Barriers and facilitators to smoking cessation in pregnancy and postpartum: The healthcare professionals’ perspective

Objectives: Healthcare professionals and the healthcare environment play a central role in protecting pregnant and postpartum women and their infants from smoking-related harms. This study aimed to better understand the health professional’s perspective on how interactions between women, healthcare professionals and the environment influence how smoking is managed. Design: Semi-structured interviews and focus groups. Methods: Data were from 48 healthcare staff involved in antenatal or postpartum care at two UK sites, including midwives, obstetricians, health visitors, GPs, pharmacists, service commissioners and Stop Smoking Service (SSS) advisors and managers. Thematic analysis was guided by a Social-Ecological Framework (SEF). Results: Themes were divided across three SEF levels and represented factors connected to the management of smoking in the healthcare context and the beliefs and behaviour of pregnant or postpartum smokers. Organisational level: service reconfigurations, 'last resort' nicotine replacement therapy prescribing policies, and non-mandatory training were largely negative factors. There were mixed views on opt-out referral pathways and positive views on carbon monoxide monitoring. Inter-personal level: protection of client-professional relationships often inhibited frank discussions about smoking, and weak inter-service relationships affected SSS referral motivation and quality. Individual level: professionals felt community midwives had primary responsibility for managing smoking, though midwives felt under-skilled doing this. Midwives’ perceived priority for addressing smoking was influenced by the demands from unrelated organisational initiatives. Conclusions: Opportunities to improve clinical support for pregnant smokers exist at organisational, inter-service and healthcare professional levels. Interactions between levels reflect the importance of simultaneously addressing different level-specific barriers to smoking cessation in pregnanc