Purpose for the program: The aim of the program is to implement and evaluate of the 5As smoking cessation program by midwives caring for pregnant women in three counties of West Virginia in order to promote smoking reduction and cessation, thereby decreasing fetal exposure to smoking.

Proposed change: Midwives in three West Virginia counties attend the ACOG 5As training to learn to incorporate the 5As program into their care of pregant women who report that they smoke. Midwives are provided education and referral information to provide their clients and are encouraged to give messages regarding smoking reduction/cessation at each prenatal visit. Telephone follow-up and support calls to pregnant women between prenatal visits help provide pregnant women with encouragement and resources to further promote smoking reduction and cessation. 

Implementation, outcomes and evaluation: Evaluation methods will include assessing changes in midwives’ knowledge of the 5 A’s program and well as changes in the pregnant women’s reported smoking behaviors including use of smoking cessation resources, and changes in behavior as evidenced by a decrease in prenatal smoking doses (report of number of cigarettes smoked) and a decrease in smoking rates compared to baseline levels.

Implications for nursing practice: Nurses and nurse-midwives play a crucial role in health promotion for their pregnant clients as they care for them on a frequent and regular schedule. Women are highly motivated to engage in healthy lifestyle changes during pregnancy. Nurses should capitalize on this motivating period by using the 5As evidence-based program for guiding and supporting women in reducing fetal exposure to smoking. 

Keywords: prenatal smoking cessation