title: Postpartum smoking relapse--a thematic synthesis of qualitative studies.
abstract: OBJECTIVE
  Many women quit smoking during pregnancy, but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on women's experience of postpartum smoking relapse.
  
  
  METHODS
  A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data.
  
  
  RESULTS
  We screened 1336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Women's beliefs about smoking as a means of coping with stress and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the fetus) appeared to be a factor in prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness and adjusting to a new mothering identity were also reported to be important.
  
  
  CONCLUSIONS
  Among women who quit smoking during pregnancy, those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress. Partner support and a sense of changed identity are cited as factors preventing relapse.
authors.affiliation: Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Notley
authors.affiliation: Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Blyth
authors.affiliation: Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Craig
authors.affiliation: Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
mesh_terms: D001294:Attitude to Health; D066249:Craving; D005260:Female; D006801:Humans; D009042:Motivation; D049590:Postpartum Period; D036301:Qualitative Research; D012008:Recurrence; D055502:Secondary Prevention; D012892:Sleep Deprivation; D012907:Smoking; D016540:Smoking Cessation; D012933:Social Identification; D012944:Social Support; D013315:Stress, Psychological
keywords: Postpartum period; qualitative synthesis; qualitative systematic review; tobacco smoking relapse; women's experience