Student ID No: 00000000

Programme: BSc (Hons) Midwifery

Cohort: September 2007

Course Title: Academic skills For Professional Practice

PTG Leader:

Submission Date: 8th February 2008

Comment [A1]: The word

Word Count: 2,155 limit is 2000, but you can be
either 10% more or 10% less
Introduction

In one of their first documents on tackling smoking, ‘Smoking Kills – a White Paper on Tobacco’, the

Government wanted to see a reduction in smoking to improve health in Britain. Pregnant women were
Comment [A2]: When you use
the Department of Health or any
identified as a group who will be offered particular help to stop smoking (Department of Health 1998). other organisation you need to
spell it out in full the first time
you use it, then you can
I intend to review the article ‘Smoking Cessation during Pregnancy’ by Percival (2005), as this is a abbreviate it. E.g. DH 1998
Comment [A3]: Note that the
topic that I feel particularly strongly about, both personally and as a future midwife. I chose this full stop comes after the closed
bracket

article because whilst giving a brief summary of smoking during pregnancy, its main focus is on the

ways in which midwives can support and advise pregnant smokers and this is the area in which I

would like to learn more. I hope to demonstrate a clear understanding of the subject matter and its

relevance to my future practice as a midwife, as well as demonstrating my academic skills in the

selection of the article, reading and writing.

Prior to reading this article, my feelings and values with regards to smoking during pregnancy were

somewhat judgemental. I found it difficult to understand how a mother-to-be could put her unborn

child at such risk. In fact, many pregnant smokers feel labelled by society as ‘uncaring’, and so hide

their real smoking habits, an act which does not benefit anyone in the long run (Owen and Penn 2000).

Reading this article and researching further the points that it covers has prompted me to take a good

look at my own, quite biased values. I am a non smoker and therefore have no real understanding of

what it must be like to be addicted to a substance that is harmful to both women and babies, but yet

cannot do without. Supporting women as they attempt to give up smoking requires specialist skills

and knowledge, which I hope to develop through this essay and as a midwife in practice.
 Comment [A4]: See how the
headings link to each aspect of the
Article review assessment criteria

My chosen article is written by Jennifer Percival, a registered nurse, midwife, health visitor and

tobacco education project manager. I was easily drawn to the subject and found it through searching

one of the databases I found in the first course activity. The article provides a brief overview of

smoking during and after pregnancy, touching briefly on various issues ranging from the problems

associated with smoking during pregnancy, through to the National Smoking Cessation Guidelines and

the National Institute for Clinical Excellence (NICE) recommendations on the use of Nicotine

Replacement Therapy (NRT) for pregnant women. Percival draws on others work throughout the

article, making several references to the work of Owen and Penn (1999). The survey of knowledge,

attitudes and behaviour was also beneficial to my own work. Percival also quotes the work of West et
Comment [A5]: If there is
more than 2 authors, put the first
al. (2000) amongst others. The author covers all the key points in the article, mentioning briefly the author and then et al.

socio-economic factors influencing smoking during pregnancy, considering the notion that a

percentage of women do stop smoking in pregnancy, only to return to smoking after the birth. She

highlights the wide range of problems associated with smoking in pregnancy but not in detail,

however, references to Larsen et al (2002) are made in order that the reader can obtain further

information.
Comment [A6]: Ensure that
you create a space between
paragraphs. Avoid very long or
very short paragraphs
Percival (2005) considers at what stage of pregnancy most damage occurs and briefly explains the

cause of damage. The article is predominantly concerned with the fact that despite statements in the

National Smoking Cessation Guidelines advising that midwives should be offered training and support

in this area, the reality is that, ‘midwives often have a poor understanding of nicotine addiction’

(Percival 2000). Most importantly and most beneficial to me as a student midwife, is the way in which

the article suggests ways of helping women to quit smoking during pregnancy and offers a range of

questions to be asked during routine appointments in order to initiate a conversation about smoking.

This enables the midwife to establish any concerns that the woman might have and to build up a
trusting relationship with her client. NRT is briefly mentioned as a treatment to help a woman who is

struggling to quit smoking. Weighing up the risks of smoking and the benefits of NRT is encouraged.

Lastly, the article covers the ways in which midwives can approach women after delivery to discuss

the protection of children from exposure to smoke, emphasising the importance of encouraging a

degree of choice and control not only during childbearing but also in the parenting years ahead. The

issue of smoking cessation during pregnancy is huge and much research has been conducted regarding

the subject, however, the article summarises the main points clearly and concisely with the main focus

on what midwives can do to aid smoking cessation during pregnancy.

Comment [A7]: See how the

headings link to each aspect of the
Relevance to my future role assessment criteria

As the lead professionals in the care of pregnant women, midwives are in the best position to offer

smoking cessation advice to pregnant smokers (Tobacco Information Campaign Team 2002).

However there seems to be some discrepancies in the literature on smoking cessation. Studies show

that counselling from a smoking cessation specialist together with written support materials enables 1

in 15 women to stop smoking, however behavioural support provided by midwives as part of their

normal duties has not been shown to be effective in aiding smoking cessation in pregnant smokers

(West et al. 2000). Pregnancy is an ideal time for women to consider giving up smoking as they are

motivated by the need to make lifestyle changes to benefit the health of their baby (Dunkley 2000), so

it seems a shame that many midwives feel that their knowledge and skills in this area are inadequate

(Klerman and Rooks 1999). In Percival’s experience, midwives often have a poor understanding of

nicotine addiction and assumptions are often made about why a woman chooses to smoke. It seems to

be a recurring theme in the literature I have studied, that the way in which smoking cessation advice is

given, the amount of time spent with the women and the health professional giving the advice are all

important factors in aiding smoking cessation and therefore specialist training for midwives is

essential.
As the article emphasises, before midwives can begin to offer smoking cessation advice it is extremely

important for them to understand why women smoke. Smoking cessation interventions which rely on

advising women of the hazards of smoking often try to scare women into quitting and will be

unsuccessful as the majority of pregnant women are very aware of the detrimental effects of smoking

on both themselves and their baby (Dunkley 2000). Evidence shows that when asked, 35% of

pregnant women cited habit as the main reason for smoking, closely followed by 31% stating the

reason to be addiction (Owen and Penn 2000). It is widely documented that socio-economic factors

such as social grouping, age, profession and income have a major effect on smoking during pregnancy,

with women from professional, managerial and clerical professions being three times less likely to

smoke than women from skilled and unskilled manual professions (Owen and Penn 2000). It is clear

that for women on a low income, who may not be able to afford luxury items and leisure activities,

smoking may be their only form of enjoyment and relaxation (Dunkley 2000). The percentage of

young pregnant women aged 16-24 is also high with 51% reporting that they smoked. It is evident

that women are more likely to struggle to quit smoking if they have a partner who smokes (Tobacco

Information Campaign Team 2002). Partners should be very much involved in smoking cessation

interventions in order to provide support and encouragement for the woman and should therefore

receive advice and counselling themselves in order to quit (Dunkley 2000).

In the context of my future role as a midwife I need to be aware of how I can establish the woman’s

readiness to change her smoking behaviour, as identified by Percival (2005). Prochaska and
Comment [A8]: The reference
to Prochaska and Diclemente
Diclemente (1993), cited by Dunkley (2004), developed a behaviour change cycle to assist health (1993) is called a secondary
reference – it is referred to by an
author whose work you have read.
professionals with this. Women will fall into one of several categories, from those who have no You have not read the original
article/ book.
Avoid using too many secondary
intention of smoking known as precontemplators, those who are thinking of quitting known as references as you are relying on
someone’s else’s understanding/
interpretation of it.
contemplators, those who are ready to quit and those who have relapsed. Different types and levels of You do not need to put this in the
reference list.
intervention can be used by the midwife to effectively target women at different stages of the cycle.
Not everyone will want to quit smoking and it is important that this decision is respected. In respect

of my future professional role as a midwife, we can only advise women of the risk factors and offer

advice. For women who are considering quitting, we should work with the woman to explore the

reasons for wanting to quit and the barriers stopping her from doing so. Strategies should be

considered to overcome triggers and nicotine cravings. If and when a woman decides to quit, a stop

date needs to be identified, as does a team of people who will support her, such as family and friends.

For those women who have relapsed, we should praise them for the attempt as unsuccessful quit

attempts work towards successful quitting. Valuable lessons may have been learnt which will aid

future quit attempts (Dunkley 2004).

Comment [A9]: See how the

headings link to each aspect of the
Use of academic skills in selection, reading and writing assessment criteria

I found this article in a search for an article on smoking using the key words smoking and pregnancy.

Most of the information used for this essay came from journal articles and websites found using the

internet. I found the course online activity about databases quite helpful but I found the librarians more

helpful. Initially, I was able to find the titles of relevant articles and library staff who helped me to

find hard copies of the journals that I wanted. I think that the electronic databases are a great source of

information and I need to improve my skills in this area so that I can make greater use of them in

future projects. I felt happier on this occasion to stick to what I knew best and I was able to find more

information in a shorter space of time, but I’m sure with more practice I will gain confidence in using

the specialist databases.

Having had some past experience of essay writing, I am aware of the need to start gathering

information as early on as possible, thus avoiding panic at the last minute. I started to research my

chosen topic straight away, taking into account the fact that we were going out to placement in early

October. Having previously worked as a healthcare assistant I am aware that writing an essay is the
last thing I feel like doing after a busy shift, so I made a conscious effort to get as much done as

possible, before our placements began. I also found some of the on line discussions helpful and the

activities helped a bit in doing the essay. The tutor feedback was a good guide as well as the other

students’ contributions. I was uncertain about referencing at the beginning, but I went through the

handout line by line. This was valuable, particularly as I missed the lecture on referencing due to

sickness.

I have used various skills to complete this piece of work, many of which I did not initially recognise to

be academic skills. My education and work experiences so far have already enhanced some of those

skills such as searching for information, taking notes, organising and presenting work and essay

writing. However, some have been developed by completing this assignment. I think that identifying

the key points in a piece of writing and summarising the article effectively have definitely been the

most challenging for me personally.

I found it helpful to talk through my ideas with the small group of friends I have made, but I’m better

at generating my own ideas at home when I find a quiet time. I could not work in short bursts; this is

what I had hoped I could do – work around my young son, but I just got irritable! I decided to wait

until I had a reasonable length of time to work on the assignment, usually at least half a day off from

university or practice. I gathered all the information first and then set out a plan. I did not use any

mind maps but did use the marking grid as a guide to the sections in the assignment.

Conclusion

In conclusion, I have not only improved my knowledge and understanding of the midwife’s role in

supporting women in smoking cessation but I enhanced my academic skills by improving my ability to

select my article, research the topic and write my essay, although I still need to become more familiar
with electronic data bases. For me, the most significant skills being the ability to accurately

summarise a piece of writing and the ability to link research to future practice. I have investigated an

aspect of practice in relation to my professional role, as I am now able to use the behaviour change

cycle to establish a woman’s readiness to change her behaviour, offering advice and support which is

specific to her individual needs.

Reference List

Department of Health (DoH) (1998) Smoking Kills: A White Paper on Tobacco DoH London.

Dunkley J (2000) Health Promotion in Midwifery Practice: A resource for health professionals
Bailliere Tindall.

Dunkley J (2004) Health Promotion in Midwifery in C Henderson and S Macdonald (eds) Mayes
Midwifery: A text book for midwives 13th ed Bailliere Tindall. Comment [A10]: Note that the
references are single spaced, but
do create a gap between each,
Gilliland F, Berhane K, McConnell R, Gauderman W, Vora H, Rappaport E, Avol E and Peter J otherwise it will look very
bunched up
(2000) Maternal smoking during pregnancy, environmental tobacco smoke exposure and childhood
lung function Thorax 55: 271-276.

Klerman L and Rooks J (1999) A Simple, effective method that midwives can use to help pregnant
women stop smoking Journal of Nursing and Midwifery 44 (2): 118-123. Comment [A11]:
Note here how you write the
volume, part and pages.
National Cancer Institute (NCI) (1999) Health effects of exposure to environmental tobacco smoke.
Report of the Office of Environmental Protection Agency Smoking and Tobacco Control Monograph
10 NCI.

Owen L and Penn G (2000) Smoking and Pregnancy: A survey of knowledge, attitudes and behaviour
1992-1999 Health Education Authority (HEA).

Percival J (2005) Smoking cessation in pregnancy Nursing Times 101 (06): 50 Comment [A12]: Note here
how you write the volume, part
and pages.
Tobacco Information Campaign Team (2000) Helping pregnant women to stop smoking British
Journal of Midwifery 10 (11): 663-666. Comment [A13]: See above
…and so on…

West R, McNeill A and Raw M (2000) Smoking cessation guidelines for health professionals: An
update Thorax 55 (12): 987-999.