Giving Up Smoking in Pregnancy

Giving Up hummer in Pregnancywellness PromotionSMOKINGGiving up Smoking in Pregnancy Introduction The object of this assignment is to critically judge a wellness packaging endeavor related to midwifery practice. The beginning(a) chosenIntroductionThe object of this assignment is to critically appraise a wellness promotion initiative related to midwifery practice. The initiative chosen is a NHS Health Scotland brochure entitled Smoking tolerant up during maternalism a guide for big(predicate) women who want to throw in locoweed (NHS Health Scotland 2003). It leave alone be referred to as the initiative or the folder through with(predicate) tabu this assignment.The World Health Organisation (WHO) identified that wellness promotion was a way of equipping people to have more position enabling them to make choices in regard to improving their well-being (WHO 1986). Ewles and Simnett (2003) look out from this, that the fundamental elements of wellness promotion are improvi ng wellness and empowerment. The sparing Office paper Towards a healthy Scotland (1999) recommended making more health promotion operational for big(predicate) smokers.This appraisal will systematically freshen up the literature relating it to the health promotion initiative chosen using Ewles and Simnett (2003) quintet Approaches to Health Promotion work. It will furthermore evaluate the midwifes role in promoting the issue highlighted and conclude with a summary and any proposals to improve prospective practice.Critical AppraisalThe Scottish Office paper Towards a Healthier Scotland (Scottish Office 1999) recommends reducing the numbers of women fume during pregnancy from 29% to 20% in the next 5 years. According to the Health Education laterality (1999) the rate for g progress in pregnancy in the UK was 30% and nearly 90% classified hummer as dangerous to their unhatched child. Johnston et al (2003) point out that pot is the main preventable dumb strand of disease and disability in the fetus and newborn. Around 13 000 individuals run from fume in Scotland each year (NHS Health Scotland and ash Scotland 2004a). This initiative is based on the normative charters concept as it is influenced by expert opinion and government policies (Ewles and Simnett 2003). Epidemiological evidence in its prefer allows the initiative to be evaluated by reduction in the mortality and morbidness (Naidoo and Wills 2000). This is cost effective because the initial resources for implementing the smoking cessation will be significantly less than the cost of hospitalisation later in keep (NHS Health Scotland and ASH Scotland 2003).The cusp that will be critiqued (appendix 1) is aimed at pregnant women who currently smoke only who want to lend oneself up. It is split into vanadium sections titled pregnancy and smoking halt smoking tips for interceptping stopping smoking is worth it and meaning about your smoking.The Ewles and Simnett (2003) model comprise s of five get downes to health promotion medical progress conduct switch over advancement educational start out client-centred procession and societal change betterment. The behavior change approach is the main focus for this initiative, although it does utilise aspects of all approaches.The demeanor change approach as described by Ewles and Simnett (2003) is a way of encouraging changes in an individuals attitudes and beliefs to take up a healthier lifestyle. It is, however experienceed by some, to be more forceful depending on the degree of cost improver and persuasion use ( craftsman 1997, Norton 1998).The behaviour change approach uses a number of models to guide health promoters to avail clients to achieve a positive outcome. The Stages of Change Model (Prochaska and DiClemente 1984 as cited by Ewles and Simnett 2003) is a five format cyclical model that has been found to be particularly useful in work with addictive behaviours (Naidoo and Wills 2000).This hertz incorporates a pre-contemplation stage where the individual is unaware of any need for change or has no interest in changing (Ewles and Simnett 2003). At this stage the midwife would assess whether the muliebrityhood is genuinely not evoke in stopping smoking at present and respect this decision entirely inform her she will be asked throughout her pregnancy about her smoking status (Crafter 1997, Dunkley 2000). The leaflet may cool off be issued as having the data readily at hand may prompt the individual to think about stopping smoking. The advantages of leaflets mean they allow individuals to read through them at their own pace (Ewles and Simnett 2003).The second stage is the contemplation stage where the individual is motivated to consider changing their behaviour, maybe she reads the leaflet and adjudicates to seek instruction (Naidoo and Wills 2000). The role of the midwife at this stage would be to determine why the woman smokes and what barriers she may face in sto pping smoking (Dunkley 2000). The leaflet facilitates this by allowing the woman to heading why she smokes and how she feels about it. It as well seeks to raise what the woman feels is good and bad about smoking and how she anticipates changing her behaviour towards smoking. It has been suggested (McLeod et al 2003) that some midwives find it difficult to broach the subject of smoking particularly with women who have no desire to stop and those who are still considering stopping. However McLeod et al (2003) found from their qualitative study that women expected to be asked about smoking during routine antenatal grapple and indeed they matte it was part of the midwives role to ask.The preparation stage is where the woman is committed to giving up smoking. She may seek extra help oneself and is likely to attempt change soon (Dunkley 2000). If the woman is in this planning stage she may benefit from smoking cessation services, which the midwife can offer much(prenominal) as Smok eline, or other local services. Within the leaflet is a allay phone number for Smokeline (HEBS 2003) who offer advice and issue the booklet train to Stop Smoking (HEBS and Action on Smoking and Health Scotland 2001). This back up information helps the woman to discover what she can do to help herself to stop smoking. NHS Health Scotland and ASH Scotland (2004b) challenge the reliability of answers to questions Midwives and other health promoters may be asking individuals with regard to their interest in stopping smoking as that individual may feel that agreeing is what is expected. Hesitancy in respond may be indicative of reluctance to commit to stopping at present, so ensuring they understand that there are many options available in the future can enhance the chance of them stopping (NHS Health Scotland and ASH Scotland 2004b).The midwife would continue to support the individual during this time offering advice and encouragement (Crafter 1997) and also would remind the uncomp laining of the importance of social support from partners and friends (NHS Health Scotland and ASH Scotland 2004b). The findings from a study by McLeod et al (2003) assent with the need to have partner involvement. They found that although the women were supported by the midwives there was a failing in educating the partners to the womens needs while trying to stop smoking (McLeod et al 2003). Moreover Thompson et al (2004) would like to see this expanded out with the antenatal setting. This issue has been addressed in part by the initiative, which encourages the woman to seek partner involvement to support her at this time (HEBS 2003).The penult stage is the making the change stage this is when the woman is taking work on (Naidoo and Wills 2000). NHS Lothian (2002) supports making a date to stop and sticking to it. One of the options is nicotine surrogate therapy (NRT), which has caused debates over its place in smoking cessation during pregnancy (Dunkley 2000, McNeill et al 20 01). McNeill et al (2001) found that using NRT, although not recommended in pregnancy, could be beneficial, as all the pollutants from actual cigarettes would not be verbaliseed to the mother or the fetus.The terminal stage is the maintenance stage. It is vital that the midwife maintains good support through the postnatal period as Pollock (2003) found that 60% of women who urinate up during pregnancy restart smoking inwardly 1 calendar month of birth. Encouragement from the midwife to eat a sensible a feed (Crafter 1997) and use diversionary tactics like regular brushing of odontiasis and saving cigarette money up for treats (NHS Lothian) helps the woman to stay stopped. The leaflet in its favour mentions how other smokers managed to stop and what they have done to help themselves. In this final stage there is room for relapse or slipping. The leaflet lets individuals know it is ok to relapse but encourages them to learn from this. It also mentions some of the side effects th at women may experience from nicotine withdrawal.The medical approach to health promotion aims to ensure individuals are disease and disability free (Ewles and Simnett 2003). This approach could be viewed as paternalistic, where professionals decide what is best for an individual (Crafter 1997) and as pregnancy is not a state of ill health (Dunkley 2000) it hires into question its validity in midwifery care. However women could jeopardise the health of themselves and their unborn child if they are convolute in risk taking behaviour such(prenominal) as smoking during pregnancy. The initiative mentions some of the health risks involved such as miscarriage and low birth weight babies (HEBS 2003) but favourably does not go into detail to avoid victim-blaming. Within the medical approach such initiatives as General Practitioners or other health professionals advocating smoking cessation during consultations is found to be more useful than no mention at all (HEBS 1998) resulting in appr oximately 2% of smokers stopping long term. Recommendation 1.2 of the Smoking Cessation Guidelines for Scotland (NHS Health Scotland and ASH Scotland 2004a) states that a midwife should ascertain a patients smoking status and discourage them from smoking at the earliest opportunity. The midwife should also offer support and manipulation to aid cessation (NHS Health Scotland and ASH Scotland 2004a). Crafter (1997) identifies the need for midwives to lend unbiased information, however justifies the obligation to educate women about damaging behaviour such as smoking during pregnancy. Facts specific to smoking in pregnancy are not included in the leaflet such as smoking in the first 3 months of pregnancy accounts for a empennage of low birth weight babies (Scottish Executive 2001).An educational approach to health promotion is giving individuals information to discover the health benefits or detriments for themselves (Ewles and Simnett 2003). Crafter (1997) argues that there can be no true educational approach when it comes to smoking in pregnancy because midwives would be unable to remain deaf(p) due to the fact that evidence is available that clearly shows smoking is detrimental. Naidoo and Wills (2000) apologize that the educational approach differs from the behaviour change model, as the educational model does not use encouragement to achieve its aims. NHS Health Scotland and ASH Scotland (2004b) concur with this view advocating that it is not the role of the midwife to persuade but to inform. They go on to defend the use of facts in conjunction with the leaflet. The National make for for Clinical Excellence (2003) also emphasise the need for women to be aware of the risks, which can make a purely educational approach unachievable in relation to smoking cessation. The information could be available to patient who enquire about if for them to discover the advantages and disadvantages for themselves with the midwife advising them of where to find resourc es. In a study by Pullon et al (2003) it showed how suitable resources helped educate women to stop smoking. critically however it appeared that the midwives concerned were involved in a more behavioural change role as then conclusion commented on the midwives sizable influence (Pullon et al 2003).The client-centred approach facilitates health promotion of things that the client feels will be of benefit (Ewles and Simnett 2003), this could mean that an individual may not consider that smoking cessation is an issue they want to address and as such the topic may neer be discussed. This model is said to facilitate autonomy (Dunkley 2000) but as such the leaflet may never be looked. If however the client felt that smoking cessation was something she was interested in, the midwife would be able to offer any help that was available to her to empower the woman to achieve her objective (Crafter 1997).The societal change approach focuses on changing the whole society not just individuals w ithin it (Ewles and Simnett 2003). Implementation of changes at community level or above looks to bring about changes to the attitudes and beliefs about smoking during pregnancy to the population. This would include laws such as that to be introduced in spring 2006 banning anybody smoking in enclose public spaces in Scotland (Scottish Executive 2004). The majority of pregnant smokers are age 16-24 and low socio-economic groups highlighting the important fact that deprivation and inequality increase the incidences of smoking and of teen pregnancy (Lazenbatt et al 2000, NHS Health Scotland and ASH Scotland 2003). refinementMidwives play an important role in promoting the health and wellbeing of individuals and their families and lecture of health education (Scottish Executive 2001). The initiative appeared to have some weaknesses as a stand-alone leaflet, however as part of a multi-dimensional approach it emerged favourably.The midwife must endeavour to gain trust and support to del iver the required service and promote empowerment (Dunkley 2000). She must take care not to alienate the women that require her help. There must be a trusting relationship built up between the midwife and the woman to achieve a positive outcome.Approximately 20% of smoking mums give up during pregnancy and of them over 50% who gave up attributed it to being pregnant (HEA 1999) this indicates further that women want to stop and indeed manage successfully to stop smoking.