When Misti Williams feels the urge to light up a cigarette, she can click on her cellphone for help. Her screen saver features a list of things she can do to distract herself from her nicotine cravings as she tries to quit smoking.
For 18 years, Williams has struggled with tobacco use. Now pregnant with her fifth child, she hopes she can finally kick the habit.
She’s not alone. More than a quarter of pregnant women in Kentucky smoke. Not only do they adversely affect their own health, but they put the well-being of their unborn children at risk as well.
KET’s Connections explored efforts to reduce tobacco use among expectant mothers. The guest was Kristin Ashford, an associate professor at the University of Kentucky College of Nursing who specializes in prenatal care and ways to end tobacco and illicit drug use among pregnant women.
The Risks of Smoking During and After Pregnancy
Even from the earliest days of a pregnancy, women who smoke are endangering their babies.
“During the first eight weeks of life is when all the fetal organs are developing, and that’s a very, very important time to stay away from any carcinogens,” says Ashford. “Cigarettes can contain carcinogens, and those can cause lifelong impact on the infant.”
Any level of nicotine is considered unsafe for expectant mothers, says Ashford, so pregnant women should avoid smoking even one or two cigarettes a day. If they do continue to use tobacco, studies show that women who smoke are more likely to have miscarriages, or their babies may be born too early or have a low birth weight.
The health risks continue after birth as well if babies are exposed to the second-hand smoke of their mothers or other family members, or to third-hand smoke if they come into contact with surfaces that are covered with smoke particles.
“Women who smoke during pregnancy, their children are more likely to have behavioral problems later in life,” Ashford says. “It has also been associated with ADHD and other types of learning disabilities.”
About one in four pregnant women in Kentucky smoke. (Nationally the rate is about 10 percent.) Ashford says in some Kentucky counties, nearly half of all pregnant women are smokers. Even electronic cigarettes, battery-operated smoking devices that allow users to inhale vapors that contain nicotine, flavorings, and other chemicals, are proving popular among expectant mothers.
“We spoke with women who were choosing to smoke electronic cigarettes in pregnancy and they told us they thought initially it was a safer alternative,” says Ashford. “The truth is we don’t know – we don’t have that evidence yet.”
In fact some pregnant women smoke both e-cigarettes and traditional cigarettes, says Ashford: the former because they thought it was safe and the latter for the extra hit of nicotine.
Kicking an 18-Year Habit
Misti Williams says she started smoking at age 13 so she could fit in with the popular kids at her school.
“Whenever I first started, I wasn’t even inhaling,” says Williams. “It had the nastiest taste to it, but I wasn’t going to stop it because I was already in with them girls and looking cool with my brother’s friends.”
Within six months, she was smoking two packs a week. By her mid-20s, she was smoking two packs a day.
As a young adult, Williams also became addicted to opioids and served six years in prison. She’s been clean from drugs for nearly seven years, but kicking her cigarette habit has been harder. Williams tried to quit multiple times, and always felt guilty when she relapsed. She even smoked during and after her first four pregnancies.
“I knew that second-hand smoke is bad for my children, but I would justify it in my head – my parents smoked around me all my life, it’s okay,” Williams says. “I would tell myself this just so I could keep doing what I was doing.”
Now five months pregnant with her fifth child – and at the urging of her oldest daughter – Williams has gotten serious about quitting. She’s in the “Get Fit and Quit” program that is a partnership between the UK College of Nursing, Chrysalis House (a substance abuse treatment center for women in Lexington), and the YMCA. She’s been smoke-free for two months, thanks to the program’s counseling and support services, like the tips on her cellphone screen saver that Williams can refer to when she craves nicotine.
It took her 18 years, but Williams says she’s finally ready to quit. And she hopes other moms will do the same.
“If you don’t want to smoke, if you want to actually quit, you can,” Williams says. “Just because you have certain types of cravings, that doesn’t mean that you’re a bad person, it just means that you need help, and it’s out there.”
Replace Smoking with a Healthy Behavior
Ashford says most pregnant women feel ashamed of their smoking habits, yet are still unable to quit.
“It certainly is an addiction and we have to treat it as one,” she says.
That includes addressing withdrawal symptoms. Ashford says those can include cravings, heart-rate changes, and depressive behaviors, all of which can be combated with the help of a tobacco treatment specialist.
Part of Ashford’s research includes interviewing women who stopped smoking during a pregnancy and did not relapse post-partum. She says those women saw their pregnancy as a good opportunity to make long-term behavior changes. That mindset helped them move from seeing cigarettes as a comfort to something they want to avoid.
“Also, women who were successful adopted a ‘change behavior,’” says Ashford. “They replaced their smoking behavior with a healthy behavior.”
For example, the “Get Fit to Quit” program replaces smoking with exercise, a cessation strategy that Ashford says is showing promising results. These replacement behaviors can help alleviate common triggers for smoking, such as reaching for a cigarette when stressed or after having a meal. Finally, she says it helps to enroll the mother’s partner in his or her own smoking cessation program if they use tobacco.
Some pregnant smokers do try to quit cold turkey, but Ashford says that’s difficult for most people. In fact, two-thirds of mothers who quit during pregnancy will relapse, she says. She says it’s critical to remind those mothers that it’s even more important for them to quit after giving birth.
“They don’t understand that second-hand smoke after they deliver that baby is just as harmful to the baby long-term as smoking during pregnancy,” Ashford says.