Models for Access to Maternal Smoking CessationSupport

(MAMSS)

Mererid Bowley,Consultant in Public Health

MAMSS Project Management Group

Prevalence of maternal smoking

Inequalities in maternal smoking

The first nine months can shape my future...

Risks associated with maternal smoking

Effectiveness of smoking cessation interventions in pregnancy

Outcome Risk Ratio (Confidence

Interval)

Percentage reduction

Smoking in late pregnancy

0.94 (0.93-0.96) 6%

Low birth weight 0.83 (0.73-0.95) 17%

Preterm birth 0.86 (0.74-0.98) 14%

Lumley et al Cochrane Database of Systematic Reviews 2009

Evidence base for maternal smoking cessationRecommendations for midwives:• CO Monitor• Training• Discuss health risks and refer all pregnant

smokers (opt-out)

Recommendations for NHS Stop Smoking Services:

• Flexible, client centred approach• Address barriers to smoking cessation• Feedback to midwives• Intensive interventions and on-going support

MAMSS Aims and ObjectivesAim:To evaluate the extent to which improvements in the delivery of

smoking cessation services to pregnant women can increase the proportion of pregnant smokers who engage with stop smoking services and reduce the number of women smoking during pregnancy.

Objectives:• Fully implement NICE guidance for smoking cessation services for pregnant

women in selected pilot and usual care sites• Design and deliver different models of service delivery for smoking

cessation services for pregnant women• Compare the effectiveness of new models of service delivery with usual care

Summary of project interventions

15th July 13

Challenges and limitations

• Not a Randomised Control Trial• Different data systems used across the

Health Boards – some are still paper based• A variety of different partners• Can only be part, not all, of the solution to

maternal smoking

• Excellent integration between public health teams and maternity services in health boards with pilot sites

• NICE guidance has been implemented across pilot and usual care areas.

• Midwives have received brief intervention training and been issued with CO monitors

• Early results from all project intervention areas are positive– Referrals from Midwives are higher than anticipated– Engagement and quit rates are higher than previous

service delivery data

Progress so far

‘ I think the whole scheme is absolutely brilliant. The help and support that’s there helps and guides you to becoming a non smoker, and that benefits everyone, family and baby’s health.’

Rachel, Ruthin

“I wanted to give up smoking for my lifestyle, my health and especially as I am pregnant. I want to ensure that my baby is healthy and isn’t breathing in cigarette smoke. I also want to be a good role model for my baby when it’s older and for others as well. I am feeling really good and much healthier. My skin feels better and I am drinking lots of water. I’ve also got more money which means I can buy the baby more things.”

Natasha, Garth

‘Because Annmarie (Maternity Support Worker) came twice a week it meant that I wanted to do better. She helped me understand how to break my habits. My sister is pregnant and she has given up too.’

Sarah, Rhyl

Acknowledgments• Siobhan Jones – Chair Project team, Lead BCUHB• Shantini Paranjothy – Academic lead, Cardiff University• Lorna Bennet – Academic support• Aimee Grant – Academic support• Rachel Lewis – Project manager, lead BCUHB• Mererid Bowley – Project Lead, ABHB• Annie Petherick - Project Lead, ABHB• Sarah Barnes – Project Lead ABHB• Angela Jones – Project lead CTHB• Margaret Munkley – Project lead CTHB• Christian Heathcote-Eliot – Project Lead ABMU• Catrin Jones – Project Lead ABMU• Carol Owen – Stop Smoking Wales• Ceriann Tunnah – Stop Smoking Wales• Sharn Jones – midwifery rep• Maternity Services Staff in BCU HB, CTHB, ABHB, ABMU

Diolch yn fawr

Thank you