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Pregnant women's reactions to routine CO monitoring in the antenatal clinic

02 July 2015
13 min read
Volume 23 · Issue 7


Guidelines from the National Institute for Health and Care Excellence (NICE, 2010) recommend the use of routine carbon monoxide (CO) monitoring in all pregnant women. However, there is no research describing pregnant women's experiences of being offered the CO test at booking.


This was part of a phenomenological study conducted to examine midwives’ experience of using CO monitoring for smoking cessation in pregnancy. Individual semi-structured interviews were carried out and recorded with 10 midwives who use CO monitoring at booking. They were asked about women's reactions to the test. Data were analysed using Colaizzi's (1978) approach and bracketing.


Midwives reported that women were generally happy to accept the test. However, pregnant women appeared to be uninformed about it. Other reactions described include curiosity, shock, relief, guilt and surprise at the results.


Overall, women's reactions were positive but an increased public awareness of the test would smooth its implementation.

Carbon monoxide (CO), a colourless, odourless and poisonous gas, is a waste product of cigarette smoking. CO monitoring is an immediate and non-invasive method of determining smoking status (National Institute for Health and Care Excellence (NICE), 2010). CO monitoring has been found to be useful in identifying smokers for referral to specialist smoking cessation services, and it is suggested to be more objective than the use of questionnaires in determining levels of smoking in pregnant women (King and Edwards, 2009), who may feel guilty or ashamed and therefore under-report their smoking habits to midwives.

The measurement of CO level is referred to as a biomarker (King and Edwards, 2009) and is carried out by a breath test. Air is exhaled into the CO breath test monitor and a reading is given after a countdown of 10 seconds.

A chart is provided with details of expected levels, which are colour-coded for ease of use: green indicates normal levels, while red indicates high levels of CO.

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