Conclusions

Participants had a negative image of ‘the smoking pregnant woman’: a low educated woman living with a smoking partner and ‘bad exam- ples’ in their history. It could be possible that these prejudices hinder a conversation about smoking cessation.

The most important barriers reported to providing smoking cessation counselling are lack of time, restricted communication skills and fear of provoking resistance. Even trained midwives experience these barriers and have doubts about their competencies in giving smoking cessation advice. Gynaecologists seem not interested in training regarding smok- ing cessation and prefer to refer their clients.

The following two possible suggestions to help smoking pregnant women should be explored:

Training in smoking cessation counselling of a team member who is seen as a confidant by the pregnant woman. This could be a trained midwife, who can provide prenatal care combined smoking cessation advice.

A possibly more effective strategy in Flanders is to use an abbreviated version of the 5 A’s framework, more specifically the AAR-method. The role of the midwife and gynaecologist is then limited to asking ques- tions about smoking behaviour, providing brief advise, determining the readiness to quit and referring clients to specialized smoking cessa- tion counselling.

Further research should focus on the implementation of the AAR- method in order to increase the number of pregnant women who stop smoking.

Conflict of interest

The authors do not have any financial and personal relationships with other people or organisations that could inappropriately influence or bias their work.

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