Addressing health challenges in our region – smoking in pregnancy

Last week I had the pleasure of meeting with colleagues at the Durham Centre to explore one of the most topical issues in health care to date. Smoking. More specifically smoking in pregnancy.

As a part of the Yale System Leadership Programme cohort for 2018/19, one of our objectives is to create a piece of work that addresses a specific challenge for our Integrated Care System stretching across both the south and central Integrated Care Partnerships for the region.

For us, we felt strongly that smoking in pregnancy was an ongoing issue across our region that we would like to impact with positive change. No easy task we appreciate – but as leaders for major public bodies across our area, we certainly have a responsibility to try to get to the root cause.

This project is a part of our development programme, but as a group we are committed to going beyond the end of our time with Yale to fully explore the challenge.

There are some startling statistics that exist. Around 65,000 babies are born to mothers who smoke every year. The national average of women who will smoke throughout gestation is around 10%. For the north east, that figure almost doubles to a heady 17% of soon-to-be-mothers who will continue with tobacco intake during pregnancy.

By 2025 the aim is that this statistic will reduce to just 5%. An ambitious target, but one we must all commit to supporting to ensure positive birthing outcomes.

So, in short our project journey started with…

1.The Problem

Too many women in the North East smoke in pregnancy.

  1. The Objective

To reduce the number of women who smoke in pregnancy.

…where we ended wasn’t quite where we started in our first session. Our direction changed exploring the root cause analysis. Our discussions became ‘why are so many women in the north east smoking at time of delivery?’.

From cultural to communication issues, addiction through to availability the reasons offered by delegates in the room were vast and daunting. The statistics continued to underpin the narrative and discussion. Maternal smoking doubles the likelihood of stillbirth, chance of miscarriage can be up to 32% more likely and children born of smoking mothers have a 50% higher chance of having a heart defect.

As a group we journeyed through the myths, the psychological and physiological reasoning and beyond, our lightbulb moment arrived about two hours into our explorative discussions.

As health practitioners, local authorities and beyond our approach to smoking in pregnancy is steeped in a language that doesn’t address the root cause. Smoking is an addiction. Tobacco is a drug. Individuals become dependent.

Our primary conclusions surrounding the issue were directly linked to communication. Who is communicating? How are we communicating? When are we communicating?

This issue belongs to all who support the pregnancy journey, we need to encourage ownership across the whole system. From the very first discussion with the newly pregnant mother, asking about and discussing nicotine as an addiction to identifying pathways to support getting clean, becoming smoke free.

Our rhetoric must change. This is the beginning of our exploration surrounding smoking in pregnancy and we are under no illusion that it will be fixed with any speed. There is a cultural shift that must happen within all of our services to even begin to evolve the process. We look forward to keeping you up-to-date with our challenges as a group…

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