Ashwin, Catherine Anne Cecelia
(2013)
A mixed methods study exploring the intricacies of smoking: stopping and relapsing during the transition to motherhood.
PhD thesis, University of Nottingham.
Abstract
Background
The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010, British Medical Association [BMA] 2004). Consideration of these facts encourages many women in giving up the habit during this period. However, following the birth the decision to remain abstinent from smoking is often a difficult one for women to make with quite a number relapsing in the first few months. The risk factors for smoking during pregnancy predominantly focus on the health of the baby whereas the longer term risks and benefits of not smoking, although identified by women are not reinforced in preparation for post natal abstinence.
With knowledge of the high numbers of women relapsing to smoking postpartum the purpose of this study was to explore the experiences of women during transition to motherhood who stopped smoking during pregnancy.
A mixed methods study was undertaken using both quantitative and qualitative approaches in the form of questionnaires and interviews.
Participants
Women were initially recruited to the study through questionnaires made available in the antenatal clinics in two large teaching hospitals in the East Midlands. In total 216 questionnaires were returned from a possible 400, however, nineteen had been incorrectly completed so were excluded. Of the remaining 197 questionnaires 75 had been completed by women who had not smoked at the beginning of pregnancy and as such were excluded from the final analysis. Women willing to participate in the interviews left contact details on the questionnaires. In total 27 women were interviewed on three occasions, once between 28 and 36 weeks of pregnancy and twice in the postpartum at six weeks and between three and six months. The women interviewed comprised women born in the UK and women born outside of the UK with ages ranging from 16-38 years of age.
Analysis
The questionnaires were analysed using SPSS which produced pertinent demographic details of the range of women within the catchment area for the study.
Data collected during the interviews were finally analysed as a continuous narrative from each woman aided by the use of NVIVO software.
Results/Findings
Data arising from the results of the questionnaires showed that 53.2% of the women were primigravida and 57.6% were in close contact with a friend or relative who smoked.
The data also indicated that the majority of women gave up smoking for the health of the baby and had little professional help in stopping. Some of the women considered that partners were supportive when stopping smoking, but overall, the women considered they stopped of their own accord.
Findings from the interviews revealed three original concepts that had a further six themes and 15 subthemes. Social influence, barriers and facilitators, and most significantly, pregnancy seen as a new start in life or just an interval were the three key concepts arising from the study. These concepts were further broken down into themes and sub themes that impacted upon a woman’s relationship with smoking. The social influence of friends and family worked both positively and negatively for women with regard to remaining a non-smoker, professional support was generally seen as positive. The health of the baby, breast feeding, self-efficacy and self-belief, nausea, the smell and taste of cigarettes and policy change were also drivers for stopping and staying stopped. Where relapse was more likely, women struggled with issues of guilt, stress and difficulty in breaking long standing habits. However, the overriding factor in remaining a non-smoker was the notion of beginning a new chapter in their lives; a new life they discussed planning to stop and the emergence of a new identity. For some women returning to smoking was a reverse of these ideas, viewing pregnancy as an interval or suspension of their lives and a return to smoking signified a return to their previous, familiar identity and confidence in who they were.
Conclusion
It is anticipated the findings from this research will contribute to the development of more successful interventions to aid long term smoking cessation in the future by adding to the knowledge of the complexities of smoking cessation during pregnancy and the transition to motherhood. Further research is recommended to look at supporting women in achieving higher levels of self-belief and self-efficacy and to consider pregnancy as a time to start a new phase in their lives. For interventions to be successful greater collaboration between health professionals and women must take place to ensure that such interventions meet the needs of the women.
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