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)
0.94 (0.93-0.96)
Percentage
reduction
Low birth
weight
0.83 (0.73-0.95)
17%
Preterm birth
0.86 (0.74-0.98)
14%
Smoking in late
pregnancy
Lumley et al Cochrane Database of
Systematic Reviews 2009
6%
Evidence base for maternal
smoking cessation
Recommendations for midwives:
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CO Monitor
Training
Discuss health risks and refer all pregnant
smokers (opt-out)
Recommendations for NHS Stop
Smoking Services:
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Flexible, client centred approach
Address barriers to smoking cessation
Feedback to midwives
Intensive interventions and on-going support
MAMSS Aims and Objectives
Aim:
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:
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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
Progress so far
• 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
‘ 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
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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