You are entitled to your opinion and I will grant you two points. Point one, I wouldn't really have told here that her children would be better off if she were dead - it was just an idle daydream of mine. Point two - yes, the early stages of labour isn't the best time for some health promotion. But she wasn't distressed and sometimes you just have to say something. Now to the meat... I read a couple of your blogs posts a day or two ago, and thought that I'd stop by in a bit for a closer look. Having read one or two posts that mention Paramedics, I'd say you have a rather low opinion of us ambulance people, something that you, maybe unconsciously, show when you refer to me in your post as an 'ambulance driver'. Tut, tut, unless you do know that this is the quickest way to get our backs up. I'll put some comments in the relevant posts when I finish here. However, from what you write, I'm guessing that you are a GP, and I've been a shade dismissive of some of them myself over treatment of such common occurrences as MIs and asthma attacks. The thing is... My personal view of smoking has been coloured by seeing children die from asthma and cot death, where both parents smoke, and the relationship between smoking and childhood illness is a strong one. (for example the reference to research here) More research here and here Us ambulance people have a role in health education, just as everyone in the NHS has a role. Sure my timing could be better, but seeing a pregnant woman smoking, and then joking about it (the very common 'low birthweight is a good thing' that another commentor has noted) is enough to make me a shade angry. So, yes, bad timing perhaps, but I'm human too, and I get the occasional emotional response to something that is so stupid it makes my eyes bleed. Just remember that I'm around three times more likely to find myself at that house dealing with a cot death, than in a non-smoking house. At the end of the day, she didn't care what I said, she just sent her kids to stand out in the cold so she could smoke in the warm... How much should I respect a person like that?