The importance of providing smoking relapse counseling during the postpartum hospitalization

OBJECTIVES: To determine during the postpartum period (a) the most feasible time for addressing smoking relapse, (b) the reasons women relapse, (c) differences in relapse rates in women who receive a counseling intervention in the immediate postpartum period compared to those who do not, and (d) differences in self-reporting of tobacco use compared to cotinine analysis. DESIGN: Randomized clinical trial. SETTING: Medical center in the Northeast United States and two prenatal care sites. PARTICIPANTS: A nonprobability convenience sample of 62 pregnant women. INTERVENTION: A brief counseling session using empowerment techniques, motivational interviewing, identification of stressors and individual coping strategies, and educational materials. MAIN OUTCOMES MEASURE: Relapse to smoking measured by cotinine analysis and descriptive data collected during the antepartum, intrapartum, and postpartum periods. RESULTS: Fifty-two percent of women relapsed to smoking by the 2nd week postdelivery, identifying rest and relaxation and depression as main factors for relapsing. Chi-square analysis showed no significant difference between the two groups regarding the intervention provided. There was a 39% discrepancy rate between self-reporting of tobacco use and cotinine analysis during pregnancy and a 27% discrepancy rate after delivery. CONCLUSIONS: Because of the high occurrence of relapse in the first 2 weeks after delivery, it is imperative that nurses provide interventions to women before their postpartum hospital discharge to prevent smoking relapse. Nurses should also address smoking behaviors each trimester because women stopped smoking at different time intervals and self-reported data were unreliable.