Ashley Adams had no trouble quitting smoking during her pregnancy.
Morning sickness and dry heaves made her too nauseated to crave cigarettes. And seeing pictures of low-birth-weight babies at a health clinic made her determined to protect her child.
"Those pictures just broke my heart," says Adams, 22, of Shawnee, Okla., whose first child was born in 2006. "I said, 'I'm not going to put my kid through that.'"
Adams quit cold turkey, becoming part of the 45% of pregnant smokers who give up cigarettes. That is far higher than the 10% to 20% rate among all smokers who typically quit after going through a smoking-cessation program, says Tom Glynn of the American Cancer Society. And that rate is especially high, he says, given that pregnant women are typically advised against using smoking-cessation medications, such as nicotine patches or gum.
Before becoming pregnant, Adams said she had no idea that smoking was dangerous for her baby, or that prenatal care was so important. But with a newfound zeal, she began seeing a doctor regularly and banned smoking in her home, even posting a "No Smoking" sign on her front door.
Adams' resolve faltered, however, under the stresses of new motherhood.
Her son, Johnathon, wailed for five hours every night. He had trouble latching on to nurse, leading Adams to worry he was undernourished. With her husband working 10-hour days and her family two hours away, Adams soon felt isolated, exhausted, overwhelmed and depressed.
Within a month of his birth, she was smoking again. Although she never lit up in front of her son, Adams was eventually smoking two to three packs a week.
Half of expectant mothers who quit smoking fall back into the habit within six months of delivery, according to the Centers for Disease Control and Prevention. Up to 80% resume smoking within a year, according to the American Legacy Foundation, which fights tobacco use.
Yet most want to stop. More than 75% of women smokers -- whether pregnant or not -- want to quit, and half say they've tried to quit in the past year, according to the cancer society.
While researchers have done few studies on the needs of postpartum mothers, experts say it's easy to see why they relapse.
Smokers often turn to cigarettes in times of stress, says Alex Parks of the American Legacy Foundation. Cigarettes are tempting for mothers trying to lose their pregnancy weight and stay mentally sharp, in spite of waking up every two hours to feed their babies.
Women who suffer from postpartum depression are much more likely to resume smoking, as are those whose husbands smoke, Parks says. Up to half of women who smoke during pregnancy have a mood disorder, such as depression, according to the cancer society.
Moms need more help, both for their sakes and for the health of their children, Parks says. Most smokers aren't aware of resources to help them quit, says Tracy Orleans, senior scientist at the Robert Wood Johnson Foundation. "These women believe that all it takes is willpower, but that's just not the case," she says.
Doctors play an important role in helping smokers quit. Research shows that even three minutes of smoking-cessation counseling can double a pregnant woman's chance of quitting, Orleans says.
More intensive counseling is even more effective.
In one promising approach funded by her foundation, counselors reward pregnant women who remain smoke-free with coupons for baby supplies, Orleans says.
"It breaks quitting up into smaller segments of time," says Orleans, who says women in the program had their blood tested for nicotine byproducts. "So women think, 'I just have to get through the next month,' or 'If I can make it 10 more days until my next checkup, I can get this $20 gift certificate.' It helps you rally the willpower you need."
Because mothers often see pediatricians more than their own doctors, the American Academy of Pediatrics has created the Smoke-Free Home Program, which trains children's doctors to counsel parents about quitting.
Adams, who is due to give birth to her second child any day, has once again given up cigarettes.
This time, however, she isn't doing it alone. Instead, Adams has enrolled in Oklahoma's telephone quit line. State quit lines are now using a new free postpartum program developed by the American Legacy Foundation and medical groups.
Telephone counselors make three to four follow-up phone calls to check in on new moms, reminding them that non-smokers miss fewer workdays and make fewer trips to the pediatrician. They also discuss coping with temptation, withdrawal and triggers that can lead to relapse, Parks says.
"It's comforting to have someone to talk to," Adams says. "I can't go back to smoking now, because I'm going to have this person calling me to ask if I've had a cigarette."
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