Barriers and Facilitators to Staying Smoke-Free after Having a Baby, A Qualitative Study: Women's Views on Support Needed to Prevent Returning to Smoking Postpartum

Abstract

Background: Postpartum return to smoking (PPRS) is a common and important public health problem. Interventions to prevent PPRS have not been shown to be effective. We aimed to qualitatively explore the barriers and facilitators to staying smoke free after having a baby, and women’s views on support needed to avoid PPRS to inform future intervention development. Methods: We conducted semi-structured telephone interviews (n=26) with pregnant women who quit smoking (n=9), and postpartum women who were abstinent at delivery and returned to smoking (n=7) or stayed smoke free (n=10). Inductive thematic analysis was used. Results: Five overarching themes were identified: i) smoking intentions, ii) facilitators to staying smoke free, iii) barriers to staying smoke free, iv) support to avoid relapse and v) e-cigarettes, nicotine replacement therapy and varenicline. Facilitators to staying smoke free were the health benefits to their baby, whilst barriers included stress, cravings and being in environments where they would previously have smoked. Women wanted continuous offers of support to stay smoke free through-out the extended postpartum period, with particular interest in support for partners to quit smoking and self-help support. Women expressed safety concerns for e-cigarettes, nicotine replacement therapy and varenicline. Conclusion: Offers of support to stay smoke free should continue throughout the postpartum and engage with partners or other household members who smoke. Reassuring women about the relative safety of nicotine replacement therapy and e-cigarettes by a health professional, particularly for those who are breastfeeding, could be beneficial.