Betsi Cadwaladr University Health Board area where 5,800 babies were born between 2017-18, has one of the highest rates of pregnant smokers in Wales

As part of the NHS Help Me Quit for Baby project, run by the Betsi Cadwaladr University Health Board, a dedicated team of smoking cessation advisors, who work solely with pregnant smokers, see women in their own homes for as many appointments as takes for them to quit. They also offer support to family members or partners who want to quit.

Across Wales, around 16% of mums-to-be smoke throughout their pregnancy and 11,864 unborn babies are exposed to harm from tobacco each year.

The Betsi Cadwaladr University Health Board area where 5,800 babies were born between 2017-18, has one of the highest rates of pregnant smokers in Wales.

Thanks to the project 238 pregnant women were given help to quit between April 2018 and March 2019, according to the Welsh Government’s latest figures on smoking cessation services.

One in five sudden infant deaths is linked to smoking, as well as long term problems in children such as learning difficulties, hyperactivity, ear, nose and throat problems, obesity and diabetes. Research has shown that children with parents that smoke are three times more likely to take up the habit in later life.

Women in North Wales are referred to the Help Me Quit for Baby service by their midwife at any time during their pregnancy, after taking a CO monitor test to measure the amount of carbon monoxide in their bodies. If a woman agrees to take part in the programme, she is offered weekly specialist support and free nicotine replacement therapy (NRT).

The team believes being able to see women in the comfort of their own home, is key to their success. Home visits also mean the team can also speak with other members of the family who smoke and offer them cessation support. As well as protecting the health of the unborn baby, the team hopes that by helping women and their families to quit smoking, they can enable the baby to live in a smoke-free home once it is born.

“A woman’s family has a huge influence on whether she continues to smoke,” said Kellie Salmon, one of the support workers.

“If a partner is adamant that they want to carry on smoking then that’s a really big barrier to the woman giving up and means you have to work even harder to get them to quit. But if the partner is on board then there’s good chance they will quit together.

“The fact that we see women in their own homes is a unique selling point of the scheme.  It’s great from a practical point of view because a lot of them live in rural areas and some can’t drive. But it also makes it easier to establish a rapport with them because often they are more relaxed and comfortable in their own home environment.”

During the appointments the team get to know the women they work with and find out more about why they smoke, admitting they can often become ‘a shoulder to cry on’. A big part of the quit process is encouraging behavioural change and getting them to adjust their daily routine, according to Help Me Quit for Baby team member Jackie Buckley.

She said: “Many women say the only way they can cope with their lives is by smoking.  They see it as the only way they can have five minutes to themselves.

So, we encourage them to find other ways to de-stress such as playing a game on their phone instead.

“Often they go round to see their families and everybody gathers together to have a smoke. It’s a ritual and they still want to be a part of that. It’s really important to get them to come up with their own ideas of how to deal with those sorts of situations.”

Smoking in pregnancy carries serious health risk. The carbon monoxide in tobacco smoke reduces the amount of oxygen to the placenta which can lead to There is, says Jackie, a big taboo around the subject of smoking in pregnancy, and many women feel ashamed of their habit – a feeling that stops some admitting they smoke and seeking help to quit.

The team aims to adopt a totally non-judgemental approach to the women they work with and are keen to empathise that they are not there to criticise or lecture their clients: “We take a very non-judgemental approach,” said Jackie.

“We tell women that we’re not there to judge them but to get the best support for them to quit smoking. If it becomes too clinical then that becomes a barrier so we try to speak to them as we would with a friend and we encourage them to be honest, for instance, if there is a blip and they start smoking again. It also helps to share stories of other women we have worked with who have managed to stop smoking.”

Although women are primarily referred to Help Me Quit for Baby by their midwives, as news of the project’s success spreads, the team are increasingly being contacted by women who have heard about their work via word of mouth.

The greatest reward for the team however, is when a woman successfully quits smoking, giving her new born baby, a better chance in life: “When people do quit it’s just so rewarding and we really feel we’re doing a job that makes a difference to people’s lives,” said Kellie.

Suzanne Cass is CEO of the tobacco control campaign group ASH Wales. She congratulated the team on the success of the scheme and said she hoped it would one day be available across Wales: “Smoking is not a lifestyle choice for pregnant women, it is an addiction that poses a serious health risk to them and their babies.

“It is crucially important that tailored, non-judgemental support is available to help these women to quit in an environment that they feel comfortable in.

“The success of this project shows what can be achieved by thinking outside the box and providing flexible, innovative and targeted support that is designed to meet the needs of pregnant smokers and their families.”