Smoking while pregnant: Maternal struggle

Twenty-year-old Kendra Bay started smoking when she was 16.

While she said “everyone does it” isn’t an excuse for smoking, it was her reason for starting. But that’s not about to keep her from quitting. Every day her reason to stop smoking grows a little bigger.

Bay is 33 weeks pregnant. She’s due to give birth to her daughter, whom she is naming Emilye, on June 2. Bay has quit smoking for several weeks at a time in the past, but ultimately she keeps turning back to her habit. But this time, with the birth of her daughter, Bay said she has all the motivation she needs. By then, the stress of planning her May 4 wedding will also be over.

“Before I got pregnant I would criticize people for still smoking when they were pregnant, but when it’s you, it’s harder,” Bay said. “... It’s the thing you need to do, but it’s at one of the most stressful times in your life.”

Bay isn’t alone. In Douglas County 24 percent of women smoke during their pregnancy, according to a birth certificate statistics report.

“We have tobacco use that is twice the state average,” said Marilyn Carter, Health Education program manager for the Health Department. The national average is 10 percent. “That’s quite startling.”

The high rate is of particular concern because of the known risks associated with smoking for mom and baby, said Dawnelle Marshall, Public Health Division director for the Health Department.

Doctors and other health professionals have known for decades that smoking among mothers-to-be is associated with lower birth weights, higher infant mortality rates, premature births and an increased risk of Sudden Infant Death Syndrome, Marshall said.

Over the years research has also revealed that smoking during pregnancy can affect children later in life, potentially leading to asthma or other respiratory problems and learning and attention disorders. Also, children exposed to tobacco while in the womb are more than twice as likely to become regular smokers themselves compared to children who were not exposed, according to a Centers for Disease Control and Prevention report.

SMOKING STRUGGLE

As Bay’s belly grows bigger, the urgency of her quitting becomes more apparent, she said. At Bay’s ultrasound a week and a half ago, she saw that the baby inside of her is starting to look more like a little person and less like an alien, she said.

Since then, Bay said she has tried to smoke less and has been at one to two cigarettes a day. At one point during her pregnancy, she smoked as much as half a pack a day.

Bay’s fiance, Adam Fain, recently quit smoking. Bay’s nurse, Shelley Wells — who visits Bay at home as part of the Health Department’s maternity case management program — said she hopes that will encourage Bay to quit as well.

When she stays busy, Bay said she is less likely to smoke. But when her time isn’t occupied or she feels overwhelmed by stress, Bay said she is more likely to light a cigarette.

“I think it’s a mental thing,” she said. “Like saying, ‘I’m stressed. I could just use a cigarette and I’ll be OK.’ It’s like people who say, ‘I’m gonna feel better after a cup of tea, or after my bath.’ It’s a crutch for stress.”

Using smoking as a coping mechanism for stress is common among women who continue to smoke during their pregnancies, said Kirstin Carhart, manager of the Douglas County Prenatal Clinic. Carhart said nurses at the prenatal clinic remind women of the dangers of smoking, the birthing complications they face and the financial strain of buying cigarettes and encourage the women to try and quit.

“Twenty-four percent of mothers smoking is not acceptable,” Carhart said. “And we need to find a way to change that.”

By the numbers ... Smoking & pregnancy • In 2005, 5,643 live infants (12 percent of live births) were born to Oregon mothers who used tobacco during pregnancy. Each of those pregnancies cost an average of $749 more than births to nonsmoking mothers, increasing Oregon’s neonatal health care cost by $4.2 million. • In Douglas County, 24 percent of expecting mothers smoke during pregnancy, compared to 12 percent in the state and 10 percent nationwide. Oregon rates have decreased 30 percent since 1996, but data suggests it is on the rise. • Approximately 13 percent of women reported smoking during the last three months of pregnancy. Of those, 52 percent smoked five or fewer cigarettes per day, 27 percent smoked six to 10 cigarettes per day and 21 percent smoked 11 or more cigarettes per day. • Of the women who smoked three months before pregnancy, 45 percent quit during pregnancy, but 52 percent started smoking again within six months of giving birth. • Babies who are born to women who smoke during pregnancy are about 30 percent more likely to be born prematurely, more likely to be born with low birth weight (less than 5.5 pounds) and are 1.4 to 3 times more likely to die of Sudden Infant Death Syndrome (SIDS).

INCENTIVE TO QUIT

Armed with the staggering statistics, the Douglas County Health Department developed an incentive-based smoking cessation program, modeled after a pilot program used in New York. In late March, Marshall got word that the Health Department was awarded a $10,000 March of Dimes grant to make the project a reality.

The “Baby & Me — Tobacco Free” project will provide 35 to 50 women with gifts if they quit smoking and stay smoke-free postpartum. During pregnancy, enrolled women will attend four classes where they will receive smoking-cessation counseling and will have their cheeks swabbed to test for carbon monoxide, Carter said. Each time a woman is tested and is smoke-free, she will receive a $10 cash gift certificate and will be entered into a drawing for a gift basket.

After giving birth, the women will continue with monthly carbon-monoxide testing for six months. Each time they are smoke-free, they receive a $20 diaper voucher from Wal-Mart, Carter said.

The project is set to begin in May or June and will be offered to women who already utilize various programs available at the Health Department — such as the prenatal clinic, maternity case management and Healthy Start — but still need help quitting.

Department officials hope the project will be successful and can be done again and offered to a broader range of women, Carter said. Given the success rate of the pilot project, officials have reason to be optimistic. The initial project documented that 100 percent of the women enrolled in the program quit while pregnant, and 87 percent remained smoke-free at six months postpartum.

The Health Department also received a $7,000 grant from the Health Care Coalition of Southern Oregon to fund a project aimed at physicians. With the grant money, department officials hope to educate physicians and dentists to provide a brief intervention every time they see a patient who is pregnant or of child-bearing age, Carter said.

The goal is to arm physicians and dentists with tools to encourage women to stop smoking. They will learn how to ask smoking-related questions in a way that encourages patients to open up rather than feel ashamed or embarrassed by their habit. Physicians will also be encouraged to refer their patients to the Oregon Tobacco Quit Line, Carter said.

Health Department officials hope the two projects will help bring the state’s high rate of maternal smokers down to a reasonable level.

“I would love to see zero,” Carhart said. “But I’d take 12 percent at this point, just to be at the state average.”

UNCERTAIN FUTURE

The new projects funded through grants, coupled with the existing programs offered at the Health Department, leave department officials optimistic that their efforts will have a positive impact on lowering the number of expectant smokers, Carhart said.

The women who are considered most at risk of smoking while pregnant — those with limited education, lower socio-economic status or who are covered by state insurance programs — are the same women who tend to walk through doors to the prenatal clinic at the Health Department, Carhart said.

Having a clientele of largely high-risk patients already poses complications for getting women to quit smoking, but with the current economic struggles, Carhart and other department officials worry that their interventions may become even more difficult.

“Without the (timber) safety net revenue from the federal government, the prenatal clinic at the Health Department is slated to close on June 30,” Marshall said.

If the prenatal clinic closes, the 300 women, on average, who use the clinic annually will be left with few options for care and assistance with smoking cessation. The two projects funded through the grants would not be affected by the closure of the prenatal clinic, but getting women enrolled in the other Health Department programs would be more difficult without having the clinic as an entry point.

Carter said the two projects and the uncertain future of the prenatal clinic will put department staff and local physicians and dentists to the test. In the end, Carter said she hopes all of the parties can come together and effect positive, long-term change in the lives of Douglas County residents.

“This is our reality challenge,” Carter said.

• You can reach reporter Marissa Harshman at 957-4202 or by e-mail at mharshman@newsreview.info.