Addressing smoking during pregnancy:The challenge to start from the woman's view

The aim of this thesis has been to increase understanding on the process of smoking cessation during pregnancy from the perspective of learning. The smoking pattern before and after pregnancy related to health, Sense of Coherence (SOC) and social issues was studied among all pregnant women in south-east Skåne during the period March 1994 to August 1995. They were asked to fill in a questionnaire during the first visit to antenatal care and to answer some short questions in an interview after pregnancy. The critical point for change in smoking was when the woman became aware of her pregnancy. Women who were smokers at the time of conception declined from 30.9% to 19.3% at the time of the first visit to antenatal care. Depending on their smoking habits, the women were categorised as Non-smokers, Quitters, Decreasers, Relapsers and Continuers. In a general population the level of SOC was lower than among these pregnant women, which indicates a high level of motivation for change. Smoking and smoking cessation were related to different symptoms of ill health. Women who did not succeed in stopping smoking early in pregnancy were more often susceptible to the influence of life circumstances on smoking. However, success in stopping smoking increases self-esteem and could therefore be a way to improve self-efficacy and health in general. Pregnant and post-pregnant women’s ways of making sense of smoking during pregnancy were studied in an interview study of 17 women. A general feature amongst all women was that being a smoker and pregnant constituted shameful behaviour. Five different story types were illustrated: Smoking could be justified, Will stop smoking later, My smoking might hurt the baby, Smoking is just given up and Smoking must be taken charge of. Dialogue from a salutogenic perspective sees woman’s wish to give her children a smoke-free start in life. The woman’s way of constructing knowledge about smoking can in this way be seen as a point of access for health education. Hearsay, personal experiences and scientific facts of the dangers of smoking were interwoven with issues of well-being and social circumstances. Midwives’ ways of making sense of how they approach women who smoke were studied in interviews with 24 midwives. The story types Avoiding, Informing, Friend-making and Co-operating illustrated difficulties in changing from being an expert who gives information and advice to being a facilitator. It is suggested that health education should build on co-operation and dialogue about the smoking issue. The woman’s learning should be focused on, as she is the one who should talk and learn. The midwife’s role is to facilitate for the woman’s learning which means that she mostly listens to the woman’s view of smoking.

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