Tobacco in Pregnancy

Regional Aim: To reduce tobacco dependency in pregnancy to less than 10% smoking at time of delivery by 2020 and less than 5% by 2025.


National Centre for Smoking Cessation and Training (NCSCT) training Standards

E-learning VBA and pregnancy specific modules are primarily available through ESR or

The reintroduction of CO monitoring training can be accessed here

Different Levels Of Training Are Available For Tobacco Dependency In Pregnancy.

Making Every Contact Count (MECC) Anyone Building up confidence in engaging health related conversations, provides signposting and referral activities. MECC e-learning module.

MECC Face to face training potentially being rolled out.

Very Brief Advice (VBA) Anyone Trained to NCSCT standards.


  • CO monitor and establish smoking status.
  • Advice as to best way to stop smoking is through combination of medication & support.
  • Act & refer to service as standard in line with NICE guidance.
NCSCT brief advice for pregnant women training e-learning module (30 minutes). This does not have the practical aspect of CO monitoring.

Local stop smoking service to NCSCT standards (1&1/2 to 2&1/2 hours).

National training providers to NCSCT standards (2&1/2 hours).

VBA update training As above Minimum face to face training as above every 2 years. Elearning via NCSCT website alternative years.
Enhanced Brief Interventions (This is VBA plus medication options) Frontline clinical staff Ward delivered VBA plus a one off NRT to be followed up by a trained Stop Smoking Advisor. Trained in VBA as above plus NCSCT stop smoking medication module.

Medication training from trust (Trust specific protocols).

Enhanced Brief Interventions update training Medication update training from trust. VBA training update as above.
Stop smoking support in pregnancy Anyone standards who has capacity to offer 12 weeks ongoing support (as per chart 1).

Requires ongoing supervision and access to NRT.

Trained to NCSCT standards to provide pregnant women stop smoking support and NRT through a treatment plan. NRT can be given as voucher, PGD, prescription (dependant on local protocols). Trained in:

  • NCSCT Stop Smoking Practitioner training
  • NCSCT specialist module – pregnancy and smoking cessation
  • Local stop smoking advisor training

Trainees require regular supervision.

Stop smoking support in pregnancy update training Local stop smoking advisor annual refresher training (1/2 day). Includes local pathways and medication updates.
Risk Perception training Midwives only Training provided by IPIP only. 1 day training.
Enhanced visual key contact intervention (modified risk perception, has different names in different locations) Midwives, Obstetricians, MCA’s/SSA’s, Sonographers. Varied in local practice. Often using IPIP provided video.
Train the trainer for VBA Anyone trained in VBA To be able to roll out to anyone to provide CO monitoring and VBA. Currently provided by IPIP only. Need to have capacity to train out regularly.
Train the trainer for Enhanced Brief Interventions (This is VBA plus medication options) Anyone trained in VBA Ward delivered VBA plus a one off NRT to be followed up by a SSA. Trained in VBA as above plus NCSCT stop smoking medication module.

Medication training/updates from trust.

All maternity staff should complete annual Very Brief Advice (VBA) training. This training is designed to offer CO screening and appropriate signposting to support for smokers.

Stop smoking advisor (SSA) training is a two day certified course for those with an interest in developing specialist skills. It enables staff to offer specialist support (including nicotine replacement therapy) to women and families at the point of contact.

Very brief advice (VBA) train the trainer is a one day training day. On completion of the course, participants will have the skills necessary to facilitate VBA training in their own teams and trust.

Any courses taking place in 2020 will be communicated to Heads of Midwifery and maternity managers.

To book, please gain your management approval and email [email protected] with your name, job title, place of work and email address.

Tobacco dependency in pregnancy during Covid-19; a rapid update for the North East

Watch the full webinar below:

All the presentations were so powerful, there were some stark messages of why supporting pregnant women who are tobacco dependent is so imperative and why every baby counts.

Dr Ruth Sharrock, Respiratory Consultant, Clinical Lead on Treating Tobacco Dependency for the ICS Prevention Board and joint chair of the regional Smokefree NHS Taskforce set the scene on the NE progress, impact of stalling CO monitoring and the direction of travel in relation to the NHS LTP plan.

The evidence from Dr Clea Harmer, CEX of Sands UK, emphasised to us that smoking is THE number 1 modifiable risk factor in pregnancy and worryingly the fact that still births have been increasing in the pandemic and smoking a clear causal link in many of these.  Martyn Willmore PHE Tobacco Control Senior Programme Manager, provided a detailed review of the evidence supporting the reintroduction of CO monitoring.

Louise Hand, Public Health Midwife at South Tees, shared an honest account of their recent approach to reimplementing CO monitoring and how they are maintaining a high clinical importance to maternal smoking as key for their focus on addressing health inequalities and Saving Babies Lives.

Dr David Crane took us through the benefits of the Smoke Free app which has been commissioned for free access to pregnant women and their partners in the NENC and Dr Ryc Aquino updated on the regional evaluation of the Smoke Free app.

Dr Sharrock summarised the event, highlighted how powerful and crucial undertaking a CO test can have on a clients journey to stopping smoking and concluded with a plea that CO monitoring should be reinstated where it is safe enough to offer face to face consultations.

Below are a list of the documents mentioned throughout the presentations.

Additional documents:

NHS  Long Term Plan

Reintroduction of CO monitoring for maternity staff that includes a risk practice tool

HSE Ventilation advice –

Undertaking remote consultations good practice guide

Breath Testing In COVID-19 – Bedfont Scientific Ltd. – Our family, innovating health, for yours – Based in Maidstone

LMS NRT Provision Recommendations

North East LMS Tobacco Dependency in Pregnancy Pathway and Script 070819

Training and local resources – LMS Learning Hub

Leaflets/Posters – Smoking in Pregnancy Challenge Group  –

Smoke Free app –

Twitter information – @smokfreeNHS_NE and @Northernlms

Professional information resource available on KHub – please email Tiffany Ghee [email protected]

Useful links

Range of tobacco dependency in pregnancy support materials.

Smoking in pregnancy challenge group

Information on Fresh who work in partnership with local authorities and the NHS in the Northeast.

Baby in bag leaflet (S4L184) – Login required to view and order leaflet

Useful documents

The North East tobacco dependency in pregnancy pathway and script can be downloaded here.

NE regional maternity audit and recommendations (May 2018) can be downloaded here.

Royal College of Midwives Position Statement can be downloaded here.

Action on Smoking for Health (ASH) have released information on incentives scheme and updated use of e-cigarettes briefings aimed at professionals. A short key messages document for health professionals working with pregnant women and their babies can be downloaded here.t