Smoking In Pregnancy
Informing women of the dangers of smoking in pregnancy and supporting them in a quit attempt is one of the important health promotion activities of the midwife.
Broaching the subject of smoking can be difficult and some midwives feel that they may come across as judgemental and thus avoid the issue.
It is important to achieve a balance between informing the woman and offering support and alienating the smoker who does not want to stop.
Are they ready for change?
The Process of Change
Raw (1986)
Seventy percent of smokers are considering change, this process of contemplation may take several years before they are ready to stop. when the individual perceives the benefits of stopping outweigh the cost and when they really believe change is possible they will seek information and support. Most addicts find change difficult to maintain, and smokers on average relapse three to four times before being successful.
Raising the issue
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Ask open questions such as "how do you feel about your smoking?" "what do you most enjoy about smoking?" "Why do you want to stop smoking?"
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Be non-judgemental
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Establish what stage of change they are at
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Match messages to stage of change
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If not ready to change, leave door open
Supporting a quit attempt
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Arrange prescription for Nicotine Replacement therapy (NRT), NRT doubles the chance of success and is safe in pregnancy.
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Give information on withdrawal symptoms
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Plan alternative behaviours, and avoidance of "triggers"
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Set a quit date
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Review and offer support on a regular basis
There are organisations country-wide that will provide you with training and information (free of charge) to help you to provide smoking cessation advice to women.
Logo provided by NHS: Smoking Don't give up giving up campaign
Bibliography
Department of Health (2002) Helping Smokers Stop: a new approach for health professionals London Department of Health
Dunkley J (2000) Health promotion in midwifery practice: A resource for health professionals London Bailliere Tindall
Lancaster T Silagy C Fowler G (2003) Training health professionals in smoking cessation (Cochrane Review) The Cochrane Library Issue 3 Oxford Update Software
National Institute for Clinical Excellence [NICE] (2002) Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation Technology Appraisal Guidance No. 38 London NICE
Raw M (1986) Smoking cessation strategies in: Miller W & Heather N (Eds) Treating addictive behaviours: processes of change New York Plenum
Michelle Southam © 2003