Supporting pregnant women to quit smoking: postal survey of New Zealand general practitioners and midwives' smoking cessation knowledge and practices.

AIM: This study examined New Zealand general practitioners' (GPs) and midwives' smoking cessation knowledge and support offered to pregnant women who smoke.
METHOD: Postal survey of a random sample of 776 New Zealand GPs and midwives, undertaken between September and October 2006.
RESULTS: Responses were received from 39% (147/376) GPs and 57% (203/355) midwives. Almost all GPs indicated that they were involved in confirming pregnancy during the first trimester, compared with only 55% of midwives. There was high reported routine recording of smoking status (84.5% for GPs and 98.5% for midwives) and almost all participants thought it was consistent with their role to ask about smoking in pregnancy, discuss the effects of smoking, and ask if women who smoke wanted to stop smoking. Whilst 71% of GPs reported usually advising pregnant women who smoke to abstain completely only 11% of midwives said they do this. Midwives were much more likely to advise cutting down. Over 60% of participants said they usually provide cessation counselling to pregnant women. Reported recommendation of nicotine replacement therapy (NRT) was low. Only 34% of GPs and 31% of midwives were likely to recommend nicotine gum.
CONCLUSIONS: GPs are in a pivotal position to offer stop smoking advice at the time of confirmation of pregnancy, when the motivation to quit is highest. Insufficient emphasis on the importance of early and complete smoking abstinence is being given by most midwives. Intermittent nicotine delivery mechanisms (such as the nicotine gum, inhaler, lozenge, or microtab) are not well known and need to be promoted more to pregnant women who smoke.