Breaking the Cycle

Breaking the Cycle: How The SiP Project Is Transforming Smoking In Pregnancy Across Cheshire And Merseyside, by Steve Jones, CMCA Senior Programme Manager

Smoking during pregnancy remains one of the most significant modifiable risk factors for poor health outcomes in both mothers and babies. The Smoking in Pregnancy (SiP) Project – a multi-agency collaboration across Cheshire and Merseyside – set out to change this narrative by improving patient safety and cancer prevention through a personalised maternity pathway focused on treating tobacco dependency (TTD).

What was the aim?

The SiP project’s objectives were ambitious: reduce the number of women smoking during and after pregnancy, train and support the maternity workforce, and facilitate effective referrals to community providers.

By creating targeted campaigns and linking women to patient-centred resources, the project supported women on their ‘quit journeys’ and fostered a culture of positive change.

A collaborative approach

The Women’s Health and Maternity (WHaM) programme – a sub-regional organisation helping to transform women’s health and gynaecology services – underpinned the project. It aimed to develop a safe, high-quality, and sustainable model of care for women’s services across seven provider trusts in Cheshire and Merseyside. These included:

• Countess of Chester Hospital NHS Foundation Trust
• Liverpool Women's NHS Foundation Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• Southport and Ormskirk Hospital NHS Trust
• St Helens and Knowsley Hospital Services NHS Trust
• Warrington and Halton Hospitals NHS Foundation Trust
• Wirral University Teaching Hospital NHS Foundation Trust.

The project was initially funded by Cheshire and Merseyside Cancer Alliance, which also donated workforce time where necessary, and supported by NHS Cheshire and Merseyside.

The project team consisted of several specialist staff to uphold a collaborative approach and provide project management, clinical leadership, maternity expertise, and community engagement support.

Why does it matter?

Smoking in pregnancy causes harm from day one. Nationally, it is linked to:

• 5,300 foetal/perinatal deaths
• 2,200 premature births and 19,000 low birth weight babies
• Increased risk of developmental anomalies.

Children exposed to tobacco smoke are at greater risk of sudden infant death, respiratory illnesses, and are twice as likely to become smokers themselves.

For mothers, smoking increases the risk of complications such as placenta praevia, deep vein thrombosis, miscarriage (by 27%), and stillbirth (by 47%).

Project ambitions and actions

To tackle these challenges, the SiP project aimed to:

• Provide a consistent approach across Cheshire and Merseyside
• Track and report each woman’s progress from booking to birth
• Train and support the maternity and health workforce
• Understand barriers to quitting and seek innovative solutions
• Develop peer support models and communications campaigns
• Host learning webinars and promote co-production
• Ensure supported self-management and shared decision-making
• Embed personalised care into smoking in pregnancy pathways.

The communications campaign had the message: ‘Quitting is tough – but so am I’, acknowledging that quitting smoking is not easy, but smokers are tougher than they think and can give up.

A dedicated campaign website was launched – Home - Quitting is tough, But so am I – with this message: “If you’re here to quit, well done for taking the first step. When you stop smoking it will be your achievement, you will have done it thanks to your own hard-work and determination, and it will be something to be proud of. But a helping hand is always useful, so we’re here to support you along the way. Here you can find facts about the benefits of quitting, resources to help you build your own Quit Kit, and advice on local services available in your area.”

There was a website to help, giving women useful tools, like the “build your quit kit” section with resources, information and signposting to stop smoking services and other support covering all nine areas in the ICB region.

The website also offered information on Nicotine Replacement Therapy (NRT), plus easy-to-understand advice and links to local support. There were also links to stop smoking and wellbeing apps, with tips, progress trackers, and more. Getting active can really help when people are trying to quit, so the site pointed people to places where they could find exercise ideas too.

Extra support was added thanks to Koala North West, a local charity, which offered a peer support network, so people could chat with others by phone or video, join a private Facebook group.

Impact and results

The key outcome measure of the project was to reduce the smoking at time of delivery (SATOD) rate across the region.

Cheshire and Merseyside started with a SATOD rate of 11.3% in Q1 2022/23, well above the national target of 6%. Through the SiP project’s interventions, this rate dropped to 9.5% in Q1 2023/24, 7.4% in Q1 2024/25, and most recently, 6.3% in Q3 2024/25 –demonstrating significant progress towards the national target.

Other notable achievements include:

• Carbon Dioxide testing offered at every antenatal appointment
• Enhanced pathways based on NHSE maternity models
• Improved patient experience and increased workforce capacity
• Early pregnancy intervention pilot at Mid Cheshire Hospitals NHS Foundation Trust, with 50% of participants smokefree at delivery after engaging with specialist practitioners

Partnerships and testimonials

The project’s success is rooted in partnership working, with funding from the Cancer Alliance and collaboration with groups like the Living Well Bus and Koala North West. The Smoke Free App was adapted for pregnancy-specific messaging, and peer support networks were established.

Staff and patient testimonials highlight the project’s impact:

“I enjoy giving patients the 28-day quit chart, I like to go over the positive benefits that they will feel in the first 28 days. It’s nice to see patients' reactions to some of the benefits that they don’t realise will happen.” (Staff member)
“I don’t want to quit just for my baby, but for my long-term health too.” (Parent to be)
“I want to save money to decorate the nursery.” (Parent to be)

Legacy and looking forward

The SiP project has spread best practice across all provider Trusts, upskilled the workforce, and created scalable, personalised care models. The introduction of carbon dioxide testing at every antenatal appointment and the development of the ‘I am tough’ campaign, with its suite of resources that empowers women to access support and tools for quitting.

Peer support networks, ongoing staff training, and the integration of new roles like Maternity Health Champions ensure the project’s legacy will continue to drive cultural change and improve outcomes for future generations.

Conclusion

The project has been incredibly successful in a number of metrics, but none more so than reducing the number of women who smoke in pregnancy from almost double the national goal to nearly hitting the NHSE target.

It was also recognised nationally with being named as runner-up in the Maternity and Midwifery Services Initiative of the Year category of the Health Service Journal Patient Safety Award 2025.

Jon Hayes, Managing Director of Cheshire and Merseyside Cancer Alliance, said of the achievement: “It is fantastic for this project to be recognised nationally. It was a well thought out and executed campaign which has had success in increasing the number of women who give up smoking once they become pregnant. This is obviously good for the long-term health of both the mother and baby.”

The SiP project stands as a leading example of partnership working, system change, and patient benefit. By reducing smoking rates in pregnancy, it delivers one of the greatest safety measures for the local health system – saving lives, improving health, and building a smokefree future for Cheshire and Merseyside.