You are an FY2 in a postnatal Ward
Personal Details:
Name: Sarah Wilson
Age: 32
Medical Record:
Past medical history: Para 1. Delivered a healthy baby boy one week ago. Normal vaginal delivery.
Regular medication: non
Allergies: None known.
Notes:
You are in the postnatal ward. Sarah is a new mother who is a heavy smoker (20-30 cigarettes/day). She continued to smoke throughout her pregnancy and has not stopped since delivery. Her husband is also a smoker. The midwife has asked you to speak with her about smoking cessation.
Task:
1. Counsel her on the importance of stopping smoking for her health and her baby’s.
2. Discuss smoking cessation methods and create a plan.
Opening Sentence: “Hi, Doctor. The midwife said you wanted to talk to me?”
Open History (to give freely): “I know it’s about the smoking. I tried to stop when I was pregnant, I really did, but it’s so hard. I’ve been smoking since I was 15. It’s the only thing that calms me down, especially now with the baby and everything.”
Cues to give: “My husband smokes too, so it’s hard to be the only one stopping.”
ICE (Ideas, Concerns, Expectations):
Ideas: “I know it’s bad, but I smoke outside, so I don’t think it can harm the baby now he’s born.”
Concerns: “I’m worried I won’t be able to cope without cigarettes. Will I get really stressed and be a bad mum?”
Expectation: “I suppose you’re just going to tell me off and tell me to stop.”
How to Act: You are tired, a bit defensive, and feel guilty. You are worried about being judged. You love your baby but feel overwhelmed.
More History (only if asked): The baby is doing well, breastfeeding, and has no issues. You feel a strong urge to smoke after feeds and when you feel stressed. Your husband smokes in the house, but you try to smoke by the back door. You have tried to quit before, but it only lasted a day.
Social History: You live with your husband. Both of you smoke.
Questions to ask:
“Is it really that harmful if I’m not smoking in the same room as him?”
“Are the nicotine patches safe while I’m breastfeeding?”
Opening & Building Rapport:
Hi Sarah, I’m Dr. [Name]. Firstly, many congratulations on your new baby boy! He’s beautiful. How are you feeling in yourself? How are you coping with everything?
Introducing the Topic (Non-judgmentally): The midwife asked me to have a chat with you about smoking. I’m not here to lecture you at all. My job is to support you. Can we talk a little bit about it?
Smoking History & Readiness to Quit: You mentioned you’ve found it hard to stop. Can you tell me about your smoking? How many do you smoke a day? When do you find you most want a cigarette? What have you tried in the past to help you stop?
You mentioned your husband smokes, too. Have you ever talked about quitting together?
ICE (Ideas, Concerns, Expectations):
What are your own thoughts on how smoking might affect the baby now that he’s born?
What’s your biggest worry when you think about stopping smoking?
What were you expecting me to say today?
Explain the situation:
Hi Sarah, thanks for chatting with me. And congratulations on your beautiful baby boy! I’m not here to tell you off at all. I’m here to see how we can support you. I know how incredibly difficult it is to stop smoking, especially when you’re feeling stressed and have been doing it for a long time. We’re here to help, not to judge.”
Addressing and answering the patient’s ICE:
You mentioned that you smoke outside to protect the baby. It’s great that you’re thinking about that, but unfortunately, the harmful chemicals from smoke linger on your clothes, your hair, and your breath for hours afterwards. When you hold the baby close, he is still exposed to them. This is called third-hand smoke, and it significantly increases his risk of serious problems like sudden infant death syndrome (SIDS), asthma, and frequent chest and ear infections.”
Next Steps:
The best thing for both you and your baby is to quit completely. You asked about the patches. Yes, nicotine replacement therapy (NRT) like patches, gum, or sprays is safe to use while breastfeeding. They give you the nicotine to help with the cravings, without all the other poisonous chemicals from the cigarette smoke. It’s much safer for the baby than smoking is. We can prescribe this for you before you leave the hospital.”
Self-help measures:
You also mentioned your husband smokes. It is almost impossible to quit if your partner doesn’t. It would be best if you could both try to quit together. We can provide the same support for him. There are also free local ‘Stop Smoking’ services that offer one-to-one support and have been proven to be very effective. We can give you their details.”
Quitting is the single most important thing you can do for your own health and your baby’s. It will reduce your risk of heart disease and cancer, and you’ll feel better and have more energy. We are here to help you start that journey today.
Addressing ideas, concerns, and expectations: Reframe the consultation from a lecture to a supportive, non-judgmental conversation. Correct her misconception about the safety of smoking outside. Reassure her that NRT is safe.
Offer and prescribe NRT. Provide a referral to local Stop Smoking services for both her and her husband. Emphasise the benefits for both mother and baby.
What is scenario testing? This is a health promotion and counselling station. It tests the candidate’s ability to use a non-judgmental, motivational interviewing style to encourage behaviour change. It requires knowledge of the risks of passive/third-hand smoke and the principles of smoking cessation, including NRT safety in breastfeeding.