Background: The objective of this study was to assess different smoking patterns during and after pregnancy and relate these patterns to socioeconomic conditions and different health issues such as symptoms, drug consumption and health care use. Methods: The study group included 337 pregnant women from a district in south Sweden. A questionnaire was filled in during the first part of pregnancy and an interview was conducted after the baby was born. The women were categorised according to their smoking habits. Results: The categories defined were continuers, relapsers, decreasers, quitters and non-smokers. Among relapsers three symptoms, difficulty in relaxing (OR 4.48), restlessness (OR 9.59) and dysphoria (OR 3.98), were more common than among non-smokers. All three musculoskeletal symptoms were most common among continuers. Among quitters the OR for backache was 2.05, for numbness In the arms and legs 2.76 and for tearfulness 2.92. Educational level was relatively high among quitters and few had a smoking partner. Among smokers (decreasers, relapsers and continuers) 24% used drugs regularly, compared to 5% among non-smokers. Conclusions: To prevent smoking during pregnancy awareness of the relations between different smoking categories and symptoms could make it easier for hearth personnel to individualise support. A possible starting point is to discuss how to cope with different symptoms occurring during smoking cessation. Women with predictors for continued smoking during pregnancy, such as low education, unemployment, a smoking partner and multiparous, should be focused on more intensively and preventive strategies suitable for their special needs should be developed.

OBJECTIVE: to use empirical data to assess the theoretical relevance of using a salutogenic, instead of a pathogenic, perspective to prevent smoking during pregnancy. DESIGN: quantitative study, a questionnaire was completed during the first trimester of pregnancy and an interview was conducted after the baby was born. SETTING: a geographically defined area in the south-east of Sweden. PARTICIPANTS: all 395 women in the study area who were pregnant during the study period 1994-1995. FINDINGS: the women were categorised according to their smoking habits. A significant difference in the sense of coherence (SOC) score was shown between smoking and non-smoking women in indicators of bad health. Women who relapsed to smoking showed a lower level of SOC, particularly in the manageability component, than others. The SOC score was higher in the whole study group than in other comparable, non-pregnant populations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a salutogenic perspective could be used in antenatal care as a basis for encouraging pregnant women to stop smoking. This could enhance the SOC by making smoking more understandable for the woman, by discussing smoking as a way of coping, and by encouraging the woman's own capacity and motivation to stop smoking. Starting a dialogue about smoking from the woman's point of view could do this, with the midwife and the woman exploring together the woman's thoughts about the smoking problem.

In general, most women are familiar with the need to stop smoking when they are pregnant. In spite of this, many women find it difficult to stop. Using a phenomenographic approach, this study explored Swedish pregnant and post-pregnant women's ways of making sense of smoking during pregnancy. A total of 17 women who either smoked throughout pregnancy or stopped smoking during pregnancy were interviewed. Five different story types of how they are making sense of smoking during pregnancy were identified: smoking can be justified; will stop later; my smoking might hurt the baby; smoking is just given up; smoking must be taken charge of. Based on the study it is argued that the approach used in health education in relation to smoking cessation in antenatal care needs to move from information transfer and advice-giving to the creation of a dialogue. The starting point should be the woman's knowledge, concerns, rationalizations and prejudices. A model is suggested in which a woman may move in a space on three axes depending on life encounters, dialogue and reflections on meaning. The goal in health education would be to encourage movement along three axes: 'increase of self-efficacy towards control', 'increase awareness by reflection on meaning of the smoking issue' and 'avoidance of defense of the smoking behavior'.

OBJECTIVE: to describe the qualitatively different ways in which midwives make sense of how to approach women smokers. DESIGN, SETTING AND PARTICIPANTS: a more person-centred national project 'Smoke-free pregnancy' has been in progress in Sweden since 1992. Using a phenomenographic approach, 24 midwives who have been regularly working in antenatal care were interviewed about addressing smoking during pregnancy. FINDINGS: four different story types of how the midwives made sense of their experiences in addressing smoking in pregnancy were identified: 'avoiding', 'informing', 'friend-making', 'co-operating'. KEY CONCLUSION: the midwives' story types about how they approached women who smoke illustrated the difficulties of changing from being an expert who gives information and advice to being an expert on how to enable a woman in finding out why she smoked and how to stop smoking. IMPLICATIONS FOR PRACTICE: health education about smoking that is built on co-operation and dialogue was seen by the midwives as a productive way of working. The starting point should be the lay perspective of a woman, which means that her thoughts about smoking cessation are given the space to grow while she talks.