HOW SHOULD MIDWIVES DISCUSS SMOKING-BEHAVIOR IN PREGNANCY WITH WOMEN OF LOW EDUCATIONAL-ATTAINMENT

Objective: to understand how women with low educational attainment per ceived the fact of their smoking during pregnancy in order to be able to construct suitable counselling programmes. Design: qualitative stud y using tape-recorded interviews. Setting: clinic north of Stockholm, Sweden. Participants: thirteen women who had given birth during the pr evious months and who had smoked during pregnancy. Findings: all of th e women were aware that smoking presented risks to the fetus. Several had themselves experienced the damaging effects of smoking on the fetu s. However, many talked about other women who had smoked and still giv en birth to healthy babies. Nevertheless, the majority felt guilty bec ause they smoked, partly because it made them feel as though they were 'bad people' and partly out of concern for the baby. Most of the wome n stated that warnings and moralising from midwives did not make them cut down their smoking; on the contrary, many smoked more. Conclusions and implications for practice: none of the women had reached the stag e where they felt motivated to stop smoking. Realistically speaking, p robably only a few of them would be able to change their smoking habit s during pregnancy. The Interviews, however, showed the significance o f a client/patient-centred methodology, based on the client's/patient' s outlook and social situation. A potentially successful strategy coul d be to co-ordinate client/patient-centred methodology with cognitive behavioural programmes. An important task is also to confirm and stren gthen these women in their roles as mothers-to-be and to introduce the subject of smoking in such a way that the women choose to reduce thei r smoking as much as possible, given the individual's own ability and social situation. These women might benefit from being confirmed in th eir maternal role despite the fact that they smoke. Group discussions, where they could 'think it over', would also be of significance, cons idering the influence of social norms.