1 Partners in Change Midwives as Partners in Smokefree Change Sharon Bennett and Stephanie Cowan, Education for Change, Karen Guilliland, NZ College of Midwives, Chris Hendry, Maternity and Midwifery Provider Organisation

2 Partners in Change Challenges for Midwives Increased risk of spontaneous miscarriage complications in labour pre-term delivery unsafe birth weight stillbirths neonatal and infant death lactation failure Time matters more in pregnancy and childhood.

3 Partners in Change Programme How we think makes all the difference to how we practice. Mini workshops For increasing knowledge One day courses For developing skills Case studies To support learning into practice

4 Partners in Change Principles Understand first Partnership Brief intervention Strength-based Step by step approach To influence change in a behaviour means to understand that behaviour.

5 Partners in Change Modules 1. Understanding tobacco impact, behaviour, change Creating safety through trustworthy communication. 2. Assessment questioning, listening, knowledge 3. Discussion experts, resources, using 2 minutes 4. Support referring on, case studies, evaluation

6 Partners in Change The Partnership Building readiness SupportChange Do the right thing at the right time. Guiding decisions Strengthening action Protecting new change Thinking about it Deciding how Taking steps Holding the change

7 Partners in Change Features Financial support to attend Certification Link Midwives Panel of experts Brief intervention Lunch!! Be strategic; know where you are going in discussions, and why.

8 Partners in Change Demonstration Discussion Bridges and Barriers The aim is for people to come up with their arguments for change.

9 Partners in Change Using two minutes … Smokefree language fosters smokefree thinking.

10 Partners in Change People get closer to being smokefree with every attempt.

11 Partners in Change Learning Confidence to raise the issue “I no longer feel afraid to bring up the subject” Recognising cues “This was my window of opportunity to raise some doubt that smoking was enjoyable.” Turning negatives into positives “The first question I changed was “Are you smokefree?” instead of “Do you smoke?” A little and often, by many over time makes a difference.

12 Partners in Change Using open questions “By using more open questions the response is greater.” Solution-focused discussion “We walked through a typical day together identifying her smokefree times and places” The value of 2 minutes “I feel that putting a 2 minute slot into each visit is encouraging for both of us.” Changing smoking in pregnancy is everyone’s business.

13 Partners in Change 122 one day courses Over 1400 participants Over 250 ‘experts’ Over 780 case studies with evidence of applying course principles Results to date Midwives want to know how to support more smokefree pregnancies. Course Activity

14 Partners in Change Worth of workshops (n=719) Programme aligns with practice frameworks familiar to midwives.

15 Partners in Change Personal impact Initial assessment n=170, 6 month assessment n=102

16 Partners in Change Practice impact Initial assessment n=170, 6 month assessment n=102

17 Partners in Change Smokefree outcomes MMPO data on changes during pregnancy and across years

18 Partners in Change Summary “ I chose this case because on first sight there appeared too many problems in order for her to change. She proved me wrong and has given me insight into the idea that in the partnership for change, I have support tasks and she does the changing.” (Course participant) How can you create partnerships for lasting smokefree change?