Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

OBJECTIVE: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding. DESIGN, SETTING AND PARTICIPANTS: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care. Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction, a programme of education and support for breast feeding or both programmes. Sixty-one midwives recruited a total of 297 women. INTERVENTIONS: Structured programmes provided by midwives. FINDINGS: Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced, stopped smoking or maintained smoking changes than women in the control group, at 28 weeks and 36 weeks gestation. Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation. There was no difference in rates of cessation or reduction between the groups in the postnatal period. There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed. KEY CONCLUSIONS: Education and support by midwives, as part of primary midwifery, can facilitate smoking cessation and reduction during pregnancy.

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy.

This study describes the development and evaluation of education programmes and associated resource materials to support smoking cessation and reduction, and breastfeeding promotion strategies for pregnant women who smoke, during usual primary maternity care by midwives. Education programmes and resource materials were developed by midwives and researchers as part of a cluster randomized trial of Midwifery Education for Women who Smoke (the MEWS study). Development included a cohort study, advice from lactation consultants and smoking cessation counsellors (including Ma-ori professionals), and early consultation with midwives who would be delivering the programmes. Resources developed included videotapes, charts and laminated information cards. Resources were pre-tested with pregnant women and opinion leaders. Consultation with the midwives allocated to each of the intervention groups in the trial raised a number of issues. These were addressed, and solutions incorporated into each of the programmes, to enable effective delivery within usual care. Following delivery of the programmes, women and their midwives were surveyed and a sample interviewed to ascertain attitudes to the programmes and resources. Women and their midwives responded positively to the smoking cessation education programme, the breastfeeding promotion programme and the resources used. Those women who did not stop smoking completely often succeeded in significantly reducing their tobacco consumption. Women identified their midwife as a valuable resource and appreciated her ongoing encouragement. Involvement of health professionals who are to deliver health promotion interventions is essential for successful integration of programmes into usual care. Midwives were able to effectively deliver programmes that were developed and targeted to their needs as health educators. The pregnancy-specific resources developed for women who smoke played an important part in helping midwives deliver their health promotion messages more effectively.

The midwife's role in facilitating smoking behaviour change during pregnancy.

OBJECTIVE: To explore the midwife's role in providing education and support for changes in smoking behaviour during usual primary maternity care. DESIGN: A qualitative study using a thematic approach to analysis of data collected in face-to-face interviews. SETTING AND PARTICIPANTS: Eleven women who had participated in the intervention groups of the MEWS Study, a cluster randomised trial of education and support for women who smoke, and 16 midwives from the intervention and control arms of the trial. The trial was set in the lower North Island of New Zealand in 2000. FINDINGS: Midwives acknowledged that asking women about smoking was part of their role as maternity care providers. However, many found it difficult to know how to ask women about their smoking, how to identify the women who would be receptive to advice and how to support them to make changes to their smoking. Midwives were also concerned about making women feel guiltier than they already did about their smoking, and about the impact of providing smoking cessation on their relationship with women. In contrast, women expected their midwife to ask them about their smoking. When women wanted to quit their midwife was an extremely valuable source of information and support. Midwives were also in a position to help women who did not want to quit to make other changes to their smoking behaviour. Even women who did not want to quit were prepared to be asked about their smoking. Problems arose when the way the midwife asked and the frequency of her enquiries were not appropriate for the stage of the change cycle the woman was in. IMPLICATIONS FOR PRACTICE: Midwives can effectively provide education and support for smoking change during pregnancy if they match the woman's readiness to make changes with the type of advice and support they provide.