Safe babies: A qualitative analysis of the determinants of postpartum smoke-free and relapse states

Abstract

This qualitative study explores smoking cessation during pregnancy and the factors that contribute to remaining smoke-free and relapsing. Ninety-four women attending prenatal clinics in central North Carolina who had quit smoking before 30 weeks gestation were enrolled in an observational study that included a face-to-face interview at 4 months postpartum. Results were analyzed for common themes in the two groups: those who remained smoke-free and those who had relapsed. Fetal health motivated pregnant women to quit smoking, while stress, socializing with smokers, cravings, and easy access to cigarettes tempted women to smoke. Women who remained smoke-free postpartum overcame temptations by continuing to acknowledge the health benefits of not smoking and having a strong internal belief system, significant social support, negative experiences with renewed exposure to cigarettes, and concrete strategies for dealing with temptations. For women who relapsed postpartum, factors having the greatest influence on relapse included easy access to cigarettes, lack of social and financial support, insufficient resources for coping with the challenges of childrearing, physical addiction, reliance on cigarettes as a primary form of stress management, and feelings of regret, shame, or low self-esteem. Recommendations for relapse prevention include assessing women who quit during pregnancy for low or high risk of relapse and offering comprehensive interventions and case management for those at higher risk to address the physical, mental, behavioral, and social contexts leading to relapse.

Preventing postpartum smoking relapse among diverse low-income women: A randomized clinical trial

“…Treatments that effectively address postpartum smoking relapse prevention among women with higher prequit smoking rates, potentially indicative of greater dependence on tobacco, are essential as these women are at increased risk of postpartum relapse compared with less dependent women (Fang et al, 2004;Ripley-Moffitt et al, 2008;Severson, Andrews, Lichtenstein, Wall, & Zoref, 1995). Telephone-based smoking cessation interventions have previously shown more promise among less dependent pregnant women (Ershoff et al, 1999;Rigotti et al, 2006).…”

“…These, and other stressors (e.g., partner relational problems, financial difficulty), often derail women's attempts to maintain smoking abstinence (Ripley-Moffitt et al, 2008) and clearly warrant attention within a broader based treatment program. Moreover, a lack of reliable transportation, high mobility, and lower rates of routine clinic-based care are prevalent among low-income pregnant/postpartum women (Beck et al, 2002;Gazmararian, Arrington, Bailey, Schwarz, & Koplan, 1999;Williams et al, 2003).…”

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

“…Post birth women who sustained their smoking cessation held this belief for their newborn, whilst those who relapsed had lost the incentive of being pregnant. Others report similar findings, as the motivation to cease smoking in pregnancy relies upon a woman's desire to protect her unborn baby [22,37]. This motivation detracts from woman focused approaches which have greater success in sustained smoking cessation post birth [25].…”

Longer Previous Smoking Abstinence Relates to Successful Breastfeeding Initiation Among Underserved Smokers

“…2 Breastfeeding may also delay postpartum smoking relapse. [3][4][5][6] However, rates of breastfeeding among maternal smokers are approximately 30% lower than nonsmokers and continue to lag behind rates in the general U.S. population. [7][8][9][10][11] Understanding factors associated with breastfeeding initiation among smoking women is critical to efforts aimed at improving breastfeeding rates in this group of women.…”

“…17,18 The American Academy of Pediatrics has stated that smoking is not a contraindication to breastfeeding 19 and has recommended that maternal smokers attempt to initiate breastfeeding, asserting that the benefits of breastfeeding outweigh the risks of nicotine exposure through breastmilk. However, former and current smokers continue to express misperceptions about breastfeeding recommendations, 3,20 and some pediatricians continue to resist implementing American Academy of Pediatrics breastfeeding counseling guidelines with smokers. 21 Medically underserved and minority populations, as well as heavier smokers in general, demonstrate the lowest rates of breastfeeding initiation compared with the general population.…”