Increased live birth delivery of women with natal drinking or smoking: A nursing critique
Abstract
Prenatal smoking and alcoholic drinking are for its serious health risks during and after live delivery. Amidst the ethical question on this maternal choice, a contention insists that alcohol and tobacco non-use prenatal and at natal has increased. Doubts on its validity were noted. My hypothesis: the observation came too early both in the national English and the global contexts. The contention was hard to sustain. The diverse factors affecting global decision making work against that contention. Both the American and English data failed to support that contention on the strong reality of the incomplete and potentially unsound data available. The supportive and persuasive implications for nurses and the nursing profession inevitable opened up. However, the consequent burden for the decision to use alcohol or tobacco prenatal and at delivery resides inevitably and profoundly on the maternal decision maker, changing negatively her life and that of the newborn child.
Smoking and alcoholic drinking during pregnancy have been associated with serious health problems even after live delivery. Smoking, for instance, has been associated with complications such as labor difficulties, higher risk for spontaneous abortion (miscarriage), premature births, still birth, at least low birth weight, and sudden infant death syndrome (Lifestyle Statistics Team [LST], 2016; Curtin & Mathews, 2016). Binge drinking is also associated with most of the smoking complications in addition to birth defects and neurological defects (MCHB, 2015). With these risks known imposed on the helpless, is it ethical for mothers to put their unborn children’s life to such serious risks during and after pregnancy?
However, the international interest on alcohol use or smoking during pregnancy appeared to be of relatively low for the annual global motoring of the World Health Organization (WHO) to even report it in its latest World Health Statistics report (WHO, 2015). Apparently, this issue had been left into the direct monitoring responsibility of its specific member countries. However, even in the United States, the Centers for Diseases Control and Development (CDC) had its latest survey on these metrics for women and children care last taken in 2011 (CDC, 2015). With these levels of monitoring interest, it is difficult to argue in favor of the contention that this issue is of urgent and great interest to global and national health authorities.
Nevertheless, there is a contention that alcohol and tobacco non-use during pregnancy are increasing. In England, for instance, the number of smoking mothers at the time of delivery had declined by 26 percent from 2006/07 (90,887 smoking mothers in the 601,262 live deliveries) to 2015/16 (67,195 smoking mother in the 631,225 live deliveries) (LST, 2016). Is this proof enough of the increasing number of mothers, having delivered live infants, to have alcohol or tobacco non-use during pregnancy?
Hypothesis, perspective, and position
One state’s statistic do not all nations around the world make. My hypothesis holds that the English statistic is so limited to be validly generalizable to all countries around the world. The factors affecting the behavior of pregnant mothers in deciding to use or not use alcohol or tobacco prenatal are simply, intuitively, and logically diverse to submit to a single-country generalization. Most likely, such a contention is so early, at worse so inadequate, to merit such generalization. It is more likely instead that, although some countries have increasing number of natal women not using alcohol or tobacco, more countries either continued the same level of pregnant women using alcohol or tobacco prenatal or their number increasing. In fact, it might even be harder to find countries with their prenatal women increasingly not taking alcohol or tobacco as shall be explored in the following sections.
Other salient perspectives and position
My hypothesis is grounded on the assumption that the sample of English natal mothers covered in the survey, assuming they represented all women in the English nation, is so unique and so small to represent the natal mothers around the world. The sampling size and procedure alone cannot justify it. Add to that the diversity of the global culture, the diverse possibilities, broad or limited compared to the English data cannot reasonably accept such a contention. Moreover, the contention had not be clear whether the context of such observation involves the international community or simply that of England. Thus, the first problem in the contention refers to its statistical validity.
Moreover, although this research question is a good starting point to pursue, the availability of reliable data alone constitutes an insurmountable barrier to accomplish a through and statistically well-represented sampling of all natal women in all countries in all continents. One proof of that difficulty is the WHO’s internal difficulty at getting all the data on this question (WHO, 2016). Whether or not this reality dominates the reason for its relative lack of interest in this area for reporting purpose, the fact remains that the WHO does not report it annually. Thus, a researcher pursuing this line of study will have to travel countries alone and without the resources of large organizations like WHO. The feasibility of the project becomes a subject of debate between the funders and the researcher.
Another proof came from the 2014 American data on the subject. The CDC published a study in 2016, which conducted a live birth certificate-based review of maternal smoking during pregnancy (Curtin & Mathews, 2016). It managed to gather data from 46 states and the District of Colombia, representing 95 percent of all 2014 United States births. However, Hawaii had to be excluded due to concerns over data quality, a decision that the National Center for Health Statistics (NCHS) supported and, in fact, even recommended. Thus, the researchers made it clear that their findings cannot be generalized to the entire Union for 2014.
Another proof came from the HSCIC (Health & Social Care Information Centre) itself, which has been mentioned above on its report about the declining number of pregnant women smoking at around the time of delivery (LST, 2016). The study had inevitably encountered unknown smoking status of women (due to inadequate reporting), which the study protocol cannot isolate from the reported data available and must be counted as non-smokers instead. This technical limitation can seriously affect the validity of the findings earlier mentioned. Moreover, the unknown data had increased from 1.4 percent of maternities in 2013/14 to 3.1 percent in 2015/16. Furthermore, those findings did not strongly reflect the trends in each clinical commissioning group in England. In Blackpool, for instance, smoking prevalence of prenatal mothers at delivery was 26.0 percent of maternities while in Central London it was 1.5 percent. Thus, the variation was very high. In fact, the authors of the report warned that results of their study should require caution when using it in making comparisons either between clinical commissioning groups or between countries. Overall, whatever data used in supporting the contention that there is an increasing number of prenatal mothers who ceased to use alcohol or tobacco at least until after delivery, the issue on its generalizability can be highly difficult to support or argue for. It is safer and more scientifically accurate to consider the findings as a useful guide for policy decisions although not an indisputably accurate one.
Impacts
Conclusion
The issue of prenatal drinking or smoking is an issue that impacts directly more the mother and the child more than the nurse or the nursing profession beyond putting before them a social and nursing challenge to bring change to the lives of these mothers and children. Most of the negative impacts of the wrongful decision rightly belongs to those who made that decision. The future of the infant’s life is in the hands of her mother. However, the nurse and the nursing profession must, however, take the challenge of changing lives, not merely supporting its needs.
References [5]
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Curtin, S.C., & Mathews, T.J. (2016, February 10). Smoking prevalence and cessation before
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delivery: England. England: Health & Social Care Information Centre.
MCHB. (2015). Child health USA 2014. Maternal and Child Health Bureau/ Health Resources
and Administration/ U.S. Department of Health and Human Services.
WHO. (2015). World health statistics 2015. Geneva: World Health Organization.
