title: 'Breathe': the stop smoking service for pregnant women in Glasgow.
abstract: OBJECTIVE
  to develop a pragmatic service for pregnant smokers.
  
  
  METHODS
  identification and referral of pregnant smokers to specialist services using self-report gathered on routine pregnancy booking questionnaire augmented by a carbon monoxide breath test. Engagement by specialist smoking cessation midwives using telephone contact with the offer of clinic-based counselling for women who want help. Telephone support and pharmacy provision of nicotine replacement therapy for women who decide to quit.
  
  
  METHODS
  three maternity units serving Glasgow in the West of Scotland.
  
  
  METHODS
  a relatively deprived population of 12,000 pregnant women each year in Glasgow.
  
  
  METHODS
  at maternity booking, women with either a carbon monoxide breath test result >7 parts per million or self-reporting to be a current smoker during the routine pregnancy booking questionnaire were identified as smokers. All smokers were referred on to the specially trained midwives who provided an opt-out smoking cessation intervention. This involved motivational interviewing to engage pregnant smokers during telephone contact. Women considering quitting were invited for a follow-up face-to-face meeting in a clinic setting. Women who set a quit date were offered withdrawal oriented therapy augmented by pharmacy-based nicotine replacement therapy.
  
  
  RESULTS
  booking midwives found it difficult to approach all pregnant women to talk about smoking. This was not made easier by the service requirement that all pregnant women should provide a carbon monoxide breath test at maternity booking. In one hospital, auxiliary nurses performed the carbon monoxide breath test and 2879 of 3219 (89%) women booking for antenatal care provided a sample, allowing most smokers to be identified. In another hospital where the carbon monoxide test was administered by midwives, only 1968 of 5570 (35%) women provided a carbon monoxide breath test sample; 61% of pregnant smokers were not identified and referred to specialist services. Of the 1936 pregnant smokers referred from all three hospitals, 386 (20%) attended a face-to-face appointment with specialist smoking cessation midwives, 370 (19%) set a quit date and 117 (6%) had quit 4 weeks after their quit date.
  
  
  CONCLUSIONS
  this service development provides a pragmatic approach to identify nearly all pregnant smokers at maternity booking, and an opt-out model to refer them to specialist smoking cessation services. Further research is required to establish if extra auxiliary staff in maternity booking clinics can optimise the identification and referral of pregnant smokers to specialist smoking cessation services. This telephone- and clinic-based specialist service engaged 20% of referred pregnant smokers to attend a face-to-face appointment with a specialist smoking cessation midwife. Further research is required to assess if home-based support would engage a greater proportion of pregnant smokers, or if an incentive scheme would achieve the same aim. In total, 117 of 370 (32%) women who set a quit date had quit smoking 4 weeks later, which compares fairly well with a figure of 40% for pregnant smokers in the English smoking treatment services.
authors.affiliation: Smoking Concerns, NHSGGC Dalian House, 350 St. Vincent Street, Glasgow G3 8YZ, UK.
authors.forename: Agnes
authors.initials: A
authors.lastname: McGowan
authors.forename: Shirley
authors.initials: S
authors.lastname: Hamilton
authors.forename: Deborah
authors.initials: D
authors.lastname: Barnett
authors.forename: Margaret
authors.initials: M
authors.lastname: Nsofor
authors.forename: Judith
authors.initials: J
authors.lastname: Proudfoot
authors.forename: David M
authors.initials: DM
authors.lastname: Tappin
mesh_terms: D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis; D003376:Counseling / Q000458:organization & administration; D005260:Female; D005731:Ganglionic Stimulants / Q000627:therapeutic use; D006801:Humans; D009538:Nicotine / Q000627:therapeutic use; D009721:Nurse Midwives / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000458:organization & administration; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D012944:Social Support; D013689:Telephone
chemical_list: D005731:Ganglionic Stimulants; D009538:Nicotine; D002248:Carbon Monoxide