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Using a breath CO analyser to improve rate of referrals for smoking cessation during pregnancy: An exploratory single-case evaluation

Abstract:

Background: Smoking in pregnancy negatively impacts pregnancy outcomes and wellbeing in infancy and childhood. While midwives are increasingly offering brief advice, cessation support and referral for smoking cessation, the data collected from a significant number of midwifery practices suggests that an estimated 79% of women decline referral. Aim: The aim of this single-case evaluation was to assess if voluntary use of an exhaled carbon monoxide (CO) test would increase referral rates to smoking cessation services. Because of the high rates of smoking during pregnancy by women who identify as Maori (43%), the focus was the practice of a midwife who works with pregnant Maori women. Method: This was an exploratory single-case evaluation including all women who reported that they smoked when they registered with the midwife. The midwife introduced the breath CO analyser (CO test machine) as a way of measuring mother’s and baby’s levels of CO and use was voluntary. Data gathered included: use of the breath CO analyser and number of referrals to cessation services. Additionally, an interview was conducted with the midwife on how the breath CO analyser was used. Simple descriptive statistics were produced and proportions reported. The interview was analysed deductively. Findings: Thirteen pregnant women participated in this study. Seven consented to use the analyser and six declined. Of the 13 women who were offered the analyser, 9 (69%) accepted and 4 (31%) declined referral to a smoking cessation service. The midwife perceived that the analyser made it easier for her to discuss smoking with her clients. Conclusion: The breath CO analyser may be a useful tool for supporting midwives, who care for a high number of women who smoke, to initiate discussions about smoking cessation while pregnant, and to increase acceptance of referral to cessation services. Further research is needed to determine the effectiveness of a breath CO analyser as a tool for midwives nationwide, as well as to determine extra time and resources that may be required.

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carbon monoxide testing, indigenous women, pregnancy, referral, smoking