Health professionals who care for pregnant women are well-placed to deliver smoking cessation brief advice to women and their partners.
Smoking is the most common modifiable risk factor for complications in pregnancy and poor outcomes. Smoking cessation should be a goal of all pregnant women who smoke.
Brief advice from a health professional is a major external trigger in prompting someone who smokes to make a quit attempt. A brief advice conversation with a pregnant woman about smoking can be fast, simple and effective.
Brief advice: Ask, Advise, Help
Quit’s brief advice model focuses on identifying people who smoke and helping them to access evidence-based tobacco dependence treatment; a combination of multi-session behavioural intervention through Quitline (13 7848) and nicotine replacement therapy (NRT), if clinically appropriate.
Brief advice has three steps:
- Ask all pregnant women (and their partners) about smoking status and document this in their record. This can include carbon monoxide monitoring, if available.
- Advise all pregnant women who smoke to quit in a clear, non-confrontational and personalised way, focusing on the benefits of quitting and advising of the most effective way to quit.
- Help by offering an opt-out referral to behavioural intervention through Quitline (13 7848) and prescribe (or help women to access) NRT, if clinically appropriate.
The Centre of Research Excellence in Stillbirth (Stillbirth CRE), with input from Quit, has developed videos demonstrating the steps of brief advice.
Step 1 Ask
Step 2 Advise: For women keen to quit
Step 2 Advise: For women reluctant to quit
Step 3 Help
Clinical resources to embed smoking cessation brief advice into routine practice
Quit and Alfred Health, in collaboration with the Royal Women’s Hospital Pharmacy Department, have developed an evidence-informed clinical guideline for smoking cessation in pregnancy, including an algorithm for prescribing NRT: Supporting smoking cessation during pregnancy – nicotine replacement therapy (NRT).
There are two versions of the guideline available, for health professionals providing care to pregnant women who work in:
The guidelines have been officially recognised as an Accepted Clinical Resource by The Royal Australian College of General Practitioners (RACGP) and have been endorsed by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Stillbirth CRE and the Australian College of Midwives.
Please note, the above guidelines have been designed for use in general
practice and health service settings. They can be contextualised as required,
subject to the internal approval and clinical governance processes of individual
organisations. Please see the Quit resource order form for the most current version of the drug interactions table that appears in the guideline.
Quit has also developed general smokefree policy and clinical guideline templates for health services, available here.
Online training for health professionals caring for pregnant women
Quit and Alfred Health, with input from midwives and other maternity care experts, have developed online smoking cessation brief advice training for health professionals working with pregnant women. The training aims to equip health professionals with the skills, confidence and knowledge to provide smoking cessation brief advice.
The training is an Australian College of Midwives CPD Endorsed Activity.
Duration: Approximately one hour
- Training is free.
- Understand the smoking prevalence in pregnant women and which priority populations have higher rates of smoking in pregnancy.
- Describe the health impacts of smoking in pregnancy.
- Know how to provide fast, simple and effective brief advice in a supportive, non-judgmental manner.
- Recognise the important role of multi-session behavioural intervention (Quitline, including Aboriginal Quitline) and know how to refer.
- Understand the considerations for pharmacotherapy use in pregnancy and breastfeeding, and the different types and formulations available.
- Know how to respond to common scenarios and myths you may encounter while supporting pregnant women to stop smoking.
CPD points: 1
Certification: Printable certificate
Referring pregnant women to Quitline
Quitline is a confidential, evidence-based telephone counselling service. Highly trained Quitline counsellors use behaviour change techniques and motivational interviewing over multiple calls to help people plan, make and sustain a quit attempt. Quitline has a tailored call protocol for pregnant women and can also support partners to quit.
There are three ways to refer pregnant women and their partners to Quitline:
- Online referral form
- Quitline fax referral sheet
- Send Quitline referral letters from your general practice software. (If you use Best Practice or Medical Director, these referral letters should already be on your system. Instructions to manually upload referral letters on other software or older versions of software can be found here).
Quit has developed a range of resources for maternity services and pregnant women and their partners, which you can order through the Quit resource order form.
For health professionals
- Your stop smoking plan wallet card, which you can use to tailor a quitting plan
- A table outlining drug interactions with smoking, detailing the impact of smoking cessation on dosages of some medicines
- Consulting and waiting room resources, such as The perfect reason to never give up giving up! poster.
For pregnant women and their partners
- Pregnancy & smoking brochure, a low-literacy resource highlighting the impact of smoking on pregnancy
- Secondhand smoke & your children brochure, describing the health impacts of secondhand smoke on children
- Smoking and parenthood: advice for partners, describing the effects of secondhand smoke on pregnant women and babies
- Quit because you can booklet providing facts, ideas and tips about quitting
- Aboriginal Quitline flyer introducing the Aboriginal Quitline.
Embedding smoking cessation care
Not only can the AAH model be used by individual health professionals in their everyday clinical interactions, it can also be used to guide change. The goal is to systematically embed smoking cessation care into routine practice. Read more