Cigarette smoking remains the leading preventable cause of death in the U.S. attributing to about 1 in every 5. (CDC statistics from 2006)  Of additional concern are the dangers related to secondhand smoke exposure which attributes to approximately 38.000 deaths each year. In New Jersey, approximately 8.2% of pregnant women smoke. The rate at this community hospital in 2007 was 10.5%. Most people are aware of the health risks to the fetus exposed to maternal cigarette smoking. This awareness is a motivator for pregnant women to cut down or quit smoking during pregnancy. Recognizing this, our associated prenatal clinic, has successfully collaborated with Mom’s Quit Connection, a community organization with a successful track record for helping pregnant and postpartum women decrease or abstain from cigarette smoking. 

Many mothers who quit smoking during pregnancy plan to resume following delivery. Seventy percent of women who quit during pregnancy and intend to abstain from smoking postpartally will relapse within 12 months of delivery. For this reason, we realized the need to provide focused counseling to these women while in the hospital and continued support following discharge. Our former process, while compliant with JCHAO requirements for assessment of smoking, was ineffective with respect to intervention, involving only dissemination of generic smoking cessation literature which was rarely reviewed. A commitment was made to provide meaningful education and resources to our postpartum patients. Evidence-based practice indicates that “advice and support from nursing staff could increase people’s success in quitting smoking especially in a hospital setting.” (Cochrane Collaboration). Mother Baby nurses develop a special bond of trust with postpartum mothers and are viewed as experts regarding maternal self-care and especially newborn care. Unfortunately, RNs reported feeling uncomfortable addressing smoking cessation with mothers. They cited not being sure how to deliver advice and counseling in a non-judgmental manner and not having useful resources to offer, as barriers.

In order to provide the nursing staff with the necessary education and to provide our patients with a free and convenient smoking cessation resource, we, too, have partnered with Mom’s Quit Connection. Our combined goal is to:   

• Empower nursing staff, through education and availability of appropriate patient education  materials, to provide a clear, powerful and personal message to mothers regarding the benefits of abstaining from cigarette smoking and promoting a smoke-free home environment.
• Linking patients with continued support following discharge through the use of a self-referral to a nurse-endorsed community smoking cessation program.

This intervention is based on the Ask, Advise, and Refer model developed by the Mom’s Quit Connection, The poster presentation will outline the steps that are used to Ask about smoking history in Labor and Delivery, Advise the mother of the importance of abstaining from smoking and facilitate a self-Referral to MQC. The design of this program is the culmination of seven months of collaboration with the Mom’s Quit Connection. The program will be fully operational beginning October 2008.