Perinatal smoking: a struggle to intensify

The fight against perinatal smoking should be intensified, despite the many efforts to improve the management made especially during antenatal, warned midwife tobaccologist CH Bayonne, while reporting the results of a survey in 2003 377 public maternity.

A questionnaire was sent out in late 2003 midwives frames 377 public maternity listed on the website of the Ministry of Health, addressing three themes:

1 / the care of pregnant patients who smoke during pregnancy in the service, to learn about the organization of the consultation cessation practitioner and what it was made;

2 / resumption of smoking in the postpartum period, to assess the valuation services by periods and the frequency of relapses;

3 / relapse prevention after childbirth.

"We received 214 responses of 377, of which 211 are interpreted, including 45% of maternity Level 1 60% Level 2 and 50% Level 3," said the midwife.

Only 20.4% of respondents maternity held specific consultations cessation within their service. "Maternity Level 3 to have nearly half of them (43%) created a specific consultation, against respectively 19% and 14% for levels 1 and 2. This seems logical given the fact that maternity Level 3 are supposed to concentrate the most serious diseases and certainly more aware of the risks of maternal smoking, "noted the health professional.

79.6% in the consultation is not available, 70.6% of patients are referred to a smoking cessation center.

"It is clear from the survey that individual consultations (62.8%) are preferred over group meetings, as well as the method of cognitive behavioral therapy (74.4% of establishments, while 53.5% use drug withdrawal only), "says the midwife CH Bayonne.

The responses show, moreover, that these consultations are for smoking cessation 62.8% under the responsibility of midwives and 41.9% by non Obstetricians tobaccologists doctors. The number of consultations averaged 4 or 5, regardless of the level of motherhood. Consultation time is between 10 and 30 minutes for 37.2% of maternity and becomes greater than 30 minutes for 39.5% of them.

RECOVERY OF SMOKING POSTPARTUM

Only 40.8% of schools responded to the question about the existence of relapse "which proves the ignorance or the lack of interest the problem of post-natal smoking," said the midwife.

Among the responses, 46.5% observed a relapse from the puerperium, 30.2% think it occurs only after two months and 8.1% at 6 months. "We do not see a year follow-up of patients and no statistics on the rate of relapse was provided by maternity hospitals," said the professional.

Consultation on smoking cessation postpartum, few maternity (49 of 211) responded to this question. Where it exists, it is individual for 86%. The length of the longest follow-up was 2 months and corresponds to the date of compulsory postnatal visit: 32% of consultations are conducted by midwives and 60% by tobaccologists doctors inverse proportion to the antenatal period. In addition, a very significant percentage of obstetrician-gynecologists (2%) is involved in this period.

INFORMATION ON PASSIVE SMOKING

In this survey, 74.7% of maternity inform on the risks of passive smoking. "This information is usually provided in the immediate aftermath of layers (79.7%), another special moment corresponding to the meetings of the birth preparation (24%). A written document is used by 21.51% institutions. However, this subject is addressed in the mandatory post-natal consultation in 16.45% of the answers, "said the midwife CH Bayonne.

Information on passive smoking is broadcast in 88.6% of cases by midwives in 33.5% of cases by the nursery, in 30.9% of cases by pediatricians and 25.9% of case by obstetricians.

Finally, of the 211 responses received, 117 or 55.5% have maternity maternity project without tobacco.

"The relatively high response rate for a survey of this kind shows the interest in the problem of the management of smoking pregnant women by health professionals that we are. Recent years have witnessed significant progress in the field of prevention with the creation of a maternity network without tobacco. Nevertheless, too little effort has been made postnatally despite the collective awareness of the harm caused by passive smoking for infants " says the midwife.

According to her, it now remains a need to better inform women about the risks of continued smoking during and after pregnancy, as well as strategies to help stop smoking, as well, to better train caregivers at minimal advice and thus engage in a policy of prevention service.