Smoking makes your baby drop out” I always choose the later to be on the safe side. ;)

  11. Lynne says:

    Ian, while smoking during pregnancy has been statistically linked to underweight babies the majority of women who smoke produce normal sized babies. It is the heavy smokers whose babies are most at risk. However, smoking heavily during pregnancy still only runs an increased risk of below average weight, it’s not a guarantee. While Blackpool may indeed be the smoking mother-to-be capital of the UK, the difficult births are not greater than the national average and do not reflect the alarmism in the Gazette article.

    What’s in operation in Blackpool is the precautionary principle. It’s a once size fits all screening. It is not a good use of resources and a positive result for carboxyhaemoglobin isn’t proof that the woman is a smoker.
    Blackpool Victoria Hospital, where the maternity unit is based, already has a thriving and successful stop smoking clinic. Some of the larger GP practices also run weekly stop smoking clinics. The “special” clinic mentioned in the post is only special because it caters for a select kind of patient. The advice given out is exactly the same advice any stop smoking clinic would dispense. It is surplus to requirements and it looks like women are being tested to justify this duplication of effort because pregnant women are a “special” cause.

    This is rent seeking. It is sucking funding away from front line services in the name of political correctness. And I don’t know about you but I’ve been pregnant and I would object to being tested for something I don’t do. You are poked, prodded and have the piss regularly taken as it is.

    Parts of Blackpool are deprived. However, a lot of it isn’t. Then you have the surrounding, mostly affluent Fylde area to take into consideration. Living in a deprived area, especially in low grade private accommodation, runs the risk of CO poisoning from faulty gas boilers. If the leak is small then it would masquerade itself as levels of CO expected from smoking. There are diseases that increase CO in the bloodstream. Yet the pregnant woman would be referred to the oh so special stop smoking clinic.

    This stinks of the anti-smoking lobby. Smoking during pregnancy, as I said in my opening sentence, is controversial. It is also an emotional, high visibility cause which just happens to require a “special” service all of its own even though there is adequate provision already in place to support people who want to quit smoking. Maybe it’s just me but I don’t want to be needlessly screened, at an indefensible cost, to support this BS.

  12. Andrew Duffin says:

    You are trying to defend the indefensible.

    Smoking has had its day, thank goodness.

  13. Lynne says:

    Andrew Duffin, what is it you think I am trying to defend? Smoking? I’m a non-smoker.

    Yes, smoking has had its day and that is a major point of my post. The vast majority of pregnant women do not smoke so why are they being screened for it? Or do you think that it’s money well spent on a redundant process? Is protesting the unnecessary duplication of effort and the waste of money and resources in the name of political correctness indefensible?

    Over to you…

  14. NickM says:

    Smoking has had it’s day but not with me, alas. But yeah Lynne did a majestic fisking and I still tab it. And, as I read it, Lynne’s point is, this is a terrible imposition on non-smokers.

    Lynne. You got the highest praise from Julia. That was fisking with the finest knife. That was X-acto fisking. And you got praise from the Fiskmeiestegeneral. Cool!

  15. Lynne – I understand your point a lot better now and while I’m not sure I agree with you 100% you have a strong case. I’ve obviously never been pregnant, but without going into too much detail, I’ve been a father four times and only have one living child, so issues around pregnancy and the health of the unborn child still loom large, even after 30+ years. And if you think the normal poking and prodding is bad, try being part of a medical research programme!

    You are right about the risk from gas heaters and boilers. The halflife of carboxyhaemoglobin (lets call it CHG!) is I think about 6 hours, so a poorly maintained boiler could easily produce levels consistent with smoking. I would have hoped however that if high levels of CHG turn up and the women says she isn’t a smoker that someone somewhere follows through to identify the cause, rather than just calling them a liar.

  16. Thinking about it there are two factors at work here.

    One is the growing return to the Victorian idea of a ‘deserving’ and an ‘undeserving’ poor. We see it all the time in the use of terms like chav etc. There is a lot of popular support for this and unscrupulous people, not always politicians, can build quite large empires out of exploiting it. That may be a factor at work in Blackpool.

    The other is the general growth in the intrusiveness of the state, largely on the back of the security theatre after the WTC attack, but also moral panics over crime, behaviour of young people and alleged child molesters.

  17. Lynne says:

    Ian, I’m so sorry to hear that you lost three of your children. I can’t even imagine the grief and suffering you and your family have endured. It’s something I hope to God I never have to experience.

  18. NickM says:

    ian,
    Sorry to hear about that.

  19. Long time ago now. I’m not trying for sympathy, just putting things in context – in my case why I probably look at matters to do with pregnancy and childbirth with more intensity than most males.

    Lynne – you accept that there is an increased risk in pregnancy from smoking. It isn’t though a straight line relationship with levels of smoking that means that sometimes those who smoke less are at significantly increased risk. Given that there is a real medical issue I see nothing wrong with trying to address it. There are real benefits from working in a given locality too since epidemiological studies show geographical patterns to non-infectious illnesses. However the factors at work behind a geographical concentration of higher levels of smoking also correlate with other respiratory illnesses and with poor housing conditions eg poorly maintained gas boilers, dampness, overcrowding etc as well.

    The problem, as here, is therefore how these problems are tackled. The journalist says that high levels of CHG lead to an automatic referral to an anti-smoking clinic. That, if true, is far too simplistic. It treats a symptom as if it was a cause. Not unusual in medicine of course since doctors tend only to see people as collections of symptoms, and rarely in their social and economic context.

    The difficult thing for libertarians like you and for people like me who don’t accept that label but still think the state is too intrusive, is that the small state/non-state response to complex problems like these is difficult to set out in a convincing way. Much more common is an appeal to utopianism or to the conspiracy theories so common on libertarian sites. In the end though the large state response is equally unconvincing – look at the shambles of the Blair years ‘New Deal for Communities’ and in a different context the Thatcher ‘Enterprise Zones’. For an explanation just google on ‘wicked problems’.

    I don’t know the answer – the closest I have come is the strap line on my blog – ‘building a new society within the shell of the old one’ (the slogan of the old Wobblies) and the approach advocated by the late and much missed Colin Ward.

  20. John says:

    The day when each blood sample was laboured over by teams of pathologists to produce the results is long gone.
    Machines do the testing now.
    Faster, better and multiple results from miniscule samples.
    Besides, carbon monoxide is a pretty standard pollutant in this society, it may well be that the blood pollution may come from a leaking car exhaust or even a badly installed/maintained gas heater.

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