Some lessons from Swedish midwives' experiences of approaching women smokers in antenatal care

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 cooperation 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. (c) 2005 Elsevier Ltd. All rights reserved.