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.


METHODS
A qualitative study using a thematic approach to analysis of data collected in face-to-face interviews.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
McLeod
Deborah
D
Department of General Practice, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand. dmcleod@wnmeds.ac.nz
Benn
Cheryl
C
Pullon
Susan
S
Viccars
Anne
A
White
Sonya
S
Cookson
Timothy
T
Dowell
Anthony
A
D000328:Adult; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000379:methods / Q000592:standards; D009035:Mothers / Q000193:education / Q000523:psychology; D009042:Motivation; D009520:New Zealand; D009721:Nurse Midwives / Q000592:standards; D024802:Nurse's Role; D015404:Nursing Methodology Research; D010353:Patient Education as Topic / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control* / Q000523:psychology; D011295:Prenatal Care / Q000379:methods; D012648:Self Care / Q000379:methods; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D016387:Women's Health