Expectant mothers smoke more in Finland than in the other Nordic countries, and the southern city of Hämeenlinna has decided to do something about it. Carbon monoxide monitors are now a routine part of maternity clinic visits there.

The harmful effects of tobacco on foetuses have been known for decades, yet 15 percent of pregnant women in Finland still smoke. Numbers of pregnant smokers in other Nordic countries have been falling in recent years, but the percentage has remained stagnant in Finland.

Young and single moms-to-be smoke the most. Studies show that of under 20-year-old expectant mothers, half smoke cigarettes.

Tobacco has many adverse health effects for babies, many of which linger well into childhood. Nicotine has been shown to constrict the blood vessels in the placenta and limit the flow of oxygen, affecting the development of the brain and stunting growth.

A better head start Taru and Vili Lahtinen of Hämeenlinna are expecting their first child, and the chances that it will be healthy are now considerably better because Taru quit her five-year smoking habit as soon as her pregnancy test showed positive.

"It was a no-brainer that I would stop, and it was easier than I thought it would be. Mainly I found myself wondering why I hadn't done it earlier," she said.

Most of her extended family smokes. "Everyone supported me, and my mom said it was great. Even my grandmother, who also smokes, said that I shouldn't start again," she said.

New carbon monoxide monitors
The southern city of Hämeenlinna's maternity clinic's head doctor Anu Mähönen says the risks that smoking while pregnant present go beyond possible health problems for the baby.
"The risk of premature childbirth and even miscarriage is considerably higher than for mothers who don't smoke," she says.
This is why her facility has added carbon monoxide monitors to their prenatal examination regimen. All expectant mothers and their partners are asked to breathe into a tube attached to the handheld monitor on their first visit to the clinic.
"We wanted to invest in this important issue: smoke-free babies. Other municipalities have seen some good results using the carbon monoxide monitor, as they have finally gotten the pregnant smoking figures to go down," Mähönen says.

Dads should quit, too
Blowing into the monitor is voluntary, but the municipality's health care staff has been happy with the reception so far. In Hämeenlinna, partners are also asked to take the test, as passive smoking has also been scientifically shown to affect oxygen intake.

"If the pregnant woman's spouse smokes in the yard before the couple leaves for the clinic and they drive to the appointment together, we can see in the monitor reading that the mother-to-be has a significant amount of carbon monoxide in her system, enough to have an effect on the foetus," says Mähönen.

The Hämeenlinna maternity clinic offers smokers several programmes to kick their nicotine habit, so they can choose an option that suits them best. Group treatment, peer support groups and expert advisors in nicotine replacement products are just a few of the alternatives.

Taru's partner Ville plans to quit using tobacco before their first-born arrives in the world. He currently smokes three to five cigarettes a day. Taru says it's important that Ville also quit.

"Primarily so I won't start again, and so the baby won't be exposed to the cigarette smoke. The smell clings to clothing, too," she says.

Getting tough on smokers
In 2010 Finland made history by passing legislation designed to eliminate smoking entirely by the year 2030. Nicotine product advertising has been banned since 1978, smoking at work since 1995, and in bars and restaurants since 2007.

The National Institute for Health and Welfare (THL) reports the popularity of smoking cigarettes has declined steadily over the last two decades. Levels were once as high as 60 percent, but as of 2015, they were down to 17 percent. Sweden currently has the lowest smoking rate in Europe, at 15 percent. Meanwhile neighboring Russia has one of the world's highest rates, above 39 percent, with Estonia around 32 percent.