Postpartum smoking relapse - A thematic synthesis of qualitative studies

Background and aims: Many women quit smoking during pregnancy but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on women’s experience of postpartum smoking relapse.
Methods: A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data.
Results: We screened 1,336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1,031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Women’s beliefs about smoking as a means of coping with stress, and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the foetus) appeared to be a factor prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness, and adjusting to a new mothering identity were also reported to be important.
Conclusions: Among women who quit smoking during pregnancy, those who relapse postpartum commonly talk about no longer needing to protect the baby, and the effects of stress. Partner support and a sense of changed identity, are cited as factors preventing relapse.