Women who smoke during pregnancy have been identified by the New Zealand Ministry of Health as a priority group for cessation services. In addition to adverse pregnancy outcomes, the effects of cigarette exposure in utero are believed to have health implications throughout life for the developing foetus. The aim of this study was to investigate the factors that affect smoking and cessation during pregnancy. Fifteen women who had quit, tried to quit, or continued to smoke through a recent pregnancy were interviewed using face-to-face semi-structured interviews. During analysis, several key findings became apparent. Smoking played a central role in the women’s lives both in and out of pregnancy. Women were fearful and concerned about the possible effects on their growing babies. Their concerns contributed to their feelings of guilt and other negative emotions, as did frustrations over not being able to quit, adverse pregnancy outcomes and their perceived failure to meet with social expectations. However, they also doubted their concerns as most had seen, or had had their own experiences of healthy babies being born to mothers who smoked. Nonetheless, their worries led to a range of behavioural changes including spontaneously quitting, adjusting their smoking, hiding their pregnancy to continue smoking, or hiding their smoking. Changing their smoking behaviours enabled women to avoid being judged which was raised in most interviews. In addition, the importance of the context in which women lived and socialised was highlighted, as were the women’s midwives. Healthcare professionals were often spoken about in relation to the mismatch between what women wanted regarding cessation and what they were supplied. A key finding was the range of smoking statuses women presented with. This contrasts with much of the other literature that usually defines women as smokers or quitters. The use of the label ‘smoker’ in society is a generalised term that obscures differences that are important for healthcare practitioners to recognise. As a result of this study, a tool that assesses a woman’s awareness of the risks from smoking in pregnancy and openness to talking about smoking cessation has been developed. The aim is to give maternity care providers a way to broach this sensitive subject in a way that is appropriate for their client.