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ABC by LMC midwives: an innovative intervention to support women to become smoke-free in pregnancy

Abstract:

Background: Smoking in pregnancy is associated with significant adverse outcomes for women and their babies. Certain population groups contribute disproportionately to smoking prevalence in New Zealand such as younger women and Maori women. It is however a modifiable risk factor and midwives have a role to play in supporting women to achieve smoke-free pregnancies. Objective: This was a demonstration project designed to assess whether frequency of midwives’ smoking cessation advice within the home environment had an impact on smoking rates for the women and their wider household contacts over a 15 month period. Method: A prospective observational study audited the results of smoking cessation intervention practices provided by six Lead Maternity Carer (LMC) midwives using the ABC framework. Demographic and smoking data were collected by the midwives, on each woman who smoked, during a 15 month period. This included women who were already being cared for at the time when data collection commenced as well as women who registered for care subsequently. Data were also collected on the smoking status of partners and other household members, and on the frequency with which the midwives had discussions with the women and others about smoking. Findings: Young and Maori women within this project were more likely to become smoke-free than others. A significant number of the women lived in households with other smokers, which may have made it more difficult for them to become smoke-free. The midwives provided smoking cessation interventions using the ABC to the women with varying frequency; however, the frequency of these interventions did not appear to be related to the likelihood of the women becoming smoke-free. The midwives did not provide ABC at every single visit for every woman; however, for some women it was provided more often than for others. Conclusion: Although midwifery care is provided within, and acknowledges the woman’s context, the majority of women in this project faced considerable day-to-day challenges to becoming smokefree, as they lived in households with others who also smoked. Broad strategies are needed to reduce smoking, that reach beyond the realm of midwifery practice and the health care sector, such as wider tobacco control policies, public health campaigns and smoke-free environments.

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continuity of care, Lead Maternity Carer, midwife, smoking cessation, Smoking in pregnancy, young women