Introduction:
Smoking in pregnancy is a leading public health challenge. National and international studies highlight the urgent need to improve stop smoking care in pregnancy. This care gap was highlighted in the National Maternity Strategy (2016–2026) and an evidence-based care pathway was established in new National Stop Smoking Guidelines (2022). A pilot implementation of the new care pathway was undertaken in two Irish maternity hospitals. Interventions included: local implementation teams; dedicated trained and certified stop smoking midwives; implementation of QUITManager (an electronic stop smoking care record); Making Every Contact Count training for midwives; routine breath carbon monoxide tests (BCOT) with opt-out referral to stop smoking care for women who smoke. COVID-19 meant that routine BCOT was paused for infection control reasons.

Material and Methods:
This is a mixed methods evaluation, where both quantitative and qualitative data were used; the quantitative data provided service activity and outcome data from QUITManager and the qualitative data provided insights to the experiences of pregnant women who used the services and the health professionals who provided the services, through semi-structured telephone interviews.

Results:
In total, 691 women were referred to specialist Stop Smoking Midwives; 2.8% and 7.0% of births in each pilot site. Referrals were accepted by 81.6% of women, 23.4% set a quit date and 18.2% were quit at 4 weeks (intention to treat analysis), with 14.5% of women delivering a smoke-free baby. The qualitative research highlighted the importance of a non-judgemental approach in both recruitment to the programme and engagement with women in the programme.

Conclusions:
The new pathway was generally positively received by women and midwives; however, the importance of communication, and the contrast for women between fear of judgement up-front versus experience of sensitive and non-judgmental support were key themes relevant to wide-spread implementation. Proof-of-concept and lessons learned will inform and support national roll-out, including BCOT to improve referrals.

See Sláintecare Smoke Free Start: An Evaluation (2022) https://www.hse.ie/eng/about/who/tobaccocontrol/research/smoke-free-start-evaluation.pdf