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.
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.
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.
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.
Canadian Centre on Substance Abuse
Helplines and contact numbers for addictions treatment by province or territory
Centre for Addictions and Mental Health
Connex Ontario Health Services
Information about alcohol and drug treatment, problem gambling helpline, and mental health services and supports across Ontario.
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 »
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.||Read more|
|PERINTAL SERVICES BCPersintal 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.||Read more|
|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.||Read more|
|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.||Read more|
|PREGNETSThis Ontario-based website has information for health care providers, including downloadable documents: a desk reference, patient resource card, info sheets, etc.||Read more|
|REGISTERED NURSES ASSOCIATION OF ONTARIOThis 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).
|SMOKING CESSATION FOR PREGNANCY AND BEYONDInteractive 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.