How to quit smoking in pregnancy, without the shame

Why the shame is part of the problem

Smoking in pregnancy carries more stigma than almost any other health behaviour, and the result is that people hide it — from their families and, more damagingly, from their doctors.

Hidden smoking means growth scans get interpreted without the relevant information, and it means nobody offers the help that exists.

It also drives the worst pattern there is: smoking secretly, quickly, and deeply, which delivers more carbon monoxide than smoking normally would.

Addiction is not a character defect. Nicotine is among the most addictive substances there is, and most people who stop have stopped several times before it holds.

So the practical advice is unglamorous: tell your obstetrician the truth, tell one other person, and stop treating each lapse as proof of failure.

What actually works

Behavioural support plus medication works better than either alone, and much better than willpower alone. Free counselling is available in India through the National Tobacco Quitline and through hospital-based cessation centres.

Set a quit date within the next two weeks rather than 'soon'. A date makes a plan possible.

Map the triggers before the date: which cigarettes are habit and which are craving. The after-meal one, the tea one, the one on the balcony after an argument. Each needs a specific replacement, not a general intention.

Remove the supply completely from the house and car. Half a packet kept 'just in case' is what most relapses run on.

Handle a craving with time rather than willpower: they peak and pass within a few minutes. Water, a walk, brushing teeth, calling someone, or simply waiting works.

Change the routine around the trigger — sit somewhere else after a meal, take a different route, drink tea in a different room.

And tell people, so you are not managing it alone in a household where someone else smokes.

India's National Tobacco Quitline is free on 1800-11-2356, and the government mCessation programme sends support by SMS. Your obstetrician can also refer you to a tobacco cessation centre — there are hundreds attached to hospitals across India, and they are free.

Medication, and relapse

Nicotine replacement therapy — patches, gum, lozenges — is used in pregnancy under medical supervision. It delivers nicotine without carbon monoxide, tar or the thousands of other combustion products, and it is regarded as considerably safer than continuing to smoke. It is a decision for your obstetrician, not for a pharmacy counter.

Varenicline and bupropion are generally not recommended in pregnancy. Do not start either without specific medical advice.

Relapse is normal. Most people who quit for good relapsed several times first, and the useful response is to work out what the trigger was and restart the same day rather than waiting for a new month.

One cigarette is a lapse. Treating it as the end of the attempt is what turns a lapse into a return to smoking.

If you are also using gutkha, khaini or paan with tobacco, include that in the quit plan. It is very commonly left out because people do not count it as smoking.

And if you cannot stop, keep going to appointments and keep telling the truth. Reduced smoking with good antenatal monitoring is a far better outcome than hidden smoking with none.

When to see a doctor

Tell your obstetrician at the next appointment, and ask for a referral to a tobacco cessation centre and for extra growth monitoring.

Ask specifically about nicotine replacement rather than assuming it is not allowed.

Go to hospital immediately for bleeding, severe abdominal pain, a hard painful uterus, leaking fluid, or reduced or changed fetal movements. Call 108 if travel is difficult.

If low mood, anxiety or a difficult home situation is part of why you smoke, say that too. Tele-MANAS on 14416 is free, confidential and round the clock.

This article is general information, not medical advice, and has not been reviewed by a cessation specialist or an obstetrician.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: Will my doctor judge me? — Some might. Most have seen it many times and are more interested in the pregnancy than in a lecture. The information changes their clinical decisions, which is why it is worth saying.

Q: Is stopping suddenly bad for the baby? — No. Stopping abruptly is safe in pregnancy and there is no medical reason to taper slowly.

Q: I quit and started again. — Extremely common, and not a failure. Identify the trigger and restart today.

Q: Can I use vaping to quit? — It is illegal to sell e-cigarettes in India, and nicotine-free is the goal in pregnancy. Talk to your doctor about supervised nicotine replacement instead.