Should smoking during pregnancy be reportable?

[kedhegard]

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[Quijotemd]

I think that's a bit far reaching. Sure, everyone wants women to take care of their pregnancies as best as possible, but the suggestions you propose just aren't needed. My sister in law has had three pregnancies, all without problems, and she smoked about 1/2 pack a day in each of them. She told me her OBG actually recommended not quitting during at least one of the pregnancies. He said that the stress of quitting might in itself be detrimental to the fetus. Whether this is true or not, I don't know. Once her kids were born, she continued to smoke, but only outside the home.

I don't like it either, but in my OBG rotation I remember on several occasions the crack-head moms who come in with third trimester bleeding, cramps, and a resulting abruption. This kind of behavior is far worse, don't you think?

I think the best we can do here is counsel and suggest, but not force.

 

[kedhegard]

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[mustangsally65]

Hmm. Interesting thread.
My mom smoked from the time she was 13 and her dad gave her a cigarette to try (thinking she'd get sick and hate it) until december 2002, when I was 21. She smoked during her five pregnancies, and all the time when my siblings and I were growing up.

I could not have a more caring and loving mom. She has always sacrificed everything for her kids, and I have never feared being abused, not having enough to eat, or a warm place to live.

I had a low birthweight when I was born, and have asthma and allergies and some other chronic ailments, but I don't blame that on my mom. My siblings are perfectly healthy for the most part. They were of a normal birthweight. Also, my dad is a Vietnam Veteran, and was exposed to Agent Orange and probably a bunch of other chemicals for the two years he was in Vietnam. some might say that he shouldn't have had children, but did he choose to be exposed to those chemicals? Of course not.

I think it's a toss up. People smoked for years and years when it was socially acceptable and the risks were not taken seriously. Most of them made it into adulthood, and I think today the bigger concerns are other drugs that are used.

Perhaps women who have babies who are harmed by smoking have actually been harmed from something else, that the mother isn't telling the doctor she used. The history of the patient comes from the patient for the most part, and she can lie about a lot of stuff if she wants to.

I just don't think that smoking is as bad for babies as many people make it out to be. Of course, I don't advocate it, and I've never smoked myself. Most women these days are aware of the risk, and try to quit before pregnancy. But who's to say the environmental pollutants aren't the cause of many problems that are attributed to smoking? How many kids whose parents didn't ever smoke around them have asthma, or other problems? I think there's more in the mix than just secondhand smoke.

 

[Quijotemd]

kedhegard,

I didn't "fall for that" with regard to whether or not my sister in law smokes in the home or not. My brother is vehemently against her smoking inside, so I know she doesn't. And as for abruption, maybe most can be stopped but my point was that something like crack has obvious immediate effects on the fetus when compared with smoking.

I think your tone is a bit reactionary. If you pay attention to what I've written all I said is that I agree with you--smoking is bad. Mothers shouldn't smoke while pregnant or after their pregnancy. But I don't think we should have the government come seize their children once the cord is cut.

Balance, my friend. Balance.

 

[DrBuzzLightYear]

Yes, smoking crack is bad, you don't need me to tell you that. Smoking tobacco is an equal wrong, however. It doesn't matter what the consequences are, wrong is wrong. Stealing five dollars from my friend or stealing 1000 dollars from a bank are both equally wrong, one just hurts the other person more. They are the same "sin", if you will.

i agree with Quijotemd, you're a very odd person and seriously need to calm down and gain some perspective.

 

[kedhegard]

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[Brain]

I personally am disgusted at women who refuse to quit smoking during pregnancy. I have run into several, and though I'm just an inexperienced med student, I find it outrageous that more is not done to actively dissuade these women from smoking.

I personally feel that refusal to quit smoking during pregnancy qualifies as child abuse, and that the women ought to be held more accountable for exposing their unborn children to such a risk factor. True, it is not as toxic as some other things (drugs, alcohol, etc.), but it is harmful. Furthermore, if the women are willing to actively harm their fetus in utero, think of the kind of atmosphere that child will likely be raised in. I feel that the ultimate solution is to actively threaten forced separation on childbirth, follow through for non-compliance, and to allow adoption by more suitable parents.

Any opinions?

First off, there are many things that can endanger a fetus. Why restrict it to just smoking? Suppose a pregnant woman is seen jaywalking. Should she be thrown in jail and forced to be separated from her child once it is born for putting herself and thus the fetus in danger? What if she doesn't eat a nutritious diet or take prenatal vitamins? What if she's taking antidepressants or other legal medications that can endanger the fetus? A woman does not lose her rights when she becomes pregnant. What you are proposing is a severe danger to the rights of women and families.

Let's hypothetically say that you get your way. You won't stop pregnant women from smoking or participating in other harmful behaviors. What you will eliminate is patient honesty with their physicians thereby eliminating the opportunity for physicians to council patients who wish to quit but need a little help in the process. People with your mentality are much more dangerous to maternal/child health than cigarette smoking will ever be.

 

[lexrageorge]

You need a reality check, fast. For one, many patients will do things that you disagree with. They will do things that are FAR worse than smoking, believe me. But, it is still your responsibility to treat them, like it or not.

Second, last I checked, smoking is LEGAL. There is no way you can compare smoking tobacco to smoking crack.

Third, many babies born to smokers are perfectly normal and healthy. Tragically, there are babies born to non-smokers who have serious complications. While your textbooks do explain that smoking during pregnancy is a risk factor for complications, it is just that: one factor among many.

Fourth, many smokers would like to stop, but find it extremely difficult to do so. Never mind trying to quit while experiencing the heightened anxiety of a pregnancy.

Get over yourself. Not everyone is going to lead the perfect lifestyle. I am sure your lifestyle is not 100% healthy either. I say this not as a reflection of your lifestyle, but the fact that we cannot define with 100% certainty a perfectly lifestyle.

 

[kedhegard]

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[lexrageorge]

Ok, you guys got all the non-logic out?

Jaywalking? No. Throwing yourself in front of a moving car (a proven risk...like smoking)? Yes.

Drinking alcohol is legal. Crack is legal on the moon. That doesn't make it right for pregnant women to do, though. Nobody's asking these women to go out of their way. When I explain to them the dangers of smoking and ask them to stop, and do this repeatedly until they deliver, and they continue to smoke, these women are deliberately and intentionally putting their children at risk for birth defects. Still want to defend their "rights"?

How much do you know, lexrageorge, about what smoking crack and smoking cigarettes does to babies? I would encourage you to do some reading before you tell me there's "no way" to compare the two. See the Brown U. report from 2003, for one.

Batter up! Who's next?

I will continue to defend their rights. Your job is to inform your patients of the risk, not play judge and jury. BTW, noone goes to the moon anymore, so your statement that crack is legal there is just plain stupid. Crack is ILLEGAL, period.

You will need to quote a lot more than one flawed academic study to convince me that crack and tobacco are the same.

 

[DrBuzzLightYear]

Batter up! Who's next?

please post your match list as soon as possible so i'll know which programs to avoid.

 

[JohnnyOU]

Ok, you guys got all the non-logic out?

Jaywalking? No. Throwing yourself in front of a moving car (a proven risk...like smoking)? Yes.

Drinking alcohol is legal. Crack is legal on the moon. That doesn't make it right for pregnant women to do, though. Nobody's asking these women to go out of their way. When I explain to them the dangers of smoking and ask them to stop, and do this repeatedly until they deliver, and they continue to smoke, these women are deliberately and intentionally putting their children at risk for birth defects. Still want to defend their "rights"?

How much do you know, lexrageorge, about what smoking crack and smoking cigarettes does to babies? I would encourage you to do some reading before you tell me there's "no way" to compare the two. See the Brown U. report from 2003, for one.

Batter up! Who's next?

Ahhhh...the wonderful world of future nazi-docs!

I guess some people want to be served and obeyed by their patients....as opposed to that old fashioned "serving the patient" stuff.

Some folks reek of god-complex....sad.

 

[racecarj]

Whoa! Chill down ho!

 

[Lucinda]

Football is more my game, sorry if I don't "batter up!"
Here's a thought from the can of worms opened...
What about formula feeding? Should mothers who formula feed be reported? Research has clearly shown breastfeeding is superior on a number of levels - brain development, immunity, lower DM rates, etc - to formula feeding. Yet a majority of infants, at the discretion of their mothers, are formula fed (75%+ at 6 months of age). Like giving up cigarettes, breastfeeding is HARD work, takes a great amount of personal pain, sacrifice and committment on behalf of the mother.

Of course we'll all encourage the mothers in our care to cut down or quit smoking, just as we'll encourage them to exercise, eat a balanced diet and yes, breastfeed. The patient ultimately decides her and her child's fate.

 

[jetproppilot]

Ahhhh...the wonderful world of future nazi-docs!

I guess some people want to be served and obeyed by their patients....as opposed to that old fashioned "serving the patient" stuff.

Some folks reek of god-complex....sad.

I agree. Just browsing through....think I'll go back to the anesthesia forum. Sounds like dude/dudette has some projection issues.

 

[DrBuzzLightYear]

I agree. Just browsing through....think I'll go back to the anesthesia forum. Sounds like dude/dudette has some projection issues.

hah! i am vindicated!

 

[tkim]

Outlaw jackhammers!

 

[4mykids]

Just a little thought, I have two children... 6 years old and 1 1/2 years old. With my oldest I smoked 3/4 pack a day, and with my youngest I did not smoke at all.

My oldest has skipped kindergarten so far, and is reaching to skip third grade. He is healthy as a horse, been sick 3 times in his life with just a little cold.

On the other hand, my daughter who I did not smoke while pregnant has severe allergies/asthma and has a very low immune system. She is still smart, but is a sickly little thing (about every other week with something).

Just a few REAL experiences for you to think about.

 

[DrBuzzLightYear]

Just a little thought, I have two children... 6 years old and 1 1/2 years old. With my oldest I smoked 3/4 pack a day, and with my youngest I did not smoke at all.

My oldest has skipped kindergarten so far, and is reaching to skip third grade. He is healthy as a horse, been sick 3 times in his life with just a little cold.

On the other hand, my daughter who I did not smoke while pregnant has severe allergies/asthma and has a very low immune system. She is still smart, but is a sickly little thing (about every other week with something).

Just a few REAL experiences for you to think about.

yeah! my ma smoked the crack whiles she was wit child wit me an ize a much better thinker den my utter brudders. ize a gunna be a baby-doctor mah self one day!

 

[ambernikel]

I think that's a bit far reaching. Sure, everyone wants women to take care of their pregnancies as best as possible, but the suggestions you propose just aren't needed. My sister in law has had three pregnancies, all without problems, and she smoked about 1/2 pack a day in each of them. She told me her OBG actually recommended not quitting during at least one of the pregnancies. He said that the stress of quitting might in itself be detrimental to the fetus. Whether this is true or not, I don't know. Once her kids were born, she continued to smoke, but only outside the home.

I don't like it either, but in my OBG rotation I remember on several occasions the crack-head moms who come in with third trimester bleeding, cramps, and a resulting abruption. This kind of behavior is far worse, don't you think?

I think the best we can do here is counsel and suggest, but not force.

My friend was also recommended to not quit if the stress of quitting was high. Instead she cut down to about 2-3 cig. a day. We think, I would never... but some people deal with things differently than others. She beat herself up about it all the time but she just couldn't quit. It's hard to understand addiction.
I don't at all recommend smoking during pregnancy, but there are worst things that can be done. I think some anti-depressants are worse but like anything else you have to weigh the risks vs. benefits.
This all just coming from a pre-med of course! (I did a summer internship in the NICU).

 

[mamadoc]

A question for the OP:

What are you going to do with all these babies you seize?

One can definitely assert that prenatal smoking costs some number of health care dollars in premature deliveries, low birth weight infants, childhood asthma, etc. etc. There's undoubtedly any number of studies adding it up, but I don't feel like looking for them right now.

I also don't feel like looking for the estimate of what it costs to support a baby in foster care for a week, a month, or a year.... but ya know what, I bet the cost to society would be MANY multiples of the costs of prenatal smoking. After all, you're advocating that the government do it, and we all know that government projects cost a lot of money.

And let's not even start on the social cost of having a child taken away from its mother and raised in what countless studies have shown is likely to be a substantially inferior environment. A poor mother who smokes, and loves her baby, is almost always going to be better than a succession of paid, middle-class, non-smoking surrogate "mothers" doing foster care. Have you ever heard of attachment??

Yours is hardly an anarchical position, as you claim. Instead you want to control EVERYthing.

I sure hope you've got a lot of medical school to go - you've got a lot to learn. You are in for some big surprises if you think that patients are going to take orders from you and do what you say. A lot of 'em will agree with you to your face but they are going to just go on and do whatever.

And I hope that somewhere along the line you find out more about just how very difficult it is to quit smoking. Surely somewhere in your life there's someone who smokes; if you can knock off the judgmental crap for a bit, you might want to ask them how many times they've quit or tried to quit, how they feel about continuing to smoke. Quitting is HARD.

As long as I'm at it, I would like to respectfully point out to the many posters with personal experience (e.g. "My mom smoked and I turned out fine") that "the plural of anecdote is not data." (thanks to whoever has that in his/her .sig, can't remember who they are to give credit) All kinds of individual good and bad stories can be told about virtually any sort of healthy or unhealthy activity. Doesn't prove a thing, really, and is just kind of silly in this sort of argument IMHO.

 

[DrBuzzLightYear]

strong work mamadoc!

 

[lexrageorge]

As long as I'm at it, I would like to respectfully point out to the many posters with personal experience (e.g. "My mom smoked and I turned out fine") that "the plural of anecdote is not data." (thanks to whoever has that in his/her .sig, can't remember who they are to give credit) All kinds of individual good and bad stories can be told about virtually any sort of healthy or unhealthy activity. Doesn't prove a thing, really, and is just kind of silly in this sort of argument IMHO.

Mamadoc, great post. But I did want to respond to your comments regarding the use of anecdotes.

First, I think we can all agree that the OP lies somewhere between a complete idiot and a patent *****. Who knows, he/she may have been a troll, and we've just been feeding all along.

Second, I was trying to point out to the OP that smoking is a risk factor, but it is simply one factor among many. There are probably many other risk factors that we do not yet understand. Yes, some risk factors are more serious than others. Clearly, regular use of crack is far more risky to the unborn child than smoking a handful of cigarettes in a day.

Third, relying on a small handful of studies is poor medicine. Many studies are flawed, or end up measuring the affects of a different risk factor than intended. In other cases, a study's results are sensationalized and interpreted to be far more significant than they really are.

While it is true that the "plural of anecdote is not data", it is just as true that the "plural of data is not knowledge".

 

[jetproppilot]

Third, relying on a small handful of studies is poor medicine. Many studies are flawed, or end up measuring the affects of a different risk factor than intended. In other cases, a study's results are sensationalized and interpreted to be far more significant than they really are.

While it is true that the "plural of anecdote is not data", it is just as true that the "plural of data is not knowledge".

Somebody should frame this.

Many, many "anecdotes" are practiced in the private world long before the academic "experts" publish studies that prove what alotta clinicians outside the academic setting already knew.

Don't overlook anecdotal information. Thats where most ideas start.

 

[fermina]

i would also add there is an important political aspect to this problem. to arrest a pregnant woman for doing anything harmful to her fetus is essentially treating the fetus as a fully formed human with full rights. since we haven't overturned roe v wade yet, clearly we don't ascribe fetuses full rights.

by the way, since the dangers of secondhand smoke are well known to us and thus public smoking has been banned in many states -- so would we also arrest smoking daddies?

 

[TY06]

we had an ethics lab in ms1 on this very topic.
its so hard to tell.
what if the mother drinks coffee, eats hotdogs, doesnt take folic acid, eats junk food, stresses out, etc? (just examples...i dont know if hotdogs are bad for pregnant women). will you arrest her or send her to rehab?
what about the father?
etc etc. its hard to draw a line. does the mother lose her rights when shes pregnant?

 

[Beau Geste]

Football is more my game, sorry if I don't "batter up!"
Here's a thought from the can of worms opened...
What about formula feeding? Should mothers who formula feed be reported? Research has clearly shown breastfeeding is superior on a number of levels - brain development, immunity, lower DM rates, etc - to formula feeding. Yet a majority of infants, at the discretion of their mothers, are formula fed (75%+ at 6 months of age). Like giving up cigarettes, breastfeeding is HARD work, takes a great amount of personal pain, sacrifice and committment on behalf of the mother.

Of course we'll all encourage the mothers in our care to cut down or quit smoking, just as we'll encourage them to exercise, eat a balanced diet and yes, breastfeed. The patient ultimately decides her and her child's fate.

This is a bad argument - some women can't breastfeed at all. For example, what if the mother previous had mastectomies or just didn't secrete milk?

I absolutely abhor seeing pregnant women smoking. It's one thing to smoke and not know you're pregnant and another to know you are pregnant and continue to do it.

To me, that does consititute knowing you are potentially harming your unborn baby. Sure, not every person who smokes is going to have a child with problems, but you don't know for sure until they are born.

Mothers should do everything to protect their babies, including not smoking or drinking. But, there is the valid point that stopping smoking would have serious physiological and psychological effects on the mother that would translate to the baby.

I'm just glad I'm not a smoker, and not much of a drinker to have to worry about it.

In the end, as a physician, as long as smoking is legal, all you can do is tell the mother and/or father over and over again what the risk factors are.

The poster who said you are not the judge, jury and executioner is correct.

 

[Danger Man]

Thank you all for the great thread. Thank heavens!!! Issues such as these remind me of why I did not even consider OB/GYN.

Perhaps, the politically correct, nonjudgemental approach is to address the issue of women smoking during pregnancy by saying something like 'Studies have shown that smoking is certainly not good for your health or for the health of your baby. Many babies without complications are born to women who smoked during pregnancy (takes care of the anecdotal medicine arguments) but the chances of having complications (LBW, etc.) are increased as a result of smoking.' That way you have informed the mother (-to-be) of the risks that she and her baby (I mean, fetus) are incurring and allowing her to choose what path she is going to follow.

You folks are to be commended for fighting an uphill battle.

As for anecdotal medicine....oh boy, if we listened to every "My grandfather smoked 47 packs of cigarettes a day for 37 years and he doesn't have lung cancer!" stories we would still have questions about the health effects of tobacco. Medical research has value and properly conducted studies with sound statistical analyses do indeed affect the practice of medicine.

 

[Poety]

I personally am disgusted at women who refuse to quit smoking during pregnancy. I have run into several, and though I'm just an inexperienced med student, I find it outrageous that more is not done to actively dissuade these women from smoking.

I personally feel that refusal to quit smoking during pregnancy qualifies as child abuse, and that the women ought to be held more accountable for exposing their unborn children to such a risk factor. True, it is not as toxic as some other things (drugs, alcohol, etc.), but it is harmful. Furthermore, if the women are willing to actively harm their fetus in utero, think of the kind of atmosphere that child will likely be raised in. I feel that the ultimate solution is to actively threaten forced separation on childbirth, follow through for non-compliance, and to allow adoption by more suitable parents.

Any opinions?

What are your thoughts on abortion? Just curious. What if the mom who smokes finds out she has a baby with a congenital defect, should she go to jail if she chooses to abort - since it COULD have been from the cigarettes, or maybe not....?

And what about the women that drink... should they go to jail too? What if their baby is born with FAS? Afterall, don't studies show that for some women/pregnancies it takes a minimal exposure while others may require more or don't get affected at all?

Why would you think adopting out a child from its natural mother is actually better than a smoking mother? Thats a really interesting theory - wow, I can't even imagine telling a child "You were taken from your mommy because she smoked cigarettes" Doesn't that sound the slightest bit absurd to you? You could also extend this to "We took you from your mommy because she drank 2 glasses of wine throughout her whole pregnancy and you got FAS"

Ridiculous. Your kind scares me.... a lot.