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At Ste. Genevieve County Memorial Hospital — surrounded by counties where as many as one in three pregnant women smoke — when a new pregnant woman tells her doctor she smokes, she gets a visit from respiratory therapist Carrie Staab.

Staab comes armed with pamphlets and gives her spiel about the dangers to the fetus. She refers patients to the state quitline and websites that provide counseling and support over the phone or online.

“We would hand them resources, and it would end there,” Staab said. Some would quit, while some would try and fail. Others were too daunted to even try. No one followed up after the women had their babies.

Now Staab is armed with a new tool: up to 12 months of free diapers. “That gets them in and gets them interested to listen,” she said.

The southeast Missouri hospital is one of six sites across the state chosen to participate in Baby & Me: Tobacco Free, a program that supports pregnant women’s commitment to quit smoking by promising a much-coveted commodity for new moms — diapers — if they kick the habit during and after their pregnancy.

The program is gaining traction nationwide after a 2011 study showed its success in helping women quit during pregnancy, as well as staying smoke-free for months after. Twelve states have Baby & Me programs, and a dozen states have programs in the works, said program founder and director Laurie Adams, a cessation educator in New York.

It also meets another need in Missouri, which the Post-Dispatch reported on a year ago: a diaper crisis among poor families that not only causes obvious health problems, but also leads to depression in mothers and poor developmental outcomes in children.


Missouri ranks near the top when it comes to the number of pregnant women lighting up. About 17.5 percent of women smoke during pregnancy, more than twice the national average. In more than 20 counties, the rates are as high as 29 percent to 35 percent, according to the state department of health.

Smoking increases the risk of miscarriage and stillbirth, as well as having a low birth weight or premature baby, the leading cause of infant morbidity and mortality. Children born to mothers who smoke during pregnancy are also at increased risk for asthma, colic, obesity and sudden infant death syndrome.

The results are costly. Exact figures are unknown, but a 1996 report showed that smoking during pregnancy caused more than $10 million in preventable neonatal expenditures in Missouri.

The Baby & Me: Tobacco Free program involves four 15-minute face-to-face prenatal counseling sessions with a trained provider. Participants are tested with a carbon monoxide monitor, which works like a Breathalyzer. (Smokers have higher levels of the gas in their blood and breath.)

If the woman remains smoke-free, she returns after having her baby for monthly visits and tests. For every month she doesn’t smoke during the baby’s first year of life, she gets a $25 voucher. Only she can use the voucher, and it can only be used for diapers at participating Wal-Mart and CVS stores.

Because living with someone who smokes is a big barrier to quitting, Ste. Genevieve is also awarding additional $25 vouchers for another person in the household who stays smoke-free.

“We like the tone of it. It’s positive. It’s not condemning mom, but helping her in positive way,” said Trina Ragain, director of program services for the March of Dimes chapter in Missouri. The nonprofit that promotes the health of pregnant women and newborns has joined forces with Anthem Blue Cross and Blue Shield to fund the initiative in several states.


Participants hope that Baby & Me will not only help women quit smoking while pregnant but also greatly reduce the high relapse rates after their babies are born. That would help put a dent in Missouri’s overall smoking rate – 22.1 percent – the ninth-highest in the U.S.

Each year, tobacco-related illnesses cost the state about $2 billion and kill nearly 10,000 Missourians. A study released this week links half of all cancer deaths in patients over age 35 to tobacco.

Women are highly motivated to quit smoking for their baby. According to federal statistics, more than half of female smokers are able to drop the habit when they get pregnant. Yet within six months after birth, 60 percent have relapsed; and by 12 months, 80 percent have.

“A lot of women quit while they are pregnant, but boy, as soon as they deliver, they are straight back at it because they aren’t pregnant anymore,” Staab said. “That why I love this program, because it kicks in after you deliver, and it lasts a whole year.”

Studies have shown that a majority of women in Baby & Me initiatives are able to quit during pregnancy and 60 percent are still smoke-free at six months after giving birth. Findings will be presented later this month in Colorado, Adams said, where participants’ babies weighed an average of 7 pounds and 75 percent of mothers remained smoke-free three months postpartum.

“We liked the merits of the program, and the outcomes were good,” said Dr. Jay Moore, senior clinical officer for Anthem in Missouri. “We choose to support an evidence-based program that has been shown to work.”

Adams attributes the program’s success to the one-on-one counseling and the continued contact in the baby’s first year. The counseling includes in-depth descriptions on how smoking affects the health of the woman and her baby, the cost savings of quitting, how to ask others not to smoke around her and other ways to handle stress. The diapers end up being a bonus.

“It might be the carrot that draws them in,” she said, “but in the long run, it’s not what really helped.”

Stone County Health Department, west of Branson, is hoping to become the next Baby & Me location. Lynetta Smith said she often sees pregnant women intent on quitting, but many are single mothers with little support. Stresses such as job insecurity or taking care of a sick child or parent trigger their addiction.

“It’s definitely a population unlike any other,” Smith said. “There a lot more factors at play because of the stress of motherhood.”