Many women quit smoking when they become pregnant, but a high proportion take up the habit again soon after giving birth. A team at the University of East Anglia in the UK, analyzing studies of 1,031 American and Canadian women, has found that the motivation to “stay quit” is not generally strong enough to prevent new mothers from taking up the habit again within a year of the baby’s birth.
A team of researchers, led by Dr. Caitlin Notley, reviewed 16 studies to investigate why 75% of women who quit smoking during pregnancy return to the habit within 6 months after the birth, and a total of 80-90% relapse within a year.
The findings are published in the journal Addiction.
Overall, up to 45% of women stop smoking “spontaneously” during pregnancy, due to factors such as concern for the health of the fetus, social expectation, physical aversion to cigarette smoke and decreased withdrawal symptoms due to the physiological changes of pregnancy.
The researchers found that women often return to smoking because of factors relating to motivation, physiological realities, social influences and individual identity, and that stress is a major contributor to relapse. Women from lower socioeconomic groups also show a greater tendency to start smoking again.
Regarding motivation, many women believe that smoking is no longer harmful once the baby is born. Some of the mothers studied had only ever intended to give up for the duration of the pregnancy.
Danger to the baby from smoking while breastfeeding was cited as a reason for not smoking again. In contrast, some mothers said they had weaned the child early in order to be able to smoke again.
Physiological factors such as renewed cravings, which had been alleviated naturally by bodily changes during the pregnancy, had also encouraged some of the mothers to restart.
Some women found that, while not smoking had felt good, it was easy to start again, whereas those who had found smoking disgusting after they quit continued to be upset by the smell and the smoke, which made them less likely to relapse.
Social influences caused some women to return. Many found that meeting socially with friends after the birth, they were expected to behave as they had done before the pregnancy, and they easily fell into this pattern.
Women whose partners smoked found it particularly difficult to remain smoke-free. One woman mentioned that she was happy to stop during pregnancy for the sake of the fetus, but wanted to decide for herself when to stop altogether; she did not want to bow to social pressure to quit just because it was expected.
- Children exposed to secondhand smoke are more prone to pneumonia
- Their lungs may not develop properly
- They are also at higher risk of sudden infant death syndrome (SIDS).
Individual identity came into play, especially for long-term smokers, who saw smoking as part of themselves. After giving birth, some mothers experienced a loss of identity due to their new role as a mother, and found that returning to smoking helped them to establish “who they are,” in relation to “who they were” before.
Stress, overall, appears to be a main factor. The stress of caring for a new baby, sleepless nights, unhelpful partners, the sense of loneliness and loss of identity all contributed to relapse, whereas help and encouragement in terms of both child care and not smoking were cited as motivations not to return to the habit.
It appears that intrinsic motivation is more likely to encourage women to stop, while not smoking because it is expected by others is unlikely to encourage long-term quitting.This information could be helpful in the development of “quit smoking” interventions for new mothers.
There is concern that smoking after having a baby seriously affects the mothers’ own long-term health and that of their children. Not only is secondhand smoke dangerous for children, but they are more likely to smoke themselves if their parents do.
Dr. Notley calls for a “cultural shift, where women feel motivated to remain abstinent, and where they feel more comfortable with the change of identity that motherhood brings.” She adds that “support from health professionals can be very important.”Medical News Todaya relapse into smoking