Oct. 27, 2016

Tobacco wins again! How is it possible that we're still fighting this one guys?!
Cigarettes and friends (tobacco, nicotine, arsenic, +4000 other ingredients) are a totally and completely legal Teratogen (any substance that has harmful effects on the developing fetus). You can smoke, vape, chew, and dip while pregnant, and the surgeon general along with many clinicians tell you that the only real adverse effect is a smaller baby 😒.... Well... about that. Full term babies aren't supposed to be small (unless they are born to little people); smaller baby= smaller brain =neurological and cognitive effects and defects.

Why is my baby smaller? Because of this thing called Utero-placental Insufficiency. You know how we tell people with high BP and diabetes NOT to smoke because it makes the small, yet important vessels weak and constricted? Well, same concept here except it's happening within your uterus, to your placenta; you know that big beefy organ that gives your baby LIFE. Well, the mom and the growing fetus alike are getting a lot less of that awesome stuff called life. So, we've passed on a tiny brain, tiny lungs, and are setting this little one up for days (years in most cases) of neurological and peripheral vessel immaturity.

Did you know that the withdrawal severity and symptoms of an infant born to a mother who smoked a pack per day is far worse, than that of a infant who's mother used intravenous opiates, 'shot up' (heroin)? Also, of all of the categories (cocaine and other opiates, methamphetamines, benzodiazepines, marijuana, etc...) cigarettes have the longest effects on a child's/person's physical, emotional, and cognitive health. Marijuana comes in number 2 (with mostly just cognitive delays including Autism spectrum disorders). *Side Note*
*** There is no blind 'American and human' research to support that marijuana alone has such terrible effects. Studies were performed on data collected from mom's who have simply tested positive. These mom's may have also been smokers, been on antidepressants, or positive for other substances. Of the international studies (where marijuana is legal) the conclusions are that perinatal exposure to the drug alone have NO lasting or harmful effects.***

Back to withdrawal... Once baby gets over the initial hump, and completed withdrawals from the other "Hard drugs" that everyone likes to judge for, these kids usually do quite spectacularly. It is quite amazing. I mean, we all saw #LosingIsaiah.

Is anyone wondering, "What do withdrawals feel like?" Well, in adults, it goes a little something like this. First, you start Jonesin', gotta have IT, or anything like IT. You feel jittery, and then you are actually physically shaking, uncontrollably, but you're far from cold. Your bones and muscles ache, you're dizzy, your head pounds and your nose runs like a fountain because some reason a flu freight train is coming on.... Is it the flu; because all of a sudden you've got this fever out of nowhere, and everything you eat either comes right back up, or out the other end like lava. Your hands are raw from wringing them, and you just want to sleep. But who can sleep in this much pain? Every light is too bright, every sound pierces your brain, and the barest touch feels like steel wool on your skin.... Now imagine your 3 day old baby going through these exact same symptoms, a few of them, all of them, more intense, or less. Frantically searching for something, anything to suckle; but in that frenzy being too uncoordinated to maintain a latch or rhythm. Baby girl can't say it hurts too bad, may I please have morphine. Baby girl just screams. Baby girl cant say, I'm burning up, but i NEED you to cuddle me anyways; baby girl just screams.👶

Mom's who smoke cigarettes while nursing can decrease these withdrawal symptoms (education about weaning vs. cold turkey is important), but then you risk prolonged exposure; setting little one up for RSV, asthma, etc....

*Another Marijuana Side Note* **Did you know that marijuana is SIX times more concentrated in breastmilk?! Ever wonder why a person (particularly women) can smoke Mary Jane, and still come up positive months later? It's because THC binds to fat cells. Breast are fatty, and breastmilk is extremely high in healthy fats. So moms, you can have yourself a joint, and your teeny tiny baby will have SIX!**

We've all heard the myths/truths about how pregnant moms shouldn't color treat, perm, or relax their hair. Because the prospect of chemicals seeping through your scalp where there are no open wounds is 'totally plausible'. I realize its actually the inhalent factor, but hairdressers get pregnant all of the time, and there hasn't been a news story about all of their sick, or expired babies (excuse me if that was too crass). Prolonged, excessive exposure to inhalents is terrible, but giving someone a hard time for 'getting their hair did' is just ridiculous. There's also the lunch meat deal, because listeria is obviously running RAMPANT! But honestly, listeria IS harmful to a pregnancy and an unborn fetus, but by the time the recalls and news breaks of an 'outbreak' it is often too late. But, Newsflash, if you warm it, lunch meat is just as safe as anything else; and who's not cooking their hot dogs anyways?! All I'm saying is there is a bigger evil out there; and it's not the salon, or Oscar Meyer.

Unfortunately pregnant women are 'gently cautioned against' smoking, like it's lunch meat, and some offices even fail to mention smokeless tobacco, vaping, and caffeine (along with it's many hiding places). I recently asked a former patient if she smoked, and she said 'Nope'. As I'm looking down at her bedazzled skull vape pen, I asked "So that's baby daddy's then?" She honestly didn't realize that it was the same thing. #TeachingMoment. Tobacco, nicotine in much higher doses, and lord knows what else. She thought it was better for her and the baby, and I just had to let her know that vaping is only better for the environment. Wish I could've been there for her 10 months ago.

Lots of physicians have told their patients (my patients) that getting down to five cigarettes a day is acceptable for cessation, and is harmless to a pregnancy and the growing fetus. What I hear: "Just five stab wounds won't kill you." Malarky!

Women who make the decision to avoid the smoke, still can't seem to avoid the smoke. They're forced through clouds of carcinogens on the way into the grocery store, walking into the mall, and even in corners of their favorite coffee houses and restaurants. Why can't we get legislation to help us out here like they did with Alcohol. A big sign of a pregnant woman smoking, with an X over it at every merchant selling the cancer sticks... Oh wait, I know why not. $$$$ Money, the government taxes the shit out of cigarettes and accessories for vaping. They would be losing so much money not just from consumers/tax payers, but from the giant smoke-head corporations. And let us not forget the smoke-head CEOs who push through ridiculousness in senate. Duh Felicia! We only got a big push with alcohol because of Fetal Alcohol Syndrome. In addition to cognitive delays, alcohol consumption in pregnancy was linked to physical (facial) deformities. And America couldn't have that. There is such a huge stigma associated with drinking while pregnant, but it seems like everything else goes. If cigarette smoking were linked to physical deformities, someone would be acting. Unfortunately, if there isn't a TV show, billboard, or SURGEON GENERAL approved message about it, people will do it. Example: Nurse-"So Mrs. Stevenson, have you had any alcohol, cigarettes, weed, pills, or IV drugs since you realized you were expecting?" Mrs. S: "Dear Lord no, no alcohol. Of course not! But I did have a few cigarettes at my friends bachelorette party, and I've been taking my husband's percocet every now and then for this awful pelvic pain." 😵 Literally happens everywhere, everyday.

So what do they think of our standards on the other side of the pond?
In Ireland, the UK, and Australia, cigarette smoking and alcohol drinking while pregnant is quite normal. The Japanese sure don't give up their sushi 🍣, and the French aren't budging on the brie. Maybe Americans are just overly researched prudish pregnancy snobs? I guess I'd rather be an overeducated snob, than to risk future generations and fetal safety.

So... The next time your kid comes home from school beat up, or has a crazy story about the kid who spazzes out without his "chill pill" or better yet, tells you about the kid who gets angry because he just "can't get it"... in the back of your mind you'll start to be like me, thinking... "His parents probably smoke(d)!" "Or worse, they're voting for TRUMP!" 😵