Background: Smoking during pregnancy remains a major public health issue and a leading preventable cause of adverse maternal and fetal outcomes. In France, midwives play a central role in antenatal care and are key actors in smoking cessation support. However, little is known about how smoking cessation is managed in routine maternity care and how organizational and professional factors shape these practices. Objectives: To explore midwives’ experiences in managing tobacco use during pregnancy, identify perceived barriers and facilitators in routine practice, and generate context-specific, practice-oriented recommendations to improve smoking cessation support within a maternity care setting. Design: A qualitative study using individual semi-structured interviews. Methods: Nine midwives working in a single French maternity unit participated in semi-structured interviews conducted between March and May 2023. Data were analyzed using a Framework analysis combining deductive coding informed by the capability, opportunity, and motivation-behavior (COM-B) model and the theoretical domains framework, with inductive refinement to capture emerging themes. Data saturation was assessed retrospectively. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Midwives described heterogeneous practices in smoking cessation support and reported multiple barriers to optimal care. Three main challenges emerged: limited prioritization of smoking during consultations, insufficient knowledge and confidence in smoking cessation management, and organizational constraints, including lack of time, absence of structured care pathways, and limited coordination with addiction services. Engagement in smoking cessation discussions was often conditional on perceived patient motivation. These findings informed the development of practice-oriented recommendations targeting training needs, organizational improvements, and supportive tools within the maternity unit. Conclusion: This study highlights how individual capabilities, organizational opportunities, and motivational factors interact to shape smoking cessation support in routine maternity care. By adopting an implementation-focused perspective, it identifies modifiable levers to strengthen midwives’ capacity to address smoking during pregnancy. The recommendations proposed are exploratory and context-specific, intended to support local quality improvement initiatives rather than national guideline development.
Alhage et al. (Sun,) studied this question.