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Follow the NMC code including;

1.1 treat people with kindness, respect and compassion

1.3 avoid making assumptions and recognise diversity and individual choice

2.1 work in partnership with people to make sure you deliver care effectively

2.3 encourage and empower people to share decisions about their treatment and care

2.6 recognise when people are anxious or in distress and respond compassionately and politely

3.1 pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages

3.3 act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it

4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment

4.2 make sure that you get properly informed consent and document it before carrying out any action

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Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long‐term implications for women and babies. Smoking in pregnancy is decreasing in high‐income countries, but is strongly associated with poverty and is increasing in low‐ to middle‐income countries.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001055.pub5/full?highlightAbstract=smoke%7Cin%7Cpregnanc%7Csmoking%7Cpregnancy

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A study published in the American Journal of Public Health in 2008 found that smoking during pregnancy was most prevalent among participants which had less than a high school education. There was also a higher prevalence among those who were unmarried compared to married, unemployed compared to employed and had a lower household income.

https://eds-a-ebscohost-com.libezproxy.bournemouth.ac.uk/eds/pdfviewer/pdfviewer?vid=7&sid=838ac353-1be7-41a0-96c7-0719f4680c26%40sdc-v-sessmgr03

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There is not a direct link between quitting smoking during pregnancy and causing increased psychological symptoms. These findings should temper concerns that quitting smoking may have detrimental psychological consequences during pregnancy.
Solomon, L., Higgins, S., Heil, S., Badger, G., Mongeon, J. and Bernstein, I., 2006. Psychological Symptoms Following Smoking Cessation in Pregnant Smokers. Journal of Behavioral Medicine [online], 29 (2), 151-160.

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Passive smoking during pregnancy can be responsible for a baby being born with congenital disorders, intellectual abnormalities, and behavioural problems.
What is Passive Smoking & How Does It Affect Your Pregnancy (firstcry.com)

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Women with less than a high school education were found to be more likely to smoke in pregnancy compared to women who had a higher level of education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253564/

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Smoking during pregnancy is associated with subtly reduced motor competence, particularly on the non-dominant side. Statistically significant effect modification by sex was observed for only one test, providing equivocal evidence of a sex difference .

Larsson, M., Montgomery, S. M., 2010. Maternal smoking during pregnancy and physical control and coordination among offspring. Journal of Epidemiology and Community Health, 65 (12), 1151-1158.

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Smoking and BMI and late fetal death:
The results indicate that reducing the mothers’ and fathers’ smoking habit may prevent some foetal deaths.
This study suggests that smoking may increase the negative effect of a high BMI on foetal death.

Morales-Suárez-Varela, M., Nohr, E.A., Bech, B.H., Wu, C. and Olsen, J., 2016. Smoking, physical exercise, BMI and late foetal death: a study within the Danish National Birth Cohort. European Journal of Epidemiology, 31(10), 999–1009.

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Increase risk of sudden infant death syndrome

Increase risk of baby heart rate

Reduced amount of oxygen going to fetus

https://www.webmd.com/baby/smoking-during-pregnancy#1

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Maternal smoking during pregnancy is associated with violent offenses and persistent offenses, but not with nonviolent offenses, among male offspring in adulthood.

https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.156.6.857

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Role of the midwife
Advise on how to stop, reduce, Advise electronic cigarettes

Increases the risk of heath
Psychological
Psychological
The first pregnancy
Woman with less supp
Woman with less support when

Increases the risk of heath
Psychological
Psychological
The first pregnancy is considered the optimal window to modify
Woman with less supp
Woman with less support when smoking in pregnancy, are at an increased risk of complications in pregnancy and labour.

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome | Human Reproduction | Oxford Academic (oup.com)
Larsson, M., Montgomery, S. M., Maternal smoking during pregnancy and physical control and coordination among offspring. Journal of Epidemiology and Community Health (1979-). 2011;65(12):1151-1158
Larsson, M., Montgomery, S. M., Maternal smoking during pregnancy and physical control and coordination among offspring. Journal of Epidemiology and Community Health (1979-). 2011;65(12):1151-1158

Increases the risk of heath
Psychological
Psychological
The first pregnancy
Woman with less supp
Woman with less support when

Increases the risk of heath
Physical
Physical
Studies have shown a link between maternal smoking and cleft lip

https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm#:~:text=Smoking during pregnancy can cause,maternal smoking and cleft lip.&text=Studies also suggest a relationship between tobacco and miscarriage.
Psychological
Psychological
The first pregnancy is considered the optimal window to modify smoking behaviours.
Smoking is used as a coping mechanism and several barriers prevent women from quitting smoking. These include
Woman with less supp
Woman with less support when smoking in pregnancy, are at an increased risk of complications in pregnancy and labour.

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome | Human Reproduction | Oxford Academic (oup.com)

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Advise on how to stop, reduce, alternatives

Non judgemental approach; guilt isn't always effective

Refer for cessation

Look into triggers aid prompt meaningful conversations

Following the NMC Code, including

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Increases the risk of heath 
Psychological
Psychological
The first pregnancy 
Woman with less supp
Woman with less support when 


Increases the risk of heath 
Psychological
Psychological
The first pregnancy is considered the optimal window to modify 
Woman with less supp
Woman with less support when smoking in pregnancy, are at an increased risk of complications in pregnancy and labour.


Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome | Human Reproduction | Oxford Academic (oup.com)

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Studies have shown a link between maternal smoking and cleft lip

https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm#:~:text=Smoking%20during%20pregnancy%20can%20cause,maternal%20smoking%20and%20cleft%20lip.&text=Studies%20also%20suggest%20a%20relationship%20between%20tobacco%20and%20miscarriage.

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Increases the risk of heath 
Psychological
Psychological
The first pregnancy 
Woman with less supp
Woman with less support when 

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can cause tissue damage on fetus, on the lungs and brain

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The first pregnancy is considered the optimal window to modify smoking behaviours.
Smoking is used as a coping mechanism and several barriers prevent women from quitting smoking. These include low levels of willpower, inability to re-motivate quit and not personalizing smoking  risks. The role of the midwife is therefore to frequently approach the subject of quitting smoking and personalise the risks of smoking.

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Women with less than a high school education were found to be more likely to smoke in pregnancy compared to women who had a higher level of education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253564/

Women can feel a sense of judgement when smoking during pregnancy, this can lead to them smoking in private, which can be a barrier and prevent them from seeking support with stopping smoking.
https://www.sciencedirect.com/science/article/pii/S1871519218306085

Women who are exposed to passive smoking during pregnancy are at a higher risk of premature labour and having a baby with a low birth weight.
Babies born to women who are exposed to passive smoke have a higher risk of SIDS.
https://www.nhs.uk/live-well/quit-smoking/passive-smoking-protect-your-family-and-friends/#:~:text=Pregnant%20women%20exposed%20to%20passive,problems%2C%20asthma%2C%20and%20allergies.

# data[].attributes.body
Woman with less support when smoking in pregnancy, are at an increased risk of complications in pregnancy and labour.

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome | Human Reproduction | Oxford Academic (oup.com)

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Increases the risk of heath problems for developing babies, may cause placenta abruption, preterm birth and low birth weight

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Carbon monoxide crosses across from maternal blood stream to the placenta. This can cause restricted growth to the baby as oxygen stores are low. This can lead to low birth weight. This can also cause a greater risks for miscarriage, ectopic pregnancy, stillbirth, birth defects, bleeding and premature birth.
https://www.tommys.org/pregnancy-information/im-pregnant/smoking-and-pregnancy/effects-smoking-your-baby

https://www.rcog.org.uk/en/patients/patient-leaflets/smoking-and-pregnancy/