Contemporary Midwifery Perspective on Smoking During Pregnancy

This article discusses the impacts of smoking during pregnancy from a contemporary midwifery perspective. It explores the principles of midwifery practice and focuses on one standard of practice related to a case scenario. The role of a student midwife in educating and supporting pregnant women in making informed decisions about smoking is also discussed.

Running head: LETTER
Letter to the Editor
Name of the Student
Name of the University
Author Note

1LETTER
Dated: 30 April, 2019.
The Editor,
XXXXX,
XXXXXXXXXX.
Subject: Contemporary midwifery perspective on smoking during pregnancy.
Sir/Madam,
Smoking tobacco at the time of pregnancy has been identified to create significant
negative impacts on the reproduction and health of the women, in addition to the general
effects that are exerted by tobacco. Ideally, women are not advised to smoke at, during, or
after their gestation period. In addition, active smokers are also encouraged to reduce their
daily cigarette consumption, with the aim of minimising the risks that are caused to the
children and their mothers. This letter is being written to you in order to draw attention to the
impacts of smoking during pregnancy. In addition, the letter will also elaborate on the
principles of midwifery practice, followed by elaboration on one standard of practice, in
relation to a case scenario.
There is mounting evidence for the fact that the profession of midwifery has the
principle objective of being ‘with women’, and also places an explicit focus on maximising
the outcomes related to reproductive health of the patients. Time and again it has been found
that oppression and gender inequality are persistent features of human societies and cultures,
and exist all across the world. In addition, these aspects also get reflected in the reproductive
health amid women, with unsatisfactorily increased rates of maternal mortality in low- and
middle-income countries (Pairman & McAra-Couper, 2015). This is in clear contrast to the
high rates of interventions in high-income countries. The midwifery profession deals with
childbirth, pregnancy, and post-partum period, together with caring for the new born infants.
In other words, there lies a clear difference between the medical profession of midwifery and
allied medical specialities. It has been established that most females should be provided the
provision of accessing midwifery-led models of care (ICM, 2014). In addition, women must
also be encouraged in order to seek help from the care models, while placing due caution on
application of the advice, in relation to considerable obstetric or medical complications
(Moloney & Gair, 2015). The basic principle of midwifery is based on the fact that the
process of childbearing is a profound experience and it carries noteworthy meaning to the

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pregnant women, the community, and their family members. Furthermore, according to
Yanti, Claramita, Emilia and Hakimi (2015) the philosophy also considers birth as a normal
physiological procedure and regards midwives as most suitable and competent care providers
who have necessary skills and expertise of attending and proving care to women who are at
low risk, during their pregnancy, labour period, delivery, and postnatal period. It is a well-
known fact that midwifery profession has the capability of empowering women in order to
undertake responsibility for own health, and that of their family members. The profession
most often involves fostering partnership with females and encompasses a continuous,
personalized, and non-authoritarian care approach (Tierney, Sweet, Houston & Ebert, 2017).
It has often been found that healthcare professionals who implement an authoritarian care
regimen, increase fear among the patients, and subsequently result in non-compliance to the
proposed treatment plan. In contrast, the midwifery profession comprises of delivery of care
in a manner that is holistic in nature, and is based on an understanding of the physical,
emotional, psychological, spiritual, social, and cultural experiences of females. The
philosophy of midwifery is also based upon utilisation of best available evidences. The
profession of midwifery is in practice for several centuries, and has characteristics and
features that have progressed contrarily, according to regional, cultural, social, and local
knowledge and traditions (ICM, 2014). In addition, it has also been found that continuity care
models that are led by midwives, are often associated with decrease in the usage of epidural
anaesthesia, lesser number of episiotomies, reduction in instrumental births, and an increase
in breastfeeding and the rates of spontaneous vaginal births (Sandall, Soltani, Gates, Shennan
& Devane, 2016). Females also display a reduced likelihood of experiencing preterm birth on
being subjected to appropriate midwifery care practices.
The Nursing and Midwifery Board of Australia (NMBA) has accurately defined
midwives as competent, educated, and authorised individuals for providing effective and safe
delivery of quality care services that directly promotes the health and wellbeing during birth,
pregnancy, postnatal time, and parenting transition. The board has formulated seven
standards of practice that are namely, (i) promotes wellbeing and health through
implementation of evidence-based midwifery practice, (ii) fostering engagement in
professional relations and respectful partnerships, (iii) demonstrating the competence and
answerability for midwifery practice, (iv) undertaking thorough and comprehensive health
assessments, (v) formulating plans for midwifery practice, (vi) delivering quality and safety
in midwifery practice, and (vii) evaluating the outcomes for improving midwifery practice

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(NMBA, 2018). These principles are related to the contemporary philosophy of the
profession owing to the fact that midwifery-related continuity of care is bestow the midwives
with the accountability and responsibility for delivering incessant care to all childbearing
women, besides fostering a multidisciplinary system of discussion and recommendation with
allied health care providers. Of the aforementioned standards, standard 1 holds relevance to
the scenario of smoking during pregnancy.
The chosen aspect of care among pregnant women is smoking at the time of
pregnancy. An example of a clinical scenario is that Sarah has been established in labour for
five hours at her home, and upon her arrival at the birth suite, she has been found restless. An
hour later, when the midwife leaves the room, Sarah stated being an active smoker, and
enquired if she can smoke, since it will help in relieving her stress and tension, in relation to
the impending childbirth.
As a student midwife, it is crucial to facilitate her decision making capabilities, such
that the health outcomes for both the pregnant female and the child to be born, is enhanced.
Thus, the primary role of the student midwife would be to educate Sarah on the harmful
impacts that tobacco smoking can exert on her health and wellbeing. In addition, efforts will
also be taken to explain the various adverse events that might arise during the delivery of the
child, if she is allowed to smoke cigarette. The duty of a student midwife also requires
demonstration of skills that are necessary for establishing an environment of cultural safety,
which will directly enhance patient care, and reduce the likelihood of suffering adverse health
outcomes. This can be accredited to the fact that the standard 1 requires midwives to conduct
health assessment and educate the patients for supporting reproductive health and birth (1.3).
Furthermore, they are also accountable for recognising the care strategies that important for
women, and should also include the pregnant women during major clinical decision making
(1.1). In addition, they are also required to support formulation, implementation, and analysis
of health programs and initiatives that are based on current evidences (1.6) (NMBA, 2018).
Furthermore, recommending essential intervention, based on scholarly evidences that prove
the effectiveness of the strategies, will also form a crucial component of the role entitled to
the student midwife.
Owing to the fact that mother wishes to be allowed to smoke, prior to her delivery,
meeting her request for smoking would initiate several health risks. It commonly results in
premature rupture of the amniotic sac that eventually induces labour, prior to the full-term

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development of the child (Rouzaire et al., 2017). In addition, smoking has also been allied
with untimely separation of the placenta from the location of attachment. There is mounting
evidence for the fact that such premature separation often creates significant distress for the
fetus, and might even result in miscarriage (Huuskonen et al., 2016). In addition, considering
the case scenario of significant importance can be accredited to the fact that evidences have
established the presence of an increased probability of premature birth among women who
generally smoke during their pregnancy, in comparison to their non-smoking counterparts
(Ion & Bernal, 2015). Tobacco smoking can also bring about an impairment of the overall
development of the placenta which will result in a substantial reduction in the flow of blood
to the foetus. These circumstances might also result in heavy bleeding throughout the
delivery that might jeopardise health and safety of the mother and the child (Erlingsdottir,
Sigurdsson, Jonsson, Kristjansdottir & Sigurdsson, 2014).
In contrast, not allowing her to smoke before the delivery might make the patient feel
that she is being disrespected. In addition, it would also result in a violation of the ethical
principle of autonomy that focuses on taking into consideration the rights and wishes of the
patients, in relation to making necessary decisions about their clinical care. Owing to the fact
that autonomy allows healthcare providers to provide patient education, but prevents them
from influencing patient decision, not permitting Sarah to smoke would lead to a disruption
of the therapeutic relationship with the patient (Herring, 2014). However, educating her on
the adverse health events that might occur if she smokes even during, and after childbirth
might help her realise the willingness to provide her safe and high quality care services. In
addition, the decision would also have the potential implication of increasing awareness and
knowledge in the patient on smoking and its harmful effects during pregnancy.
To conclude, it can be stated that the profession of midwifery is not merely limited to
the providing direct care services to the patients, but also extends beyond the well-defined
roles, where necessary skills and knowledge require to be implemented, while fostering
relations with the pregnant women. All midwives should take into consideration the harmful
effects that smoking creates on the health of the mother and the child, and must provide care,
within the scope of their practice.

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References
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