Smoking in Pregnancy

What is the project?

The NHS Long Term Plan includes funding for every trust over a 3-year period to develop an in-house (NHS) based tobacco dependence treatment service for pregnant women/birthing people. The service must be established, offered, and delivered by end of 2023/24.

The recommended model for pregnant women/birthing people is more intensive than models for the non-pregnant population and should be delivered within maternity services – in house. It expands on recommendations in NICE guidance NG209 to drive engagement and on the Saving Babies’ Lives Care Bundle version 3 (SBLCBV3) recommendations, where all pregnant women/birthing people should be assessed for smoking status in their pregnancy and offered stop smoking support and treatment, including behavioural therapy and NRT.

Why is the project needed and which documents support the project?

Smoking is the most important modifiable risk factor in pregnancy. The diagram below shows some of the risks associated with smoking which highlights the importance of a pathway to ensure women get the support they need to become smokefree.

In Norfolk and Waveney we have a high number of women who smoke at the time of delivery. Whilst this has slowly reduced since 2019, further work is required to improve maternity outcomes and population health.

Progress to date (as of October 2023)

All three acute Trusts in Norfolk and Waveney now have Smoking Cessation Leads in post to support the implementation of a successful service. Our LMNS Smoking Cessation Advisor has been working alongside James Paget University Hospital (JPUH) to support referrals and offer education to both staff members and the public on the benefits of a smokefree pregnancy.

At present a new Maternity Tobacco Dependency Treatment Service pathway has been developed, which will see all three Trusts offering an in-house, opt-out Tobacco Dependence Treatment Service, in line with the objectives set out by the NHS Long Term Plan and Saving Babies Lives version 3. We aim to have the service up and running by 31st March 2024. All maternity staff will be trained to deliver very brief advice about smoking to make every contact count and will be trained to make an opt-out referral. Trained Tobacco Dependence Advisors will be in post across the LMNS as part of this service to offer the bespoke behavioural support and prescribe the recommended combined Nicotine Replacement Therapy needed to produce a successful quit attempt. The advisors will work alongside the midwives to ensure a joined-up service that meets the needs of the population. See our pathway below which sets out the contact points within the service.

There is a great deal of collaborative work in progress to ensure this systemwide project is successfully implemented, with the aim to reduce SATOD rates to 6%, in line with the national ambition.