Specialist stop smoking service and community midwives working in partnership to reduce smoking during pregnancy in Nottingham City
Michelle Battlemuch, Stop Smoking Service Team Leader, Nottingham City PCT, UK and Julie Greenwood, Specialist stop smoking advisor pregnancy, Nottingham City PCT, UK

Abstract
The presentation will discuss/highlight how the Nottingham New Leaf Pregnancy and Family Stop Smoking Service adapted the process of referral for pregnant smokers and introduced mandatory annual smoking cessation training for all community midwives and support staff. This has resulted in a large increase in referrals to the specialist service and a reduction in smoking prevalence during pregnancy.

The old referral method relied on community midwives referring pregnant smokers via a referral pad to the stop smoking service.  The service negotiated a carbon copy type insertion into the hand held maternity public health record, which served as a brief intervention tool for community midwives and also a streamlined referral mechanism. 

The tool is brightly coloured and branded with the stop smoking service logo. It requires the midwife to establish the smoking status of the pregnant woman and her family. It then guides the midwife to assess how the woman feels about her smoking behaviour and offers referral to the specialist service.

One of the copies is then sent to the specialist service that extracts the required data to arrange a home visit or clinic appointment if the woman or her family has agreed to support. If the woman declines support at this point the tool is still forwarded to the service to be processed by CIS in order to extract data on smoking prevalence at commencement of the pregnancy and in the year prior to the pregnancy. The community midwife will go on to revisit the smoking behaviour at each antenatal visit.

The community midwives also received one full day of specialist ‘Smoking and Pregnancy’ training that amongst other issues included the use of the tool and brief intervention strategies for pregnant women and their families. Shorter annual updates continue to be mandatory for the midwives. 

The service has seen a dramatic increase in the number of referrals from around 350 per year to around 2,000 per year and a reduction in smoking prevalence during pregnancy from 24% to around 19%.