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Forty-one interviews were conducted with pregnant women. Participants were, on average, 26 years old and 19 weeks pregnant. Thirty-seven per cent said that they had stopped smoking. Interviews explored several topics, including women’s smoking behaviour, their thoughts about smoking in pregnancy, intentions to stop smoking, how midwives and other HPs discussed smoking, the smoking cessation support received and partner, family and friends_’smoking behaviour and attitudes. The main findings are presented inTable 8.

TABLE 8 Summary of main findings from pregnant women’s perspective

Finding Illustrative quotations from pregnant women

Women’s circumstances

Many of the women faced challenges such as living in large households, not living with their current partner, being carers of children or parents in ill health, preparing to be single mothers and being in financial insecurity with regard to welfare benefits and unstable jobs. Many described ongoing pregnancy and general health problems. Smoking was a well-established part of their routines, and served as a break from work or family life, and a way of coping with daily stress and boredom

It’s just really hard, plus this wee one stresses you out sometimes and it’s like the only time I get like a 5-minute break sort of thing . . . I kind of look forward to that break

Area A, pregnant woman 9, smoker

Risk perceptions

All women acknowledged a potential risk to the baby from maternal smoking. Although some gave detailed accounts of the risks, others expressed uncertainty about specific risks. Some women admitted that they avoided thinking or learning about the risks as they were unsettling, whereas for others their assessment of risk was the primary motivating factor in wanting to stop smoking

I don’t [think of the risks] . . . I’ve tried to avoid all the stuff because I don’t really want to know. I think you can get breathing problems . . . and they can be small . . . but to be honest that’s about all I know . . . I’d prefer not to know

Area B, pregnant woman 14, smoker

Self-belief and willpower

Those who reported having stopped smoking talked about having‘focus’, resilience in the face of setbacks and triggers,‘forcing’themselves and having a strong desire to stop smoking for the baby. Many reported less difficulty than expected to stop smoking. In contrast, women who were still smoking at interview spoke of the difficulty in stopping smoking, low desire or willpower to stop despite potential harm to the baby, and half-hearted quit attempts

On a night I’d crave it with a cup of tea and I just had to keep myself busy and go for a bath or something to take my mind off it

Area B, pregnant woman 21, non-smoker

I knew I wasn’t going to put my mind to it . . . to try and stop smoking

Area A, pregnant woman 2, smoker

TABLE 8 Summary of main findings from pregnant women’s perspective (continued)

Finding Illustrative quotations from pregnant women

Influence of partners

Women reported that their partner’s attitude towards smoking in pregnancy, whether or not their partner smoked and the support they offered, influenced the ease of stopping smoking

I think it’s harder with [partner] smoking because if he goes for a cigarette then I will go with him for one

Area B, pregnant woman 14, smoker

Influence of family and friends

Many women recalled conversations with family and friends about babies born with no apparent ill effects from maternal smoking. These experiences were used by some women to refute the risks communicated by HPs and to make them feel better about smoking

A few people have been quite nice about it, they’ve been like‘oh, it doesn’t matter, I smoked all the way through mine’and‘I’ve got two beautiful perfectly healthy kids’. . . and‘they smoked more than you’that makes me feel a bit better

Area A, pregnant woman 5, smoker

Workplace

The workplace was reported to make quit attempts easier or more difficult depending on routines, job demands and level of stress. Some work environments were dominated by a smoking culture, in which smoking, taking breaks and socialising with colleagues were inter-related

At work I smoke a lot more, I think it’s just, it’s the only kind of break that I get sometimes . . . it gets me away from the customers when they’re annoying me

Area A, pregnant woman 5, smoker

Midwife’s role and relationship with pregnant women

Women said that smoking in pregnancy was raised by midwives at the booking appointment. They described variation in the time devoted to the issue, however, with some feeling discussions were rushed with little detail about risks. Women often said their midwife was‘nice’,

‘supportive’and non-judgemental. They also said that midwives often reassured them about their smoking behaviour in early pregnancy or told them that they were doing well if they had cut down. Some women described a lack of pressure in their midwife’s approach to smoking

I think I tried to ask questions but she [midwife] kinda told me that she’s not a specialist . . . I did think my midwife would know what was dangerous and what wasn’t

Area A, pregnant woman 7, smoker

She said that she didn’t believe that she needed to sit and lecture me and that I could approach the subject with her . . . And actually that was what I wanted, I didn’t want an overbearing lecture, there is enough things going on during pregnancy

Area B, pregnant woman 9, smoker

CO monitoring

CO monitoring served as a visual indicator of risk to the baby and helped women understand the potential harm of smoking. Those screened often described shock and feeling ‘bad’or‘embarrassed’at seeing the result. When

repeatedly used, this was a tool that appeared to aid motivation and self-esteem

I didn’t realise exactly how much CO’s going in . . . once I’d seen that . . . I tried as much as possible to stop

Area A, pregnant woman 7, smoker

It was a confidence boost, thinking‘well that’s 2 weeks and it’s like, the nicotine, the carbon monoxide’s out my body, what’s it going to be like at 4?’

Area A, pregnant woman 12, non-smoker

NRT

Perceptions of NRT were mixed, but there were some positive accounts of using patches in pregnancy. Many of those trying the inhalator said it had helped them to cut down or stop smoking. There was some concern over the safety of using NRT while pregnant and several women had sought clarification from HPs

I swore by those, they were really good . . . you don’t even think about a fag when you are on a patch

Area A, pregnant woman 17, non-smoker

I was like‘they are safe?’and she goes,‘I wouldn’t be prescribing them to you if they weren’t’

Area B, pregnant woman 16, smoker

APPENDIX 3

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