Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy

This study describes the development and evaluation of education programmes and associated resource materials to support smoking cessation and reduction, and breastfeeding promotion strategies for pregnant women who smoke, during usual primary maternity care by midwives. Education programmes and resource materials were developed by midwives and researchers as part of a cluster randomized trial of Midwifery Education for Women who Smoke (the MEWS study). Development included a cohort study, advice from lactation consultants and smoking cessation counsellors (including Ma-ori professionals), and early consultation with midwives who would be delivering the programmes. Resources developed included videotapes, charts and laminated information cards. Resources were pre-tested with pregnant women and opinion leaders. Consultation with the midwives allocated to each of the intervention groups in the trial raised a number of issues. These were addressed, and solutions incorporated into each of the programmes, to enable effective delivery within usual care. Following delivery of the programmes, women and their midwives were surveyed and a sample interviewed to ascertain attitudes to the programmes and resources. Women and their midwives responded positively to the smoking cessation education programme, the breastfeeding promotion programme and the resources used. Those women who did not stop smoking completely often succeeded in significantly reducing their tobacco consumption. Women identified their midwife as a valuable resource and appreciated her ongoing encouragement. Involvement of health professionals who are to deliver health promotion interventions is essential for successful integration of programmes into usual care. Midwives were able to effectively deliver programmes that were developed and targeted to their needs as health educators. The pregnancy-specific resources developed for women who smoke played an important part in helping midwives deliver their health promotion messages more effectively.