Health visitors help postnatal mothers stay smoke-free, study finds

Women who receive health visitor support alongside smoking relapse prevention advice are more likely to remain smoke-free after childbirth, according to a major study involving researchers from the University of Stirling. 

A team led by the University of East Anglia (UEA) tested BabyBreathe, a programme funded by the National Institute for Health and Care Research (NIHR) which is designed to help women who quit smoking before or during pregnancy stay smoke-free after giving birth. 

Professor Michael Ussher of the University of Stirling’s Institute for Social Marketing and Health (ISMH), was a senior investigator on the study and led recruitment at two of the trial sites.  

Professor Ussher said: “This study is the first to show that an intervention focussing on support from a health visitor may help women avoid returning to smoking. These findings are important as many women stop smoking in pregnancy but then return to smoking soon after their baby is born.” 

The BabyBreathe scheme provides one-to-one support from trained health visitors, alongside digital tools, text message support, a dedicated website and app, and a relapse-prevention kit sent to families after birth. 

The study published in the BMJ shows that women who received this intervention as intended, with support from trained health visitors, were significantly more likely to remain smoke-free 12 months after giving birth compared to those without health visitor support. 

Real difference

Lead researcher Professor Caitlin Notley, Professor of Addiction Sciences at UEA’s Norwich Medical School, said: “Quitting smoking during pregnancy is an incredible achievement, but staying smoke-free after a baby is born can be just as challenging. 

“Too often, support ends once a woman has quit, even though the stressful months after birth are when many women are most at risk of returning to smoking. 

“Our research shows that when health visiting services are trained and supported to deliver specialist relapse prevention advice, they can make a real difference by significantly improving women's chances of staying smoke-free. That means better health for mothers, babies and entire families.” 

A total of 886 women from England and Scotland who had successfully stopped smoking before or during pregnancy took part in the study, as part of a large-scale randomised, controlled trial. 

Participants were randomly assigned to receive either the BabyBreathe intervention or usual care – the latter of which offered no advice or support to prevent smoking relapse.  

Although BabyBreathe was not delivered as intended for around one in five participants during the trial, either due to health visitor workforce pressures, missed appointments or administrative issues, health visitors provided one-to-one tailored advice and support to women in the intervention group. This was delivered at the end of pregnancy and immediately after the baby was born. 

This support included advice on alternatives to try if they experienced urges to go back to smoking, as well as advice for partners and family members, and access to specially designed digital resources including the BabyBreathe app and website.  

A relapse prevention 'kit' was also posted to women immediately after the birth of their baby and support continued for up to 12 months postpartum, at all routine health visitor appointments. 

The intervention was the result of more than a decade of research and development involving women, families, health professionals and researchers – who worked together to co-design, develop and test this practical support package. 

When researchers looked at participants who received the intervention as intended, 57.6 per cent remained smoke-free at 12 months in the BabyBreathe group – compared to 49.9 per cent for those with usual care. 

These findings suggest that health visiting services could play a significant role in ensuring the consistent delivery of relapse-prevention support, therefore also supporting the health of the entire family by helping more mothers to remain smoke-free after giving birth. 

Reduce risks

Professor Caitlin Notley said: “Women of childbearing age who quit and stay non-smoking can reduce their risks of developing a smoking-related disease to almost the same level of risk as non-smokers.  

“There are also great benefits for babies and children brought up by parents who do not smoke in avoiding exposure to second-hand smoke, and in helping to prevent the next generation from taking up smoking. 

“Until now, health visitors had no training on smoking relapse prevention. This meant that when women had made the extremely important – and difficult – health behaviour change of quitting smoking during pregnancy, no one picked up on this and gave them positive praise and support. 

“This new approach extends the intensive support for initially quitting smoking that pregnant women are offered, going one step further to help women to stay smokefree in the long term.” 

The researchers note several limitations of the study that impacted the primary analysis, including incomplete delivery of the BabyBreathe programme and low engagement with some of its components. The participant group was also more highly educated and less socioeconomically deprived than the wider population, which may have affected the programme’s overall effectiveness and limit how broadly the findings can be applied. 

The Institute of Health Visiting (iHV) worked collaboratively with UEA on the BabyBreathe study. 

Vicky Gilroy, Director of Innovation and Research at the iHV, said: “Health visitors and their teams are uniquely placed to support women in preventing smoking relapse as part of their universal offer. 

“It has been a privilege to contribute to the BabyBreathe study and help develop the evidence of the importance of their role. The findings reinforce the need for all health visitors to receive training in this important area.” 

This research was led by UEA in collaboration with the University of Stirling, University of Edinburgh, City St George's, University of London, the University of Exeter, Glasgow Caledonian University, the Institute of Health Visiting (iHV) and the Norfolk 0-19 Healthy Child Service. 

The paper Effectiveness of the BabyBreathe intervention for maintaining postpartum smoking cessation: multi-centre pragmatic randomised controlled trial is published in the BMJ.