Know when to refer

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It is important to recognize that for many women smoking is a secondary issue—to poverty, trauma, violence, lone motherhood, and other factors. Most pregnant smokers in Canada, especially those who do not spontaneously quit, are often experiencing multiple social and economic pressures. In these cases, tobacco cessation is not only a low priority, but smoking serves multiple purposes or “benefits” the woman in mediating her existence.

Screen all women and girls of childbearing age for tobacco use

Smoking cessation is an issue that precedes and extends far beyond the perinatal period.

For many pregnant women in “high priority” or “hard-to-reach” groups, these issues tend to blur or bury the importance of tobacco cessation and other health-seeking behaviours while pregnant. It is important to recognize that smoking cessation does not occur in a vacuum. For example, studies show that between 2 and 20% of women experience domestic violence during pregnancy.

While these issues should not be considered a barrier to engaging with women regarding their smoking, they should inform practice. In these situations, you may need to make a referral to other services and supports.

RESOURCES

Local resources vary across the country and are constantly changing. However, the following websites are a good starting place to get a sense of the range of programs that exist and to which you might refer your patients.

BC Association of Pregnancy Outreach Programs

Information about programs that provide prenatal and early parenting support to women who experience health or lifestyle challenges during pregnancy, birth, and the transition to parenting.

Visit website

BC Mental Health and Addiction Services

Programs include Adult Tertiary Psychiatry, Geriatric Psychiatry, Forensic Psychiatric Services, Child and Adolescent Mental Health, Women’s Reproductive Mental Health, and the Provincial Specialized Eating Disorders Program.

Visit website

Canadian Centre on Substance Abuse-Information about Canadian addictions treatment services and programs

Database on substance-use-treatment programs by province. Information on programs specializing in tobacco and addiction support, both in outpatient and residential treatment settings.

Visit website

Canadian Centre on Substance Abuse

Helplines and contact numbers for addictions treatment by province or territory

Centre for Addictions and Mental Health

Treatment Programs

Visit website

Connex Ontario Health Services

Information about alcohol and drug treatment, problem gambling helpline, and mental health services and supports across Ontario.

Visit website

FURTHER READING

Greaves, L., Poole, N., Okoli, C. T. C., Hemsing, N., Qu, A., Bialystok, L., & O’Leary, R. (2011). Expecting to Quit : A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women, 2nd edition

Greaves, L., Johnson, J., et al. (2004). Reducing harm: A better practices review of tobacco policy and vulnerable populations. Vancouver, BC: BC Centre of Excellence for Women’s Health. Full-text »

Nevala, J., Sears, K., and Steibelt, E. (2010). Women and tobacco info pack. Program Training and Consultation Centre (PTCC), a resource centre of the Smoke-Free Ontario Strategy (Download PDF from www.ptcc-cfc.on.ca)

 

Resources for health care providers

BEST START  

This Ontario-based resource centre supports health care providers with implementing health promotion programs, including tobacco reduction, for new parents. Resources include brochures, posters, and displays with information on creating a smoke-free environment.

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PERINTAL SERVICES BC

Persintal Services BC has developed a guideline entitled Tobacco Use in the Perinatal Period, designed to assist practitioners in evidence-based assessment and provision of care for pregnant and postpartum women.

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CANADIAN ACTION NETWORK FOR THE ADVANCEMENT, DISSEMINATION AND ADOPTION OF PRACTICE-INFORMED TOBACCO TREATMENT (CAN-ADAPTT)

CAN-ADAPTT is a practice-based research network designed to facilitate knowledge exchange in the area of smoking cessation.

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INTERNATIONAL NETWORK OF WOMEN AGAINST TOBACCO (INWAT)

INWAT is a global network of women dedicated to preventing and reducing tobacco use among women and girls, increasing women’s leadership in tobacco control and improving women’s status and women’s health.

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PREGNETS

This Ontario-based website has information for health care providers, including downloadable documents: a desk reference, patient resource card, info sheets, etc.

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REGISTERED NURSES ASSOCIATION OF ONTARIO

This best-practices guideline is not specific to pregnancy but provides a thorough overview of smoking cessation.
Integrating Smoking Cessation Practice into Daily Nursing Practice (2003, reviewed 2007).

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SMOKING CESSATION FOR PREGNANCY AND BEYOND

Interactive web-based “virtual practicum” program with simulated patient interviews and case-based learning developed by American College of Obstetricians and Gynecologists and a coalition of smoking-cessation experts.

 

Breastfeeding and Harm Reduction

Nicotine is water and lipid-soluble & hence can be secreted in breast milk.

The concentration of nicotine in breast milk will vary depending on how many cigarettes have been smoked since the last breastfeeding and how much time has passed since the mother has last smoked a cigarette.

Health Canada recommendations clearly indicate that smoking is not a contraindication to breastfeeding.

 

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