title: Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth.
abstract: OBJECTIVE
  To explore barriers and facilitators to smoking cessation experienced by women during pregnancy and postpartum by undertaking a synthesis of qualitative studies.
  
  
  BACKGROUND
  The majority of pregnant women are aware that smoking in pregnancy compromises maternal and infant health. Despite this knowledge, quit rates among pregnant women remain low, particularly among women in disadvantaged circumstances; disadvantage also increases the chances of living with a partner who smokes and returning to smoking after birth. A deeper understanding of what hinders and what helps pregnant smokers to quit and remain ex-smokers postpartum is needed.
  
  
  METHODS
  A synthesis of qualitative research using meta-ethnography.
  
  
  METHODS
  Five electronic databases (January 1990-May 2013) were searched comprehensively, updating and extending the search for an earlier review to identify qualitative research related to the review's aims.
  
  
  METHODS
  Following appraisal, 38 studies reported in 42 papers were included and synthesized following the principles of meta-ethnography. Over 1100 pregnant women were represented, the majority drawn from disadvantaged groups.
  
  
  RESULTS
  Four factors were identified that acted both as barriers and facilitators to women's ability to quit smoking in pregnancy and postpartum: psychological well-being, relationships with significant others, changing connections with her baby through and after pregnancy; appraisal of the risk of smoking.
  
  
  CONCLUSIONS
  The synthesis indicates that barriers and facilitators are not fixed and mutually exclusive categories; instead, they are factors with a latent capacity to help or hinder smoking cessation. For disadvantaged smokers, these factors are more often experienced as barriers than facilitators to quitting.
authors.affiliation: Department of Health Sciences, University of York, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Flemming
authors.affiliation: Department of Health Sciences, University of York, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: McCaughan
authors.affiliation: Institute for Social Marketing, University of Stirling, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Angus
authors.affiliation: Department of Health Sciences, University of York, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Graham
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology* / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology
keywords: literature review; midwives; pregnancy; qualitative research; smoking; systematic review