Why Do Pregnant Women Smoke?

 “My mother smoked [when she was pregnant] with me and I am fine.”

“I’d rather smoke a cigarette than take a drink of alcohol to relieve stress.”

“So you’re bored, what are you going to do? Sit down and smoke a cigarette.”

“It relaxes me.”

Tobacco use during pregnancy has been associated with many adverse effects, including abruptio placentae, fetal malpresentation, low Apgar scores, stillbirth, and birth defects such as gastroschisis and cleft lip or palate. Most nurses probably see these as no-brainer reasons for women to stop smoking once they become pregnant. Yet a new research study illustrates that the reasons pregnant women might continue to smoke are very individual, and that clinicians are not always skillful in supporting smoking cessation.

In this month’s AJN, researcher Geraldine Rose Britton and colleagues share the results of their qualitative study on the experiences of pregnant smokers and their health care providers. The researchers used a focus group methodology to learn about the smokers’ experiences and to better understand what motivated them to quit or prevented them from doing so.  There were also separate clinician focus groups to explore the approach of the 45 providers (71% RNs, 11% physicians, plus one NP, one nurse manager, four LPNs, and one PA) to pregnant women who smoke.

Not surprisingly, the researchers discovered that the issue is frustrating to both pregnant women and their maternity care providers. Some physicians and nurses felt unprepared to coach their pregnant patients in smoking cessation. And some patients used terms such as “preachy,” “judgmental,” “lecture,” and “hounding” when describing their discussions about smoking with physicians or nurses. One woman said she was “made to feel like a bad and stupid person” for continuing to smoke.

See “The Experiences of Pregnant Smokers and Their Providers” in the June issue to learn more about  barriers to quitting during pregnancy, patients’ suggestions for more effective anti-smoking messaging, and the authors’ recommendations for policy and practice.

Clinical editor, American Journal of Nursing (AJN), and epidemiologist


  1. Frances rojas July 14, 2017 at 9:54 pm

    Dear Betsy,

    Reading this blog really opened my eyes to this issue. The issue at hand is not only that women are not taking smoking while pregnant serious but also the approach that us health care providers are taking when bringing up the topic. As a nurse you know all the horrible effects that smoking while being pregnant causes the baby. Yet we almost see it as a given that the women would stop smoking. As a healthcare provider I think our approach to women that continue to smoke while being pregnant needs to change. I understand that we want to be assertive when telling pregnant women the negative effects smoking can have on the baby, but we also have to be understanding, comprehensive and nurturing when delivery such news. So, those women are more open to listening as well as, actually completing the task at hand, which are taking care of their baby. Thank you for bringing this global issue to my attention. Great blog!

  2. Daniel Gonzalez July 14, 2017 at 8:49 pm

    Smoking and smoking cessation in general are global issues, especially when it comes to pregnancy due to the possible complications. In reading on how the healthcare providers felt unprepared on how to addresses the topic as well as how patients felt judged, I think we established the crucial elements. Healthcare providers (doctors, nurses, etc) need to have more open discussions with their patients and come from a place of understanding and empowering the patient to make better choices. When a patient feels their healthcare team is truly coming from a genuine place of care and well being they are more receptive. The tone should shift from you should stop smoking for A.B.C. reasons and switch more towards education and letting the woman know that the staff is there to help her get the best quality of care, including alternatives to smoking.

  3. Daymar College June 23, 2017 at 8:17 pm

    You would think that the health of your baby would be a good reason to stop smoking when pregnant. Maybe it really is an addiction.

Comments are moderated before approval, but always welcome.

%d bloggers like this: