Quitting smoking during pregnancy: Five keys to success

When Jennifer Legg gave up smoking, she didn't just go through withdrawal — she went through agony. "I felt like the world would fall apart if I didn't get another cigarette," says the 25-year-old college student and mom from Michigan. She snapped at her 3-year-old son. She argued with her husband. She felt grumpy all day. And whenever she caught a whiff of cigarette smoke, she suddenly wanted a cigarette like a starving woman wants a meal. But no matter how rough the cravings got, she never lost her resolve. It's amazing how pregnancy can focus a person's mind.

"I had to remind myself that I was doing it for her," says Legg, who quit smoking three weeks into her pregnancy and gave birth to a healthy daughter. "My babies are going to grow up and make decisions for themselves. At least I can do this one thing for them and give them a good start."

You may already know how hard it is to try to quit: the cravings, the irritability, the powerful urge to have "just one more" cigarette. And now that you're pregnant, you know that quitting has never been more important. Even if you've failed at kicking the habit in the past, you can do it this time. About 40 percent of all pregnant smokers manage to quit, a success rate far better than that of other smokers. Still, plenty of pregnant women continue to light up, putting their babies at risk for stillbirth, premature delivery, low birth weight, and other complications.

What separates the quitters from the women who continue to smoke? As a group, quitters aren't stronger or smarter than smokers, and they don't love their babies more. They've simply set themselves up for success. Different people take different approaches to kicking the cigarette habit, but a few winning strategies stand out. Here's a look at the top five keys to quitting smoking.

Plan ahead

Giving up cigarettes isn't as easy as crumpling up your last pack and throwing it away. You need to plan for the challenges that lie ahead. Most successful quitters set a "quit date" and make it public by telling friends, family, and co-workers. Gary Tedeschi, the clinical director of the California Smokers' Helpline, suggests picking a special red-letter day such as a birthday or an anniversary. But don't wait too long. Your baby needs you to quit as soon as possible, so next Tuesday may have to be special enough.

Once you've established the "when," it's time to think about the "how." Ask yourself if you're ready to quit cold turkey or would prefer to cut back gradually. Brandi Boggie of upstate New York took the gradual approach, going from ten cigarettes a day to one or two and then to none at all. (Luckily, her morning sickness kicked in as she was giving up those last cigarettes. It was much easier to quit, Boggie says, when even the sight of a cigarette made her nauseated.) If neither approach is working for you, consider getting counseling or asking your doctor about nicotine replacements or other quitting aids.

Whatever approach you take, you'll need to plan ahead for cravings. Cravings only last a few minutes, so your plan doesn't have to be too elaborate. Jennifer Legg would chew a piece of gum or grab something to eat. Joy Dewell, a 29-year-old mother in Montana, took walks. Anything that distracts your mind for a few minutes can help you resist the call of that next cigarette.

Get support from people around you

Giving up cigarettes is much easier if you don't try to go it alone, says Laura Hamasaka, a smoking cessation specialist with the American Legacy Foundation. "Social support from friends and family can double a smoker's chances for success," she says.

Don't wait for support to come to you — ask the people close to you for help. If you know an ex-smoker, plan to give her a call when a strong craving hits. If your friends or family members smoke, ask them not to light up in front of you. Brandi Boggie's husband agreed only to smoke outside, and he kept his promise even when the temperature dropped below zero. Shivering outside may be noble, but it's still not the ultimate show of support. If your partner smokes, encourage him to give up his habit, too.

Talk to your doctor

No matter what your approach to quitting, a conversation with your doctor can make the difference between success and "better luck next time." If you're trying to quit without nicotine replacement or other aids, your doctor can recommend a counseling program or at least give you some much-needed words of encouragement. If you want to try a quitting aid, such as a nicotine patch, gum, or spray, or the medication Zyban, your doctor can help you choose a method that's right for you.

Don't let your first conversation about smoking be your last. If you're still a smoker when your next appointment rolls around, be sure to tell your doctor. Even if you're feeling ashamed or embarrassed, it's crucial to be honest for your baby's sake. Your doctor will want to pay extra attention to the growth and development of your fetus, and she can help you prepare for your next attempt to quit. And when you successfully kick the habit, don't keep it to yourself. It might be the best news your doctor hears all day.

Keep reminding yourself why you're quitting

Giving up cigarettes can be miserable work. If you don't feel strongly motivated to quit, you'll have a hard time resisting that first craving, Gary Tedeschi says. "Smokers need to be very clear about their reason for quitting," he says. "Motivation has to be clear and personal. You have to know why you're putting yourself through something that's very difficult."

Joy Dewell found her motivation in a pile of pregnancy books. She read up on all of the dangers of smoking, and she never let those dangers get far from her mind. "Being educated about the risks really helped me," she says. Amanda Lowe, an expectant mother living in Georgia, kept telling herself that she'd never have a better reason to quit. "I just knew that if I couldn't quit while I was pregnant, I never would," she says.

Don't give up

You have a plan. You have the motivation. Your partner, doctor, and a support group of friends and family are on your side. Now it's up to you. You have to be stronger than the pull of nicotine. If you can last two weeks without picking up a cigarette, your withdrawal symptoms will start to fade and your cravings will become less and less intense. If you give in to those cravings, you'll have to go through the whole miserable process all over again.

But if you do pick up cigarettes again, don't get down on yourself or lose sight of your goal. Most smokers quit several times before they give up the habit for good. "Don't consider yourself a failure if you relapse," Gary Tedeschi says. Think about the positive: If you went a week without smoking, that's one week that your baby wasn't exposed to the toxins in cigarette smoke. And with the lessons learned from your first attempt, you're even better prepared to quit again.

Joy Dewell admits she took a few puffs from a cigarette shortly after she quit, but she didn't get derailed. She fought off her cravings, kicked her habit, and gave birth to a healthy boy in 2001. A local antismoking organization asked her to run with the Olympic torch on its way to Salt Lake City for the 2002 winter games, so she carried the torch on a freezing winter day while her son watched from the side of the road, wriggling in his dad's arms. It's only fitting that little Elijah was there in her moment of glory. She couldn't have made it without him.