A Targeted Implementation Strategy to Reduce Smoking in Pre and Post Natal Women

An evidence-based guideline focused on smoking cessation, published by a provincial nursing association in Canada has had widespread uptake across all sectors in health care provincially, nationally and internationally, with increasing impact on practice and policy changes involving nurses and other members of the interprofessional team.  A system-wide implementation program has been funded for several years by the Ontario Ministry of Health and Long-Term Care, which has been designed to support the uptake of evidence in smoking cessation practice.  This multi-pronged strategy, which is founded on the evidence-based best practice guideline, includes a focus on: building networks of champions; engaging students and schools of nursing with integration of best evidence into the curriculum and clinical placements; developing resources and tools derived from the guideline; evaluation and feedback; use of social media and web-based resources; provincial partnerships and coaching by experts.  Recently, this well established program has expanded to include a focus on the specific population of pregnant and postpartum women in order to build capacity for nurses who care for pregnant and postpartum women in primary and community care settings.

Smoking has been identified as the most important modifiable cause of pregnancy complications for otherwise low-risk women.  Significant complications associate with maternal smoking during pregnancy impact the health of the fetus, the woman and the family with whom she resides.  It is recognized as a significant public health concern as smoking increases the risk of adverse pregnancy outcomes including low birth weight, spontaneous abortions, stillbirth and prematurity. Adverse maternal health outcomes from tobacco exposure include cancer, heart disease, infertility and stroke.  As 60 to 80 per cent of women who quit smoking during pregnancy resume smoking during the first year postpartum, the risks of tobacco–related exposure through environmental tobacco smoke and nicotine and other toxins in breast milk continue beyond pregnancy. 

For many women, pregnancy is a time of heightened awareness of health risks, as well as a significant period of preparedness, which could lend itself to behaviour change.  Pregnant women also have considerable exposure to health care providers, providing numerous opportunities for dialogue and behaviour change.  Subsequently, there are many teachable moments throughout pregnancy, and evidence supports a tailored approach to cessation for this population.  However, smoking in pregnancy is associated with guilt and shame, and many women do not ask for help. As our social landscape changes and important legislation is enacted to restrict where people can smoke, pregnant women who smoke may become more isolated and ostracized.  This isolation may have negative effects on a pregnant smoker’s self-esteem, hindering the successes in harm reduction or quitting smoking altogether.  It is up to health care providers working with this population of women to open up the channels of communication and increase the dialogue about smoking in a non-judgemental way.

There are many benefits to integrating cessation interventions, health promotion and harm reduction approaches in the daily work of nurses. As such, enhancing nurses’ and other health professionals’ knowledge and skills in the area of smoking cessation for pre and post natal women is essential to support cessation and mitigate the increased risks of perinatal mortality and morbidity.   This targeted smoking cessation program aims to augment nurses’ and nurse practitioners’ knowledge and skills in smoking cessation in primary and community care settings where pregnant and postpartum mothers access services. Further, the project seeks to build capacity to support interdisciplinary teamwork and leadership in effective smoking cessation for pre and postnatal women and to increase awareness of key resources in smoking cessation for this population.

This presentation will highlight the various strategies that have been integrated within the program to support the uptake of evidence in practice, the health promotion approaches being utilized, and the various smoking cessation resources developed to support quality care for pregnant and postpartum mothers.  Program evaluation results will be shared which illustrate the impact of this program on nursing and primary health care practices and the perceived impact on pre and postpartum women and their families.