A Midland midwife has branded Government targets to reduce levels of smoking in pregnancy by 2010 "unreliable and unrealistic".
An initial target of 23 per cent was set in 1998, but fell to 18 per cent in 2005 and trusts are now expected to reach 15 per cent, with the extra requirement of cutting this rate one per cent year on year.
In an article in today's British Medical Journal, Carmel O'Gorman, a midwife at Good Hope Hospital, Sutton Coldfield, claims this is not realistic when only one in four primary care trusts reached targets between 2005-07.
Good Hope, run by Heart of England NHS Foundation Trust, has managed to cut smoking levels in mothers-to-be from 18.6 per cent in 2004/05 to just over 16 per cent this year, Ms O'Gorman admits many hospitals are struggling to do so.
She said: "Recording whether a pregnant woman is a smoker or not has been a mandatory requirement in maternity units since 2003.
"Although Good Hope does serve communities where there are pockets of deprivation, I realise we are not necessarily the norm.
"Women do fear being branded a bad mother, so women are not always honest."
Smoking is linked to low birth weight plus an increased risk of miscarriage and stillbirth.
In Britain smoking during pregnancy was linked to about 14,000 low weight births, 5,000 miscarriages and 400 still births last year.
Figures released by the Perinatal Institute, in Aston, show Birmingham is not far off the national target, with smoking during pregnancy reduced to 15.8 per cent.
Professor Jason Gardosi said: "This is primarily due to the low smoking rate in expectant mothers of Asian origin, less than two per cent.
"However this conceals the fact that 23.7 per cent of British European mothers in Birmingham still smoke during pregnancy."
Ms O'Gorman, who specialises in smoking cessation, said Department of Health targets were out of reach for most trusts because they were based on poor quality data.
The midwife believes an anonymous, nationwide survey of pregnant women should be carried out at all ante-natal appointments to establish a truer picture and a better base for such targets.
She also suggests levels of cotinine, a byproduct of nicotine which remains in the blood longer, should be monitored during pregnancy and at delivery.
This is not always due to the mother-to-be smoking, as one in five pregnant women are exposed to secondary smoke by their partner. * To read the full report visit www.bmj.com