The Poole approach to a smoke-free pregnancy
Smoking tobacco is both a pharmacological addiction and a serious social and public health issue. Smoking cessation services for pregnant women save babies' lives and have the potential to improve the health of families and communities. Engaging with pregnant smokers and their households towards quitting smoking requires a whole-team approach. Protected time for the specialist smoking in pregnancy team and freedom to develop the service improvement approach has been key in the setting described in this paper. The approach to smoking cessation described in this paper is of the quality improvement arm within the ‘Saving babies' lives’ bundle of interventions in Poole Hospital NHS Foundation Trust. The ‘plan, study, do, act’ model is described with a description of its implementation using sequential learning, enquiry, testing and being open to new ideas and approaches. The main driver questions have been: ‘how do we reach pregnant smokers who are not motivated to quit?’ and ‘what approaches will potentiate success for this group?’
Targeted and personal support for pregnant women to stop smoking as early as possible in pregnancy is an important intervention to optimise the health of both unborn babies and their mothers, and for a number of pregnancies, prevent stillbirth. It is well-known that smoking during pregnancy is one of the most important risk factors to fetal growth and development (Mund et al, 2013). Recent UK figures show some success with national smoking rates in pregnant women dropping from just under 16% in 2006/2007 to just under 11% 10 years later (see Figure 1). The Department of Health (2017) has set a new target to reduce the prevalence of smoking in pregnancy to 6% by late 2022. This paper describes one strand of measures to reduce stillbirth in Poole Hospital NHS Foundation Trust, namely smoking cessation, as well as innovative approaches to achieving this target in a group of NHS in England. It demonstrates measures of success and how innovation and research are tackling the wider determinants of maternity services users' smoking behaviours. A single new project in one trust is also described.
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