HEALTH COMPLICATIONS
Meeting these objectives will require a thorough research into the topic focused on revealing a deeper understanding into the need to ban smoking in pregnant women. It will involve examination of the health complications developing in children as well as mothers resulting from exposure to substances involved in smoking. The health complications of children and pregnant mothers who are exposed to smoking include the following:
i. Respiratory System
The contents of tobacco and other smoking elements have an impact on the oxygen supply of the baby (Centers for Disease Control and Prevention, 2016). Oxygen is crucial for the development of the baby and their respiratory system. Carboxyhaemoglobin, which results due to the exposure of red blood cells to carbon monoxide, causes a continuous reduction in oxygen to the fetus with a prolonged effect on development (Aubard & Magne, 2000). The exposure of smoking even in adults results in respiratory complications including asthma. In fetus, the results resemble however with worse implications. The nicotine passes the placenta easily and as a result there is a higher nicotine concentration which remains longer in the fetal circulation than the mother’s (Minkoff & Baker, 2003). Exposure of fetus to smoking parents during pregnancy increases chances of them developing respiratory complications (Hofhuis, Jongste & Merkus, 2003). These affect their lives after birth while also reducing their life expectancy.
ii. Cardiovascular System
The limitation in oxygen supply has an impact on the heart rate of the baby (Woolston, 2016). Limited oxygen supply to the baby increases heart activity as the heart aims to sustain the oxygen source available. Prenatal smoking increases the cardiovascular risk in both the fetus and the mother. A study has proved that exposure to nicotine, an active substance in cigarette smoking, during pregnancy causes fetal arrhythmia or abnormal heart rhythms by the mechanism involving intrauterine hypoxia (Feng et al., 2010). Subsequent to nicotine exposure substantially increases the risk of arrhythmia later in the fetus’ life. According to Xiao (2014), epidemiological studies have revealed that maternal smoking is linked with increased long-term risk of cardiovascular dysfunction in adult offspring and increased risk of postpartum hypertension and cardiovascular disease for the mother.
iii. Prenatal Complications
Smoking during pregnancy may also result in the increased chances of prenatal complications including stillbirth, miscarriages and preterm birth (Mendelsohn, Gould & Oncken, 2014). Continued exposure to contents of cigarettes by pregnant women exposes the baby to chances of suffering stillbirth as the fetus may have health complication affecting their growth (Salihu & Wilson, 2007). Furthermore, smoking during pregnancy increases the chances of miscarriages that may result in early termination of the pregnancy which may cause other complications to the mother (Pineles, Park & Samet, 2014). Exposure to tobacco during pregnancy increases the risk of preterm birth which reduces the chances of survival for the baby (Kyrklund-Blomberg, Granath, & Cnattingius, 2005). According to World Health Organization (WHO) (2015), an approximated fifteen million babies worldwide are born preterm annually and preterm birth is one of the leading cause of nearly one million deaths of children under the age of five in 2013.
iv. Neonatal Complications
Pregnant mothers that smoke during pregnancy increases the likelihoods of low birth weight and birth defects for the baby. A study using the genetic make-up of pregnant women to explore the relationship between smoking and birth weight has reinforced the evidence that maternal smoking causes low birth weight in full term babies (Tyrrell et al., 2012). Risk of birth defects in neonates who are prenatally exposed to smoking has considerably increase specifically for defects of the cardiovascular, musculoskeletal and gastrointestinal systems, the face including orofacial clefts, and cryptorchidism (Hackshaw, Rodeck & Boniface, 2011).
v. Sudden Infant Death Syndrome (SIDS)
In many cases, children seemingly healthy may die in their sleep The condition SIDS refers to the sudden death of children normally during sleep (Harris & Lorencatto, 2015). The causes of death in such cases remain unclear considering the parent may put the baby to sleep and return to find it dead despite having done all things right. Babies within one to twelve months have increased chances of succumbing to this condition especially if their mothers were engaged in smoking while pregnant (Shah, Sullivan & Carter, 2006). The possibility of this condition is increased in babies born with low birth weight and those of premature births (Athanasakis, Karavasiliadou & Styliadis, 2011). These two result from exposure to smoking during pregnancy and lack of medical care during pregnancy.
It is on these grounds that pregnant women obtain constant reviews to ensure the baby is growing well and any chances of premature birth and low birth weights are dealt with to reduce the chances of the children suffering from SIDS. SIDS may also result from babies sleeping on their bellies affecting their breathing abilities (Gilbert, Salanti, Harden & See, 2005). Unborn babies also have increased probability of suffering from the condition if they suffer breathing challenges resulting from problems in the brain caused by smoking substances exposure from their parents (Wickstrom, 2007).
LEGAL AND ETHICAL ISSUES
In Islamic perspectives, the need to ban maternal smoking is engendered by the involvement of the general purposes of Islamic Law or the maqasid al-sharia. For a medical issue to be deemed ethical, it must satisfy or no contravene one or more of the five purposes that represent the maqasid al-sharia ‘ protection of religion, life and health, progeny, intellect and resources (Kasule, 2010). As stated above, the purposes involved are the protection of life and health, progeny and intellect:
i. Life and Health
The act of smoking during pregnancy have significant evidences of the risks of killing the unborn children. Following conception, the privileges that Allah has set for unborn children such as right to life and to lineage, in the Islamic Law, then come into effect. Allah designates the being who kill their offspring before or after their birth, as wayward, mislead and ignorant (Al-Qur’an 6:140). This is a distinct proscription against the harming or killing of an unborn child. In Islam, human life begins when ensoulment occurs, the moment at which the fetus gains a soul (Al-Matary & Ali,2014), which is generally regard as 120 days after conception (Janoff, 2004). Even though the embryo is considered as living, it does not gain the status of full human life until he attains perception and volition (Albar, 2001). According to WHO (2016), up to 50% of tobacco users contribute to the annual death toll of six million due to exposure to tobacco. As evidenced by the scientific studies there is a significant association between smoking and health complications, some of which are fatal. With these findings, the Quran documented that Allah forbids the killing of oneself and of another (Al-Qur’an 4:29).
Preservation and protection of health is necessary in order to protect three out of five essential needs specifically life, progeny and mind (Al-Khayat, 2004). As stated above, smoking during pregnancy have been associated with many health complications for both the fetus and the mother. Health is defined as the absence of illness or impediment, also as a state that allows the individual to perform his activities of daily living sufficiently, and lastly it is defined as a state of balance established within the individual as well as between him and his surroundings (Satorius, 2006). Islam regards health and well-being as better than wealth and is considered as a blessing. As reported by Ibn Abbas: Prophet Muhammad (peace be upon him) said, ‘There are two blessings which many do not appreciate: Health and Leisure’ (Sahih al-Bukhari: Book 81, Hadith 1). In the instances of our role as health professionals, according to the Qur’an: ” And whoever saves a life, it is as if he had saved mankind entirely” (Al-Qur’an 5:32).
ii. Progeny
Pregnancy allows for the existence of progeny which ensures the survival of the human race. In order for this to be safeguarded, protection of progeny needs to be accomplish by means of antenatal care, obstetric care and child care, which allows healthy children to be born (Fadel, 2002). In the Quran, children or progeny is described as ‘adornments of this world’ (Al-Qur’an 18:46). The Quran also encourages Muslims to recite entreaty to Allah for the blessing of an offspring (Al-Qur’an 25:74). The above verses emphasise the importance of the protection of progeny in Islamic perspectives.
iii. Mind/Intellectual
Smoking has been associated with psychological effects such as stress and addiction (Childs & de Wit, 2010). In Islam, the protection of mind includes managing addiction to ensure human intellectual function can be maintained at its optimal level. Furthermore, smoking addiction is strongly influenced by nicotine dependence which is stimulated by the drug nicotine found in cigarettes (Cosci, Pistelli, Lazzarini & Carrozzi, 2011). Islam also encourages spiritual approach in promoting a healthy mental health. Remembrance of Allah is one of the approach recommended in the Quran to rid of depression and stress (Al-Qur’an 20:124).
The Islamic Laws as argued above aims to protect the unborn child from the exposure of harmful substances and to prohibit the early termination of the fetus unless the safety of the mother is at stake. Although the value of antenatal life is internationally acknowledged only few countries implemented constitutional and legislative prosecutions for this matter. In Ireland, the state recognises the right to life of the unborn in compliance with regards for the equal right to life of the mother (IE. Const. amend VIII), which is similar to the prenatal rights set by the Islamic Laws.
There are many dissents from the view of the human rights concerning with the mother’s rights. Conflict of rights may arise between the mother’s and the fetus’ rights with regards to the right to life (Patil, Dode, & Ahirrao, 2014). (WOMAN’S RIGHT)
IMPLICATIONS ON MOTHERS/PREGNANT WOMEN
On the other hand, smoking during pregnancy is seen to have some advantages to those engaging in the act. Many myths have developed surrounding smoking that many women consider in keeping the habit. These include the following:
One of the most prevalent myths and associations of smoking during pregnancy includes reducing stress (Ashford & LeCroy, 2009). Smoking mothers and first time mothers suffer stress that pushes them to smoking. They consider this as a positive approach to dealing with stress hence finding it difficult to quit. Association of smoking as a favourite pastime increases engagement in pregnant mothers.
Smoking has a relaxing effect in some people. Having a relaxed pregnancy increases chances of reduced stress, which proves positive for both the baby and the mother. Living under stressed situations increases chances of premature births and miscarriages that still pose a danger to the baby. These increase chances of smoking during pregnancy.
Some mothers may smoke in their first pregnancy and still produce a healthy baby. The effect of this supports their decision to smoke during their second pregnancy considering the registration of no effect on the first pregnancy. Considering this reduces the necessity to ban smoking during pregnancy. Mothers in such a situation fail to understand the health complications they expose the children to despite having given birth to a healthy baby in the first case.
Some mothers also consider having a low weight baby not a problem and therefore smoke in a bid to have a small baby for ease of birth. Many forget the health complications associated with low birth weight that may expose children to conditions that may affect them in their childhood and adult life.
Women smoking before pregnancy find it difficult to quit smoking considering its development as a habit. Many of the women smoking have developed it as a habit that they practice often. Quitting smoking requires psychological and mental help that may include admission into rehabilitation facilities. Pregnant mothers consider the difficulties of handling pregnancy under rehabilitation centres and dealing with their smoking habit and consider continuation. Banning women from smoking may prove easy in legislative aspects but changing the behavioural aspects may prove an uphill task for the parents.
According to Morris, (2010), studies have indicated that smoking during pregnancy also reduces chances of suffering from preeclampsia that is a life threatening disease that leads to increased blood pressure and protein build up in urine. Advocating for banning on smoking will increases chances of prevalence of the condition hence putting the baby and mother at risk.
IMPLICATIONS ON NURSING PRACTICE
The development of legislation and banning of smoking in women will require the government working together with the nursing community to ensure the success of the legislation (Everett, 2014). Nurses provide the practical element of dealing with the problem while the government provides the oversight and legislative needs. The legal implementation aspect also needs to work together with the community awareness arms that include the media in passing the message and spreading information on the dangers of smoking during pregnancy. The coordination between nurses, the government and the entire ministry of health in dealing with the problem increases chances of success reducing health risks of the unborn babies.
Banning smoking in pregnant women increases the legal obligations of nurses to ensure pregnant women do not smoke or stop the habit. It becomes an ethical practice for nurses to monitor pregnant mothers and ensure those that smoke obtain help in dealing with the condition permanently (Dossey et al. 2015).
Passing a law banning smoking creates an obligation for nurses to educate their patients on the dangers of smoking during pregnancy. Inclusion of programs educating women on the dangers of the habit and approaches to dealing with it proves mandatory for practice. Nurses are also charged with a responsibility of monitoring the stress effects of pregnancy on their patients to ensure its possible to deal with stress without smoking.
Recommending rehabilitation care for those addicted to smoking may support dealing with the problem. Nurses during their sessions with women may assess the ability of their attendees to deal with the smoking challenge. Those that may find difficulties in dealing with the problem may have nurses recommend rehabilitation for them as a means of ensuring they obtain permanent professional care in dealing with smoking.
Nurses also need to obtain training on dealing with smoking mothers (Michael, 2007). The passage of the law on banning smoking in pregnant women will also require training of nurses on dealing with the problem and mothers that embrace smoking. Organizing training programs and refresher course for nurses to gain an understanding of the subject prove imminent. The training prepares nurses to deal with the situation and hence increasing chances of legislation succeeding in creating the intended impact.
PROPOSED RECOMMENDATIONS
Banning smoking in women during pregnancy may prove a challenge considering the habit develops into a behavioural aspect that challenges many women in dealing away. Managing banning smoking will require not only developing legislative approaches but also creating approaches that will influence behavioural change in mothers.
Inclusion of mental and psychological examination of the mothers when they attend antenatal care during pregnancy may increase chances of reducing their smoking habits and create room for close monitoring of their behaviour. These will aid in reducing the behaviour and influence the development of a positive attitude that will reduce smoking.
Inclusion of the effects of smoking during pregnancy and educating women on the myths surrounding smoking may increase chances of dealing with the problem (Felton et al. 2013). The addition of anti-stress medication to pregnant women will reduce their need to smoke. Anti-depressants have a relaxation effect on pregnant women and the baby hence increasing the chances of quitting smoking and giving birth to a healthy baby.
Banning of smoking may have adverse effects such as increase number of smoking mothers giving birth outside of health care facilities. Therefore, nurses should advise women to give birth in health centres which will reduce chances of health complications for the baby. Parents that give birth in health centres improve chances of giving birth to healthy babies considering the presence of qualified personnel that will assess the baby at birth. These will also deal with any complications during birth or signs of miscarriages managing to save the baby and the mother.
Conclusion
In summary, smoking during pregnancy affects the health of both the baby and the mother which increases chances of death. Producing in health facilities surrounded by health professionals will increase chances of giving birth to a healthy baby. The ban on pregnant women smoking will create a legislative effect on mothers but will not necessarily affect their behaviour. Creating channels through which pregnant mothers are counselled on the dangers of smoking will increase chances of understanding the myths surrounding smoking. Educating women on these dangers will increase their awareness affecting their behaviour positively. To conclude, in my opinion, the fetus’ rights to life is more significant than the infringement of the mother’s rights to smoke which is only affected for the period until the birth of her child. Furthermore, as denoted by the four arguments surrounding the issues of banning prenatal smoking, the arguments made for banning outweigh the arguments made for against. Therefore, as prompted by the statements above, I strongly agree to ban women from smoking while pregnant.