Smoking and Your Pregnancy

Pregnancy is a wonderful time to quit smoking. Approximately 30% of women will stop smoking when pregnancy is confirmed, and more will quit later. However, studies indicate that approximately 25% will continue to smoke throughout the pregnancy. For a pregnant woman, smoking is strongly associated with numerous problems, such as bleeding and spontaneous miscarriage, low birth weight babies, premature labor, stillbirth, SIDS (Sudden Infant Death Syndrome), and the increased risk that the child will become a smoker.

Most smokers state they would like to quit but continue for reasons such as "I always go back to smoking"; "It’s too late to quit"; or "I don’t know how to begin." Most successful "quitters" report having to quit once, twice, or even three or four times before they eventually quit for good.

If you think about it, this makes sense. Imagine a ten-year, pack-a-day smoker who automatically lights up after meals, on the phone, during meetings, during a break, before bedtime, etc. The habit is so entrenched in everyday behavior that the person trying to quit has to consciously say "NO!" sixty or more times a day. This constant reminder of "quitting" along with a few withdrawal symptoms soon wears the person down. On top of that, smoking has a powerful built-in "reward system" to continue smoking, which makes it difficult to quit. Over time a smoker "learns" that a slow, deep inhale will generally calm down and relax the smoker; whereas quick, short, multiple inhales will lift and energize the smoker. It has been said that a cigarette is the only known drug whose effects (calm versus stimulation) are determined by the user. It should also be noted that the desired effect on the central nervous system occurs within seven seconds because one puff is equivalent to a 0.1 mg injection of intravenous nicotine.

Why should you quit now?

The following facts may help you make this important decision.

1. Cigarette smoke contains over 2,500 chemicals, but three major elements —carbon monoxide, nicotine and cadmium— will drastically slow down the growth of the developing baby. Smoke contains a high concentration of carbon monoxide, the lethal gas emitted from an automobile’s exhaust pipe. The red blood cells in the blood whose task is to carry oxygen to the baby (and of course to the mother) will ignore the oxygen in the bloodstream and will instead form a very strong bond with the carbon monoxide. This decrease of oxygen can retard the baby’s growth.

Studies have shown that mothers who smoke during pregnancy are three and a half to four times as likely to have a low weight baby. The average birth- weight of babies of smokers is approximately 200 grams less than babies of nonsmokers.

The good news is that mothers who stop by the fourth month of pregnancy have babies with a birth weight comparable to those babies of women who never smoked. In addition, early labor decreases by 26%! Mothers who quit after the 16th week but before the 30th week of pregnancy have babies with a higher birthweight than the babies of those who continue to smoke but lower than the babies of nonsmokers.

Nicotine, a potent and highly addictive drug, speeds up the nervous systems of both mother and baby causing the heart to beat faster and blood vessels to tighten up. This decreases the amount of oxygen and nutrients to the baby. Cadmium blocks the action of an important element, zinc. Low levels of zinc are associated with growth retardation and consequently low birth- weight.

2. Breast-feeding mothers who smoke produce about 30% less milk than nonsmokers, which can contribute to a baby’s slower weight gain. Also, nicotine is concentrated in breast milk and can excite the baby, promoting intestinal colic/crying and sleep problems.

3. Babies exposed to passive smoke during pregnancy and after birth are at greater risk for low birth-weight, SIDS, and increased middle ear and upper respiratory infections.

4. About 90% of quitters don’t use a formal program or therapist. However, many of these quitters probably learned helpful pointers from previous attempts. After an ex-smoker has quit for one year, the risk factor for heart disease is halved and after 15 years risk factors for all other smoking-related disorders are almost the same as the person who has never smoked.

5. Many pregnant quitters and their partners tend to be more successful than the general population because having a baby is a major life event and motivation is understandably quite high. Within six months, 75% of quitters relapse, and 3% relapse after six months. However, this suggests a pregnant woman who abstains from cigarettes for the nine months of pregnancy, has a greater chance of remaining a nonsmoker. In fact, one-third will quit permanently.

What can you do today to become a NONSMOKER?

Week One (Getting Ready to Quit):

• Wrap a piece of paper around a pack of cigarettes and record every cigarette you smoke for a week. Include the number of the cigarette, time, place and your mood/reason. Use these tally sheets to determine your personal "triggers" and plan to cope with these temptations.

• Smoke a brand of cigarettes that contains between 40-60% less nicotine than your normal brand.

• Collect cigarette butts in a transparent glass "butt jar" with a lid. Place this jar where you can see it when you go to sleep and get up. If temptation strikes, open the lid, add a little water and "sniff".

• Begin to act as a nonsmoker. Select non-smoking areas in restaurants and hotels.

• Choose a location at home and work that’s considered a "smoking zone". This area should be an inconvenient location such as the garage or outside.

• Store your cigarettes in an inconvenient location, such as in the attic, garage, storage shed or mail box if you live in an apartment. At work, "hide" your cigarettes in some inaccessible place like the back of the filing cabinet, or ask a supportive nonsmoker to hold them.

• Don’t buy cartons. Purchase only one pack at a time, even if that means an inconvenient trip to the store at night.

• Start an exercise plan. Exercise for 20-30 minutes every other day. Include a five-minute warm-up, 15-20 minutes of exercise, and a five-minute cool down. Maintain a heart rate of 140 beats per minute or less and keep your body temperature less than 101ºF. Brisk walking is one of the best aerobic exercises to help decrease tension and cravings.

• Practice slow, deep breathing through the nose and out through pursed lips (like a kiss) three to five repetitions, three to five times a day.

• Aim to quit by the 16th week of pregnancy, but no later than the 30th week.

Week Two (Q-Day)

• Unless contraindicated by your doctor, drink six to eight (8-ounce) glasses of water-based drinks per day. It’s a good idea to plan to drink one 8-ounce drink every hour or two while awake. Water, milk, and juice are appropriate choices; avoid caffeinated beverages. Make a point to finish every meal with a glass of water. Eat carbohydrates to minimize withdrawal irritability. These include: all fresh fruits and vegetables (especially with the skins or seeds) such as tomatoes, strawberries, grapes, cucumbers, green peppers, broccoli, beans, peas, nuts, seeds, pasta, rice, potatoes, noodles, whole grain breads and cereals.

• Discard all smoking paraphernalia in your home, office and car. Clean the car to eliminate residual smoke odor, a possible future smoking trigger.

• Temporarily avoid sitting in a favorite smoking chair or place.

• If you have trouble sleeping at night, drink a glass of milk or eat two ounces of cheddar cheese. These have tryptophan, a natural substance that promotes a state of calmness.

Week Three Plus (Miscellaneous)

• Cravings usually peak in the first 24 hours and taper over the next seven days. They are usually weaker in the morning and more difficult to manage in the evening, probably due to fatigue. You may or may not experience strong urges to smoke, but you must remember cravings will fade away in three to five minutes. Don’t give in. They will go away whether you do smoke, or you don’t. When an urge strikes, take five slow, deep breaths, and drink a full glass of water. If possible, leave the scene of the craving.

• Hypnosis is one of many tools used in cigarette cessation. Many folks think it’s a type of mind control, but it’s really just a way of tapping into your inner-self. When a person is just about to drift into sleep and upon first awakening, a person is quite receptive to auto suggestions. First take a few minutes to become relaxed. Take three deep breaths in through your nose, as deep into your lungs as possible, pause, and slowly blow out every bit of air you can, through your lips like a kiss. As you take these deep breaths, give yourself "suggestions" to breathe in clean air; slowly breathe out tension and all the other things your body no longer needs. Another suggestion to yourself is "that my body no longer needs or wants cigarettes or tobacco in any form and that my body will let me know that."

• Consult your doctor about the possibility of a Nicotine patch. There is controversy regarding their use in pregnancy because the baby is exposed to the heart-stimulating effects of nicotine, but not to the carbon monoxide, cadmium and all the other chemicals.

Editorial provided by Christine Meyer, RN, MSN, FACCE at Pittsburgh’s Ohio Valley General Hospital School of Nursing in Pennsylvania.