Acknowledge personal and social pressures to quit

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Women often feel intense pressure to stop smoking when they become pregnant. This pressure comes from partners, family members, and society at large. Pregnant women who are unable to reduce or stop smoking often feel guilty and ashamed about their smoking. Women in disadvantaged or marginal circumstances are less likely to be able to consider quitting when other pressures are affecting their lives and behaviour.

Approaches to smoking cessation that focus on the health of the fetus focus the motivation for quitting away from woman’s own health and can lead to feelings of guilt and fear. While focusing on the fetus can be a key motivator for many women, other internal and longer-term motivators have been shown to be more effective for long-term cessation and relapse prevention.

Stress & Pregnancy

Stress may be heightened during pregnancy and postpartum for a number of reasons. These may include:

  • Fear of unknown, of not being a good mother, of the process of birth;
  • Lack of sleep;
  • Social pressure to stop smoking;
  • Complications with the pregnancy/birth;
  • Relationship difficulties.

Helping women to understand the role of smoking in their lives can assist them to manage personal and social pressures to quit. Research has shown that there are five major reasons for why women smoke:

  1. To organize social relationships
    To balance, support, distance, or end relationships with partners, children, co-workers, and others.
  2. To create an image
    An image of independence, uniqueness, sophistication, acceptance, and thinness.
  3. To control emotions
    To suppress or numb negative emotions, or to bring out positive emotions
  4. To feel in control
    Smoking is seen as a source of support that is both predictable and controllable
  5. As a source of identity
    Women say they smoke to cope with the day-to-day reality of their lives. For example, they see stopping for a cigarette as a legitimate break in their lives – a break that they may otherwise have difficulty justifying.

Greaves, L. (1996). Smoke screen: Women’s smoking and social control. Halifax, NS: Fernwood.

PRACTICE TIPS

  • Acknowledge the social pressures on pregnant women to quit smoking
    Women value hearing: “I’m here to help you if you want to quit;” “I won’t be disappointed in you for smoking cigarettes;” “If you slip up, it doesn’t matter — come back to see me no matter what;” “I’m not here to tell you to quit.”
  • Don’t stay fetus-centric
    Help mothers to find their own reasons for quitting smoking (rather than just focusing on the benefits for the fetus) and to take steps towards their own goals in their own time and in their own way.
  • Help women to understand the role of smoking in their life
    Increased awareness of her reasons for smoking can help a woman manage the personal and social pressure she may feel to quit smoking even if she’s not ready.
  • Emphasize the positive things women are doing for their health and the health of the fetus
    For example, getting enough rest, preparing the home for the baby, eating regularly.
  • Highlight to new mothers the positive things they do for their children
    Ask if they would like ideas on how to help protect their kids from secondhand smoke.
  • Encourage women to continue breastfeeding
    Even if they smoke or are using NRTs to aid their cessation.

RESOURCES

FURTHER READING

Greaves, L., Kalaw, C., and Bottorff, J. L. (2007). Case studies in power and control related to tobacco use during pregnancy. Women’s Health Issues, 17(5), 325-332. PMID: 17692535 doi:10.1016/j.whi.2007.06.001

Ingall, G. and Cropley, M. (2010). Exploring the barriers of quitting smoking during pregnancy: A systematic review of qualitative studies. Women and Birth, 23(2): 45-42. PMID: 19879206 doi:10.1016/j.wombi.2009.09.004

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