Laura-Jane O’Reilly tried to quit smoking when she became pregnant with her first child at 23, but she fought. Raised in a smoking household where both parents and older siblings smoked, she was into the habit by age 12 and — although she tried to quit as a teenager — she was in her freshman year of college and up to 12 cigarettes a day as she knew it became that she was having a baby.
He was instructed by her midwife not to use nicotine replacement products and, through willpower alone, managed to down to three cigarettes a day. But the guilt was constant. “I freak out every time I light up a cigarette just imagining all the pictures on the pack and what I could do to my unborn child,” says the Waterford City mum honestly. “I used to dread my next appointment because I knew the first question would be, ‘Have you resigned yet?’ And I remember getting really upset when I told my partner there was no help and it was just so hard.”
But when Laura-Jane (30) became pregnant for the second time in 2020, the hospital asked a different question. “They said, ‘Do you want to be referred to a program?’ And I said, “Yeah, definitely! 100pc sign me up for anything and everything you’ve got — I’ll take it,” she beams. The Supporting Pregnant Women to Quit and Stay Quit program launched in January 2020 in the Southeast and last month celebrated 100 “smoke-free babies” born to mothers who had successfully quit smoking thanks to the service. Laura-Jane was one of those success stories.
The gap in services for pregnant women who smoke was recognized by Kate Cassidy, a health and wellbeing officer for HSE/South East Community Healthcare Services. With 20 years of experience in health and wellbeing and a previous role as National Tobacco Coordinator, Kate decided to tackle the issue. She secured around €200,000 in Sláintecare funding to run the first two-year pilot phase of the project, which will cover the four maternity hospitals as well as primary care and community services in Counties Carlow, Kilkenny, South Tipperary, Waterford and Wexford.
Since the end of the pilot phase in December 2021, the offer has now been a permanent fixture, where pregnant women, women who want to have children or want to become pregnant and their other relatives can be cared for free of charge and individually by two health advertising officers who will help them to quit smoking.
Laura-Jane O’Reilly with her son Oisín. Photo: Patrick Browne
Laura-Jane O’Reilly with her son Oisín. Photo: Patrick Browne
David Phelan was one of the smoking cessation officers for the first two years of the project. “What we found in common was that pregnant women are very aware of the stigma and negative attitudes associated with smoking during pregnancy,” he explains. “Each of them said when they first came into the clinic, ‘I’m really scared and nervous.’ They all expected to be met with disapproval, to be told that it was really harmful and really bad for you and the baby, but it was the complete opposite of that.”
The risks to infant and maternal health are undisputed. Smoking during pregnancy is one of the most important preventable factors associated with an unfavorable pregnancy outcome. “The biggest consequence of smoking when a woman is pregnant is carbon monoxide,” explains Kate. “Babies are often born prematurely with a low birth rate and can end up in a neonatal unit for weeks.
“But we never use scaremongering,” she reveals. “There is now a massive body of evidence of what works and we know scaremongering doesn’t work. It’s about empowering and supporting people in a compassionate way.”
“Someone who smokes 20 or 30 cigarettes a day knows it’s harmful, but they’ve become addicted to it, and nicotine is one of the most addictive drugs on the planet. You can’t just turn off something you’ve become addicted to overnight,” agrees David.
Instead, the service focuses on working together over a six-week period to set goals, develop coping strategies, and build trust and resilience in a nonjudgmental, supportive environment. After six weeks, customers are still receiving support and check-ins to keep them focused. Carbon monoxide monitors are used to illustrate the effects of smoking and the dangers are addressed, but overall the emphasis is on empowerment rather than simply saying ‘smoking is bad, don’t do it’.
Laura-Jane was nervous accessing the service. “I remember feeling, ‘Oh God, I’m going to be judged,’ but I was already so busy judging myself I couldn’t come back,” she says. “But when I came in, it wasn’t like that at all and I knew right away that I wasn’t going to be let down.”
She found the carbon monoxide aspect of her support sessions particularly beneficial. “It was the first time I’d physically seen the negative effects of my smoking and it hit me right away,” she explains. “You see the pictures on the cigarette packaging, but you keep thinking it’s someone else, not me. If it’s your own results, it’s true.” Buoyed by David’s frequent check-ins, she managed to quit in February 2020 and remains smoke-free to this day.
The statistics of the service are promising. Aside from one baby coming home smoke-free a week, long-term cessation rates are good. “Our four-week cessation rate is consistently 80 percent, while the national average is under 50 percent,” reveals Kate. Research shows that someone who reaches the four-week mark is five times more likely to remain smoke-free forever. Feedback from service users has been overwhelmingly positive, with a Your Voice report showing that 100 percent of respondents felt they were treated with dignity and respect. It is now to be rolled out nationwide.
“The HSE Tobacco Free Ireland Program would very much welcome a dedicated, intensive smoking cessation service across all 19 maternity services nationally,” says Martina Blake, National Lead Tobacco Free Ireland Programme. The provision of routine carbon monoxide testing and opt-out referral to a non-judgmental, supportive and professional smoking cessation service is an important outcome outlined in the recently published Department of Health National Clinical Guidelines for Smoking Cessation.”
However, work still needs to be done to get those who need the service to access it. Out of 1,300 referrals, only 300 people accessed the service and managed to quit. But it’s important to Kate that those who need a free service to help them quit now have someone to turn to. “It’s about improving people who need that extra support,” she says.
“I just think it’s really important for any pregnant woman to know that it’s a 100 percent safe space. You can tell them anything and you will not be judged, they are there to help.”
Laura-Jane believes that if other women in her shoes knew how positive an experience can be, they would access the service more quickly. “I just think it’s really important for any pregnant woman to know that it’s a 100 percent safe space. You can tell them anything and you will not be judged, they are there to help.”
She never looked back. “The closest I got was when I had dreams where I smoke and I wake up and I’m like, ‘Thank God that was a dream!'” laughs Laura-Jane. She is a mother to two healthy boys, Lochlainn (five) and Oisín (20 months) but mother guilt still creeps in for my second child and not my first,” she admits. “But I struggled on my own for so long that it didn’t work until I tried the program. I know I would still be smoking now if it hadn’t been for the service.”
“I’m so happy I did it,” adds Laura-Jane. “The benefits have been tremendous, but the most important thing is the benefit I give my kids by hoping I’ll be there for them for a long time to come.”
Visit quit.ie or call toll free 1800 201 203 for more information
https://www.independent.ie/life/health-wellbeing/health-features/how-to-quit-smoking-i-was-smoking-12-cigarettes-a-day-when-i-found-out-i-was-pregnant-the-guilt-was-constant-41605902.html How to quit smoking: ‘I was smoking 12 cigarettes a day when I found out I was pregnant – the guilt was constant’
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