Smokefree pregnancies

Dr Misha Moore,  National Specialty Adviser for Obstetrics at NHS England and a consultant obstetrician at the Royal London Hospital, reflects on the recent launch of version 3 of the Saving Babies Lives Care Bundle, the latest 2022/23 publication of the smoking at time of delivery data (SATOD) and documents  how NHS England supports women to stop smoking during pregnancy.

We know the single most important action for a woman who smokes to improve her chances of a successful pregnancy is stopping smoking. Whilst many still see smoking as “lifestyle choice”, we must remember that cigarettes are designed to lead to physical dependence, mainly due to the addictive properties of nicotine.

As part of the NHS Long Term Plan, the NHS supports the good work already happening within stop smoking services, by rolling out tobacco treatment services across a range of NHS settings.  More importantly for me, this means ‘in-house’ services are being developed in every maternity unit so that every woman who smokes can get the real-time support she needs to stop smoking.

Why is this important? Well, it brings me to the recent publications. Firstly, the smoking at time of delivery data (SATOD) for 2022/23, shows we’re at an all time low, with 8.8% of women smoking at the point of birth, down from 10.6% when the NHS began to roll out its Long Term Plan in 2019. Over the four years since March 2019, more than 26,000 fewer pregnant women were smokers at the time of birth than there would have been if that rate had stayed the same. Whilst celebrating that success (especially when we know young women are one of the few groups seeing an increase in smoking rates), I can’t help but reflect that there’s still nearly 1 in 10 women smoking during pregnancy. Not only does this risk long term health consequences, it also puts their pregnancy outcomes at risk. Smokers are nearly a third more likely to suffer miscarriage and have double the likelihood of stillbirth compared with those who don’t smoke. Smoking in pregnancy can impact the newborn baby even after birth, with sudden infant deaths nearly three times as likely.  This is why continued action is necessary to reduce rates of smoking in pregnancy even further.

Essentially, Saving Babies Lives Care Bundle Version 3 is a best practice guide to drive quality improvement across maternity services and reduce avoidable deaths in the perinatal period. The first element focuses on achieving as many ‘smokefree’ pregnancies as possible. Whilst initial versions emphasised identifying smoking through carbon monoxide testing and referral on to stop smoking services, the third version has evolved to also ensure a consistent and optimal treatment pathway, with delivery of NHS led inhouse services.

The reduction in smoking rates during pregnancy has been slow.  However, bucking this trend are areas like Greater Manchester, which has delivered inhouse services alongside other initiatives as part of its smokefree pregnancy programme and seen extremely positive results. We want to harness that learning and give every woman the best possible support.

A few weeks ago, during a visit to Sherwood Hospitals Foundation Trust, I saw this first hand a service set up from scratch. I witnessed the passion and enthusiasm of staff and more importantly, I saw women who had quit smoking and had healthy pregnancies, reinforcing that this is the right thing to do.  Yes, sometimes the conversations are tricky, but with compassionate support and advice, including using the simple ‘very brief advice’ technique, most women do engage. Even for those women who aren’t ready to quit.  Access to the service as part of their pregnancy care means the conversation can continue throughout pregnancy, with care ready to go when the time is right for them.

Whilst quitting as early in pregnancy as possible is the desired outcome, a quit at any point should be celebrated; And so should the efforts of colleagues like Claire and Lisa at Sherwood who are making a real difference to women. I know there are as equally motivated and passionate colleagues working across the country, given over two thirds of services are already delivering tobacco dependence treatment services.

While I have highlighted the publication to help, it is the work of Trusts which drives through the necessary changes to achieve the best outcomes.  So, I also want to recognise front line colleagues who make this a reality for pregnant women. To them, I want to say thank you and may they have continued success in their amazing work.


This Stoptober, join the thousands of smokers committing to quitting from October 1st. For free support visit Quit smoking this Stoptober – Better Health – NHS (  The campaign is calling upon smokers in England, to join the 2.5 million other people who have made a quit attempt since the campaign first launched in 2012. Stoptober offers a range of free quitting tools including: the NHS Quit Smoking app, Facebook messenger bot, Stoptober Facebook online communities, daily emails and SMS, and an online Personal Quit Plan tool.