title: Which role do midwives and gynecologists have in smoking cessation in pregnant women? - A study in Flanders, Belgium.
abstract: OBJECTIVE
  The objectives of our study were (1) to explore knowledge, beliefs and practice among midwives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.
  
  
  METHODS
  We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A's framework (Ask-Advise-Assess-Assist-Arrange).
  
  
  RESULTS
  The national smoking cessation policy seemed to be insufficiently known. "Ask" and "Advise" were part of a standard prenatal consultation, the next three steps were rarely implemented. Participants had a negative image of "the smoking pregnant woman": a low educated woman with a smoking partner and "bad examples" in their history. Reported barriers were fear of provoking resistance and lack of time and communication skills regarding smoking cessation.
  
  
  CONCLUSIONS
  These findings suggest that training in communication skills and dealing with resistance should be offered, i.e. by using motivational interviewing. It could be considered that a trained midwife or tobaccologist is part of an obstetrical team or that the AAR-method (Ask-Advise-Refer) is used instead of the 5 A's framework.
authors.affiliation: Odisee University College, Hospitaalstraat 23, Sint-Niklaas 9100, Belgium. Electronic address: Katrien.dewilde@odisee.be.
authors.forename: Katrien
authors.initials: K
authors.lastname: De Wilde
authors.affiliation: Odisee University College, Hospitaalstraat 23, Sint-Niklaas 9100, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Tency
authors.affiliation: Odisee University College, Hospitaalstraat 23, Sint-Niklaas 9100, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steckel
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent 9000, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Stop-smoking Clinic, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium.
authors.forename: Hedwig
authors.initials: H
authors.lastname: Boudrez
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent 9000, Belgium.
authors.forename: Lea
authors.initials: L
authors.lastname: Maes
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D002983:Clinical Competence; D003376:Counseling; D005260:Female; D019983:Guideline Adherence; D006176:Gynecology; D006801:Humans; D008880:Midwifery; D062405:Motivational Interviewing; D009774:Obstetrics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D037841:Pregnant People; D011295:Prenatal Care; D024382:Professional Role; D012017:Referral and Consultation; D016540:Smoking Cessation; D000074606:Smoking Prevention
keywords: Counseling; Gynecologists; Midwives; Pregnancy; Smoking cessation