Women's experiences of smoking during and after pregnancy as ascertained two to three years after birth

Lendahls, Lena; Öhman, Laila; Liljestrand, Jerker; Håkansson, Anders

doi:10.1054/midw.2002.0312

Cited by 31 publications

(66 citation statements)

References 34 publications

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“…Women and partners in the review studies talked about the benefts of a smoking break by themselves or with others. 111,115,120,[122][123][124][125] This was mirrored in our interviews. Smoking was a key part of daily routine, relieving boredom and providing a welcome pause and time away from other children, an unemployed partner or other members of the household.…”

Section: Stress and Enjoymentsupporting

confidence: 57%

“…For younger women in particular, this was seen as particularly important in maintaining friendships and social standing. 123,124,129,130,136,139 Community influences supporting smoking cessation Community influences also supported women's efforts not to smoke, although less often than they supported continued smoking. In the reviews, smoking in pregnancy -and, to a lesser extent, resuming smoking post partum -aroused disapproval from some peers, particularly when the pregnancy was visible.…”

Section: Community Influences Hindering Smoking Cessationmentioning

confidence: 99%

“…This was also evident in the review of pregnant women's views, in which advice on cutting down was perceived as being understanding of difficult life circumstances and of the perceived stress that 'abrupt' stopping might cause. [116][117][118][119]123,124,127,136,140 The referral process from midwives or GPs to a SSS was a focus of the interviews and an important organisational element. Area A had an opt-out pathway and, despite some controversy about this (e.g.…”

Section: Organisational Factors Supporting Smoking Cessationmentioning

confidence: 99%

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Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

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Background: Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). Objectives: To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design: Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/ improved interventions for future testing. Setting: Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants: Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures: The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results: Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural s...

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Section: Stress and Enjoymentsupporting

confidence: 57%

Section: Community Influences Hindering Smoking Cessationmentioning

confidence: 99%

Section: Organisational Factors Supporting Smoking Cessationmentioning

confidence: 99%

See 1 more Smart Citation

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

View full text Add to dashboard Cite

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“…While some health care professionals view such prompts as promoting a prescriptive rather than sensitive approach to discussing smoking (Flemming et al ., 2016), our participants indicated that improved prompts could help encourage and inform smoking discussions. Integrating agreed scripts to aid discussion around smoking could help professionals present a clear and comprehensive picture of the risks and avoid the common practice of raising only certain risks to minimize upset, which is largely at odds with the information preferences of pregnant smokers (Arborelius & Nyberg, 1997; Lendahls et al ., 2002). Health care professionals have reported interest in scripts for discussing smoking with pregnant women (Colomar et al ., 2015), and a midwife‐delivered standardized ‘risk perception’ intervention has already been implemented in North East England as part of an opt‐out referral pathway (‘BabyClear’) (Bell et al ., 2017).…”

Section: Discussionmentioning

confidence: 99%

“…These include a perceived reticence to discuss smoking, reinforcing and praising cutting down behaviour, and failing to provide practical help or revisit smoking at subsequent appointments (Flemming et al ., 2015; Lendahls, Ohman, Liljestrand, & Hakansson, 2002; Naughton, Eborall, & Sutton, 2013). From the perspective of pregnant or recently pregnant women, therefore, the way health care professionals manage smoking, and health care organizations support their staff to do so, could be improved.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

Naughton

Hopewell

Sinclair

et al. 2018

British J Health Psychol

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ObjectivesHealth care professionals and the health care environment play a central role in protecting pregnant and post‐partum women and their infants from smoking‐related harms. This study aimed to better understand the health professional's perspective on how interactions between women, health care professionals, and the environment influence how smoking is managed.DesignSemi‐structured interviews and focus groups.MethodsData were from 48 health care staff involved in antenatal or post‐partum care at two UK sites, including midwives, obstetricians, health visitors, GPs, pharmacists, service commissioners, and Stop Smoking Service (SSS) advisors and managers. Thematic analysis was guided by a social–ecological framework (SEF).ResultsThemes were divided across three SEF levels and represented factors connected to the management of smoking in the health care context and the beliefs and behaviour of pregnant or post‐partum smokers. Organizational level: Service reconfigurations, ‘last resort’ nicotine replacement therapy prescribing policies, and non‐mandatory training were largely negative factors. There were mixed views on opt‐out referral pathways and positive views on carbon monoxide monitoring. Interpersonal level: Protection of client–professional relationships often inhibited frank discussions about smoking, and weak interservice relationships affected SSS referral motivation and quality. Individual level: Professionals felt community midwives had primary responsibility for managing smoking, although midwives felt underskilled doing this. Midwives’ perceived priority for addressing smoking was influenced by the demands from unrelated organizational initiatives.ConclusionsOpportunities to improve clinical support for pregnant smokers exist at organizational, interservice, and health care professional levels. Interactions between levels reflect the importance of simultaneously addressing different level‐specific barriers to smoking cessation in pregnancy. Statement of contribution What is already known on this subject? Few health care professionals discuss smoking cessation support with pregnant or post‐partum women.Identified health care professional‐related barriers to supporting pregnant and post‐partum women to stop smoking include deficits in knowledge and confidence, perceived lack of time, and concerns about damaging client relationships.There is currently a gap in understanding regarding the barriers and facilitators to supporting this group and how interactions between the health care environment and health care professionals influence the way smoking is addressed. What does this study add? This study identifies modifiable factors that can influence cessation support delivery to pregnant and post‐partum women.These factors are mapped across organizational, interpersonal, and individual health care professional levels.Service structure, communication pathways, and policies appear to influence what cessation support is offered.Interpersonal and individual factors influence how this support is deliver...

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Midwives' Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco Dependence Treatment

Abatemarco

Steinberg²,

Delnevo³

2007

J Midwife Womens Health

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Clinical practice guidelines and evidence-based reviews confirm the efficacy of tobacco dependence treatment for pregnant women. The purpose of this study was to examine tobacco dependence treatment practices among certified nurse-midwives who treat pregnant women who smoke. Midwives were surveyed to determine knowledge, perceptions, and beliefs about tobacco cessation treatment and to identify practice environmental factors that support treatment practices. Half of all midwives had not heard of the US Public Health Service Guidelines (5 A's) to assist smokers in cessation treatment. We found varying levels of adherence to the clinical practice guidelines. Nearly all midwives routinely ask, advise, and assess; while fewer encourage patients to set a quit date or discuss medication options (assist) and perform follow-up activities (arrange). Barriers significantly associated with clinical tobacco treatment practice are lack of training and competing priorities in the visit. One-office support, a system in place to provide smoking cessation information and resources, was associated with increased practice. In summary, midwives believe they should be providing tobacco dependence treatment, yet they identify a need for training. The findings of this study also indicate that sustained practice change, which includes the entire practice environment, should be targeted to enhance tobacco dependence treatment.

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Women's experiences of smoking during and after pregnancy as ascertained two to three years after birth

Cited by 31 publications

References 34 publications

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

Midwives' Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco Dependence Treatment

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