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Smoking Cessation Counseling by Midwives

Evidence level:
Best PracticePromising PracticeEmergent Practice
Evidence of Effectiveness:
Enduring Impact:
Review criteria and process

Policy category

Supporting Parenting and Assisting with Childcare, Helping Vulnerable Children

Recommendation Pillars

Provide children with a safe, adequate housing and living environment, Provide for adequate living standards through a combination of benefits, Reduce inequality at a young age by investing in early childhood education and care

Countries that have implemented practice


Age Groups

Adults (age 20+), Young Children (age 0 to 5), Prenatal (before birth)

Target Groups

Mothers, Children

Years in Operation

2012  - still operating

Type of Organization Implementing Practice

Private Education Organization, National Government

Practice Overview

This smoking cessation program was available to pregnant women smokers in two provinces of the Netherlands.  Midwives from 21 midwife practices were trained on how to approach the subject of smoking and smoking cessation with their clients and supplied with a brief manual and intervention card explaining the seven-step protocol for effective counseling.  The seven-step protocol includes identifying smoking behavior in the client and her partner, providing information on the short-term advantages of not smoking, discussing barriers to quitting, goal setting, providing self-help materials, agreeing on aftercare, and then following up at 8 months gestation.  Midwives in the intervention gave pregnant women smokers a video, a self-help manual and a booklet for their partner about non-smoking and health counseling, in addition to a general folder from the Dutch Smoking and Health Foundation which is available online to all Dutch women beginning a pregnancy.   All intervention materials were delivered upon the pregnant smoker’s first visit to her midwife.  


This intervention has only been implemented in its exact form in the Netherlands, although a similar program has been studied in the UK (Hajek, et al., 2001).  Note that the intervention materials were developed in Dutch and based on the Dutch midwifery system.

Evidence of Effectiveness

Evaluation 1 

de Vries, H., Bakker, M., Mullen, P., & van Breukelen, G., The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners, Patient Education and Counseling (2006): 63(1);177-187.

Participants filled out a written questionnaire at the beginning of the intervention and completed phone interviews six weeks after the intervention and six weeks postpartum.  The outcomes measured were participant smoking in the past seven days, quit attempts since the intervention, and participants’ report of partner smoking.  Specimen samples were collected from some of the participants but too few were analysed to make any conclusions from the results.

Summary of Results for Evaluation




Treatment Group

Outcomes improved (statistically significant)


Six weeks after intervention:

Increase in odds of making a quit attemptIncrease in odds of not having smoked in the past seven days

Six weeks postpartum:

Increase in odds of making a quit attempt

Increase in odds of not smoking in the past seven days

Increase in the odds of not smoking in past seven days in  either measurement period















Outcomes with no effect



Partners reported smoking, all measurement points




Issue to consider

This programme was developed by the authors of this evaluation study, based on their previous research and the Minimal Intervention Strategy (MIS) protocol, an intervention structure consisting of 5-10 minutes of personalised, one-on-one motivational counseling followed by self-help guidance (Bakker, et al., 2003).  The evaluation was funded by grants from the Dutch Cancer Society, the Dutch Heart Foundation and the Prevention Fund.  It is important to note in a study related to an addictive substance, and, since the study did not successfully collect specimens from enough of the sample to validate the results biochemically, that the study analysis and conclusions are based solely on participants’ self-reports.

Available Resources

There are no websites or other materials about the programme available.

Evaluation Details

This evaluation sampled Dutch provinces, within which they sampled midwife practices that had agreed to participate in the study.  Randomization was done on both the province and practice levels separately, then all selected midwife practices were assigned to treatment or control group based on their province assignment.  Midwives then asked all clients pregnant in 2006 who reported smoking at least one cigarette daily to participate in the study.  141 mothers agreed to participate in the intervention and 177 mothers attending the “control” practices received normal care.  The groups differed statistically significantly in baseline levels of education and in alcohol consumption.  The study analysis controlled for province, cigarettes per day smoked at baseline, age of first smoking, smoking partner, and educational level.

Participating mothers answered a phone survey six weeks after the intervention and again six weeks postpartum.  The survey asked about their current smoking or smoking cessation and about their partner’s smoking.  Some specimen samples were collected at pretest and at the postpartum stage but were not a significant part of the study analysis.


Bakker, M., Mullen, P., de Vries, H., van Breukelen, G., Feasibility of implementation of a Dutch 
smoking cessation and relapse prevention protocol for pregnant women. Patient Educ Couns 2003;49:35–43.
De Vries, H., Backbier, E., Kok, G., Dijkstra, M., The impact of social influences in the context of attitude, self-efficacy, intention and previous behavior as predictors of smoking once. J Appl Soc Psychol 1995;25:237–57.
de Vries, H., Bakker, M., Mullen, P., & van Breukelen, G., The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners, Patient Education and Counseling 2006; 63(1):177-187.
Hajek, P., West, R., Lee, A., Foulds, J., Owen, L., Eiser, J., Main, N., Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy. Addiction 2001;96:485–94.

Enduring Impact

The final data collection stage of this study was 6 weeks postpartum, so any long-term effects of the programme are unknown.  The cost of implementation of the programme is not readily available.

Years in Operation

This practice was initiated in 1996 as part of the evaluation study and is not currently operating.

Contact Information


 Hein de Vries


 Professor in Health Communication


 Department of Health Education, University of Maastricht


 P.O. Box 616, 6200 MD Maastricht, The Netherlands


 +31 43 3882410