Introduction:
During the perinatal period, exposure to firsthand, secondhand and thirdhand tobacco smoke is without any doubt, the most significant preventable cause for a number of unfavorable pregnancy outcomes¹. Smoking is particularly widespread among the Greek population. According to data from the 2020 Eurobarometer,² the total use of tobacco and related products in Greece reaches 42%. Recent surveys conducted in Greece show that smoking during pregnancy remains a serious public health problem [3, 4]. In a 2019 survey,³ it appears that 46.73% of pregnant women declare themselves smokers at the beginning of their pregnancy while 17.55% of them continue to smoke throughout pregnancy. Another study conducted in 2021⁴ showed that 41.4% of the participating pregnant women were smokers, while the general prevalence of smoking at the end of pregnancy was 19.7%. Midwives who are constantly in contact with women during pregnancy and postpartum period have a direct role in helping them quitting smoking⁵.

Material and Methods:
The research was conducted between December 2022 and March 2023. An anonymous questionnaire created according to the objectives of the study, was utilized. The midwives that participated were either working in Health Centers and hospitals of 1st and 2nd Health District or working as freelancers.

Results:
The questionnaire was completed by 117 midwives. The outcomes showed that midwives have a positive attitude towards providing smoking cessation support and most of them stated that they do routinely inform pregnant smokers about the risks of smoke exposure. The majority of the participant midwives (86.3%) believe that smoking cessation support is an important part of their professional role. 77% of them reported the need for training in smoking cessation support. Ιt is worth mentioning that only 22% of the midwives who answered the questionnaire, reported that they know “motivational interviewing” and only 7% know the “5As Model” for smoking cessation. 60.7% of midwives reported that pregnant women were not well informed about the risks of firsthand, secondhand and thirdhand smoking exposure during pregnancy. Furthermore, 64.1% of them reported that they feel capable to provide smoking cessation support to pregnant and women in postpartum period but only 7.7% of the midwives answered correctly all the relevant questions on the effects of smoking during pregnancy.

Conclusions:
The results of the survey highlight the importance of training midwives in the techniques and methods of smoking cessation. Although, most of the midwives believe that they can efficiently help pregnant women to quit smoking, actually they lack the necessary knowledge to do so. These findings underline the necessity of having specially trained midwives and the need for maternity hospitals and health centers in Greece to implement smoking cessation programs.