Derbyshire County Council looked at their maternity pathway and ways to identify improvements and reduce smoking in pregnancy (SiP) rates. Smoking is the main modifiable risk factor associated with a range of poor pregnancy outcomes and can impact on the health of the child throughout their lifetime.
The project team aimed to “Transform systems so that support and treatment to stop smoking become routine across ante-natal and post-natal pathways.”
The team identified four main themes:
- 1. Stop Smoking Service
How can we make sure that the stop smoking service is meeting the needs of pregnant smokers with initial focus on making it as easy as possible for women to quit? This would include a flexible support offer, more specific advisors time allocated to SiP support, shorter waiting times for appointments and a new telephone referral system prototype in place with an evaluation ongoing.
- 2. System wide approach
A standardised SiP training package for midwives. A Derbyshire Smokefree Pregnancy Pathway document has been developed to support the consistency of messaging and standardise practice across all relevant organisations. A SiP implementation group that meet bi-monthly with representation across the maternity pathway (midwives, health visitors, public health and smoking cessation providers). And feedback loops which are being developed between the smoking service and midwives.
- 3. Consistent messaging
To ensure that consistent messaging about the harmful impact of smoking to mum and baby and the benefits of quitting are given at all opportunities across maternity pathway. Risk Perception Intervention training is being undertaken by a small cohort of midwives and models are being developed to offer women this intervention when they continue to smoke in pregnancy at the 12-week dating scan. This focuses on the dangers of continued smoking during pregnancy and is targeted at women still smoking at this stage in pregnancy.
- 4. Societal norms
Questions asked at booking with the Stop Smoking Service include asking if the woman has family/friends who smoke, as mums are much more likely to quit if people around them quit too. Women are encouraged to bring someone with them to the stop smoking appointment. Insight from the Design in the Public Sector Programme has helped influence a recent social marketing campaign in Derbyshire targeting smoking in pregnancy.
All patients who smoke now go through a health and wellbeing MOT with a health improvement advisor to look at other areas of support available, for example: finance and mental health. We are looking to embed SiP conversations, training and pathway across the maternity system and produce a leaflet which will be sent out to smoker to enable early intervention. There is soft market testing taking place for an app and a literature review to look how technology can be used in this space. We are also encouraging midwives to celebrate the success of quitting smoking when women attend appointments. We continue the journey to achieving the Derbyshire aim a smoke free pregnancy for all.
- Audio transcript
[00:00:00] We're a team Derbyshire. Our team is made up of representatives from public health, stop smoking service and maternity. Our challenge was to look the maternity pathway and identify improvements to help reduce smoking in pregnancy rates. The reason we chose this challenge was because Derbyshire shows rates of smoking at time of delivery is 16 percent compared to a national average of 10 percent. Smoking is the main modifiable risk factor for adverse outcomes in pregnancy. If we can reduce smoking in pregnancy rates, more babies will be going healthy and have the best start in life. And no one can argue with that. The government's tobacco control plan sets out a national vision of a smoke free pregnancy for all. It sets out a national target to reduce the prevalence of smoking in pregnancy to six percent or less by the end of 2022. Our aim is to transform our system so that support and treatment to stop smoking becomes routine across the antenatal and postnatal pathways.
Through our Design Council workshops, we identified four main themes to look at; some improvements to the stop smoking service, taking a systemwide approach across the whole pathway, ensuring consistent messages are given to parents throughout the pathway and also work to change social norms.
So where are we now? We've progressed to a more flexible support offer for women and our focus on to stop smoking support quicker and offered support for longer. We are currently prototyping and evaluating a new telephone referral system. All pregnant smokers are now offered a health and well-being MOT to identify any other health and wellbeing needs they may have. Soft market testing for an app has taken place in a literature review to look good, utilising technology more effectively. Getting the system aspects right is key. We are now much better positioned to do this since our workshops as we have established a smoking pregnancy implementation group with representation from across the maternity system. A smoke free Derbyshire pathway document and training package has been developed to standardise practice across the system. We are developing feedback loops between the stop smoking service on maternity to join up care when it comes to smoking.
[00:02:24] So we looked at consistent messages, we were looking at risk perception training and it's been organised for midwives to attend later this month. We are promoting celebrating success, for example, encouraging women to share their story and encouraging midwives to reinforce the positives of quitting. We're encouraging women and to involve significant others in that way by inviting them to attend the stop appointments. Insight from Design Council has helped to influence the local smoking in pregnancy social marketing campaign. So, we learnt we need to learn to walk before we could run and getting the basics right, before we moved on to bigger things. Some of our challenges included the challenging target to reach six percent of smoking at time of delivery by 2022. And it’s taken time to form relationships and trust with key partners to bring people together to implement key actions such as the Smoke free Pregnancy Pathway Document. Collecting meaningful smoking in pregnancy data to monitor outcomes across the system has been a challenge and we've got a change in our original Design Council team. Gaining long term funding to implement key actions required. And it's an impact time lag due to the length of pregnancy and the recording.
[00:03:45] And finally we found it a challenge at times to embed design principles across the smoking in pregnancy agenda. So what have our wow moments been? Smoke free pregnancy models are now in place at each acute trust, including a champion smoking and pregnancy midwife, we have secured funding to train midwives across both trusts in a risk perception intervention, which will be delivered to all mothers who continue to smoke at their 12 weeks scan. We are building the noise for smoking and pregnancy across the system, which can only be a great thing. We have secured a slot on mandatory training for all midwives in Derbyshire, and all midwives are family nurses now have access to a carbon monoxide monitor to help them identify mothers that smoke or have relapsed.
[00:04:31] So what's next for Team Derbyshire? We’ll continue to improve the support offer and encourage women to attend the stop smoking appointments such as offering home visits. The risk perception intervention will be implemented for women who continue to smoke in pregnancy. And we will support the roll out of training and a robust pathway way to engage women who smoke earlier in pregnancy, such as asking if they smoked before seeing a midwife and will encourage with the app development, to implement these technologies. To conclude, we are on a journey to achieve a smoke free pregnancy for all.
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