If you smoke, then just say "no" to pregnancy

Thomas Secrest's picture
Smoking causes fetal harm
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Smoking while pregnant is child abuse. Try as I might, I can’t find a flaw with that damning statement; and if there is no flaw, then we have to either rethink pregnancy or we have to rethink child abuse.

I first wrote about this topic in June 2013. As I continued to research this topic, I have noticed a pattern concerning women who smoke. At first I was a bit surprised by my observations, however, after giving it some thought it was fairly obvious and predictable.

Because of all the information regarding the dangers of smoking, western countries often associate smoking with countries with lower standards of education. For this reason many people might predict that smoking among women should be rampant in poorer countries. However, poorer countries very often have cultural or religious taboos against smoking by women. So it turns out that smoking by women in poor countries is not nearly as common as you might expect.

Instead, smoking among women is more common in countries without the taboos. With the highest rates being in Russia, Central and Eastern Europe, China, Australia, Southeast Asia, Canada, United States and Europe. The lowest rates are in Africa, India, Pakistan, Turkey, the Middle East, and Spain.

This would suggest that it is not always the lack of information or education, since Europe, Canada and the U.S. are not normally considered to be uneducated populations, despite the social diversity.

In a May 2013 article in the Journal of Advanced Nursing, researchers looked at a group of women who began their pregnancy while smoking and continued smoking. The study involved primarily women living in the U.S.

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The researchers found that the women recognized the dangers of smoking while pregnant, but felt that they derived benefits from smoking for which there was no substitute. The researchers found that the women were also often in difficult life situations. “Smoking was described as a central and defining part of life for these women. Women spoke of beginning to smoke early in life and relying on smoking during times of stress to provide a sense of control in an out-of-control existence. Smoking was a habituated response to a variety of stressors, including abusive partners, financial stress, and demands of young children. Women perceived that smoking had benefits, defining it as a source of enjoyment and a behavior ingrained in their social lives.”

It was clear that the women understood the dangers. “Women voiced feelings of guilt and experiences of strong social disapproval. Many attempted to hide their pregnancy to continue smoking; when that was no longer an option, women resorted to hiding their smoking behavior.”

Researchers reported that the pregnancy itself created conditions that reduced chances that a women would stop smoking. “Women who continued to smoke pointed to the same factors that induced them to begin smoking, including a life of stress and disadvantage. Pregnancy did not resolve those issues; rather, it exacerbated them. Continuing to smoke allowed them to maintain their "normal" and cope using a comforting and familiar strategy. Women described a need to balance the health needs of their unborn infant with competing forces, such as care of other children. One woman said that quitting smoking would lead her to "take it out" on her other children.”

I regret that so many societies still turn a blind eye to the addictiveness of cigarettes. Big tobacco companies have tremendous power and influence on all governments, both big and small. The power and influence has lead, in my opinion, to lukewarm campaigns to reduced smoking in the U.S. and in around the world. As a result there will always be a pool of people who will lead lives of addiction.

It is tempting to tell the women who smoke during pregnancy to “STOP.” However, tobacco is much too addictive and pregnancy is much too stressful for these women. Instead I am going to suggest something a bit more radical, but much easier to do.

I would say, if you are a smoker, then don’t get pregnant. Pregnancies are optional in today’s world and a woman cannot argue that she must become pregnant, especially in the countries like the U.S. and Canada. A woman must eat, sleep, drink and for this particular subset of women, smoke. However, they do not have to become pregnant.

Coming back to my original thought; smoking during a pregnancy is child abuse. I still can’t find a way around it. The damage to the fetus can be measured in increased hemoglobin, increased hematocrit and increased red blood cell counts compared to fetuses of mothers who did not smoke. These increases are fetal responses to hypoxia. Smoking while pregnant has been linked to spontaneous abortions, lower birth weights, increases the risk of sudden infant death, negative impacts on intellectual development and an increased risk that the child will become a smoker in the future.

From a practical point view, campaigns to convince women to stop smoking before becoming pregnant are likely a waste of time and money. If these women could stop smoking they would have done so long ago. Instead we need a new campaigns that drives home a simple message: If you want to smoke fine! If you want to be pregnant fine! However, doing both at the same time is child abuse!

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