Which role do midwives and gynecologists have in smoking cessation in pregnant women? – A study in Flanders, Belgium

• Previous evidence shows that pregnancy is the ideal teaching moment to stop smoking.
• Motivational interviewing techniques should be offered to midwives and gynecologists.
• Instead of using the 5 A's framework, using the AAR-method is suggested.

ObjectivesThe objectives of our study were (1) to explore knowledge, beliefs and practice among midwives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.MethodWe performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A's framework (Ask–Advise–Assess–Assist–Arrange).ResultsThe national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise” were part of a standard prenatal consultation, the next three steps were rarely implemented. Participants had a negative image of “the smoking pregnant woman”: a low educated woman with a smoking partner and “bad examples” in their history. Reported barriers were fear of provoking resistance and lack of time and communication skills regarding smoking cessation.ConclusionsThese findings suggest that training in communication skills and dealing with resistance should be offered, i.e. by using motivational interviewing. It could be considered that a trained midwife or tobaccologist is part of an obstetrical team or that the AAR-method (Ask–Advise–Refer) is used instead of the 5 A's framework.