Table 2 Included papers (n = 9) grouped by study (n = 8) (*denotes the related papers)

Abrahamsson A, Springett J, Karlsson L et al (2005) [26]

Sweden

To describe the qualitatively different ways in which midwives make sense of how to approach women smokers

Midwives (n = 24) purposively sampled, who had been offered training in person-centred methods. Experience 2-24 years

Phenomenology

Midwives used different approaches to address smoking with pregnant women. Four different ‘story types’ were identified: avoiding, informing, friend-making and co-operating.

25

Aquilino ML, Goody CM, Lowe JB (2003) [31]

USA

To examine the perspectives of Women, Infants & Children (WIC) clinic providers on offering smoking cessation interventions for pregnant women

Four focus groups (n = 25) consisting of WIC nurses (n = 14), dieticians (n = 9) and social workers (n = 2). Three participants revealed that they smoked

Data collected via focus groups and analysis was undertaken using ‘code mapping’

Factors affecting WIC staff’s provision of smoking cessation information were: time, competing priorities, staff approaches to clients, staff training, nature of educational materials and client concerns.

24

Borland T, Babayan A, Irfan S et al (2013) [32]

Canada

To explore how Ontario’s cessation policy, programming and practice encourage or discourage the provision and uptake of support by women

Key informants (n = 31) from provincial organisations that offer cessation, maternal and/or child health support to women across Ontario

Data collected by semi-structured in-depth interviews.

Data were analysed using thematic interpretive analysis

Key barriers to providing cessation support included: the absence of a provincial cessation strategy and funding; capacity issues; lack of a programme that was woman-centred, included the social determinants of health and the needs of specific groups; inconsistent practice; geographical factors.

27

Bull (2007) [27]

UK

To explore the role of midwives and health visitors in the prevention of smoking during pregnancy and early parenthood

Health visitors (n = 16) and midwives (n = 7)

Data were collected via two focus groups and analysed using qualitative content analysis

Midwives and health visitors are willing to accept professional responsibility for smoking cessation work with their patients. They perceive their role as being limited by the socio-economic circumstances of their clients and recognise that they additionally must be ‘ready to change’.

20

Ebert M, Freeman L, Fahy K et al (2009) [28]

Australia

To determine how midwives interact with women who smoke in pregnancy in relation to the women’s health and well being

Community midwives (n = 7) each with a minimum of 6 years’ experience (research initially wanted to looked at midwife/woman dyads but no women were recruited).

Interpretive interactionism design and analysis.

Data collected through two individual interviews with each midwife.

Whilst midwives acknowledge they need to engage in woman centred dialogue during smoking cessation interactions, more commonly the engagement was limited to predictable, planned and computer prompted interactions.

19

Herberts C & Sykes C (2011) [29]

UK

To identify and juxtapose midwives’ perceptions of providing stop-smoking advice and pregnant smokers’ perceptions of stop-smoking services

Midwives (n = 15) recruited from 2 acute trusts in the borough of Camden (19^th most deprived borough in England)

Three focus groups centred on the key question ‘How do you feel about talking to pregnant women about smoking cessation?’

Data analysed using constructs of grounded theory

Midwives identified both barriers and facilitators to providing stop-smoking advice. Barriers included: fear of being seen to judge women, putting pressure on women, threatening the professional relationship, lack of education to provide support, insufficient time.

Facilitators included: being more experienced, being an ex-smoker, having sufficient levels of relevant knowledge, time, a good relationship with the woman and continuity of care.

29

* Herzig K, Danley D, Jackson R et al (2006) [33]

USA

To explore prenatal providers’ methods for identifying and counselling pregnant women to reduce or stop smoking, alcohol use, illicit drug use and the risk of domestic violence

Obstetricians/gynaecologists (n = 40), nurse midwives (n = 5), nurse practitioners (n = 3), registered nurse, working in HMO (n = 1), private practice, community health clinics, hospitals and academic centres

Six focus groups with 6-11 participants in each, questioning led by an open-ended question guide. Data were analysed using a subjective, interpretive ‘editing style’ of analysis

Participants talk of specific risk prevention methods used with pregnant women who smoke (amongst the 4 risk factors studied), citing a patient centred collaborative style as particularly helpful. Harm reduction strategies rather than abstinence were recommended, along with incorporating the wider family.

26

* Herzig K, Huynh D, Gilbert et al (2006) [34]

USA

To explore prenatal providers’ methods for addressing four behavioural risks in their pregnant patients: alcohol, drug use, smoking and domestic violence

Obstetricians/gynaecologists (n = 40), nurse midwives (n = 5), nurse practitioners (n = 3), registered nurse, working in HMO (n = 1), private practice, community health clinics, hospitals and academic centres

Six focus groups with 6-11 participants in each, questioning led by an open-ended question guide. Data were analysed using a subjective, interpretive ‘editing style’ of analysis

The study addresses each of the four behavioural risks. Smoking was seen as the ‘easiest’ risk to address, but its addictive quality proved challenging to overcome.

26

McLeod D, Benn C, Pullon S et al (2003) [30]

New Zealand

To explore the midwife’s role in providing education and support for changes in smoking behaviour during usual primary maternity care

Midwives (n = 16) with between 5-20+ years in practice, who had been part of a RCT of education and support for pregnant women who smoke. Midwives had either received smoking cessation training as part of the trial (n = 9), or had received no such training (n = 7)

Data were collected through individual interviews. Midwives additionally completed a postal questionnaire, asking about education, training, smoking status, and perception of barriers to delivering smoking cessation advice

Providing smoking cessation support was seen as part of the midwife’s role, but it was perceived as difficult to start conversations on the subject, to identify women who would be receptive and to support them. There was concern over the impact of providing cessation advice on their relationship with women.

25