Smoking in pregnancy endangers both mother and fetus by increasing the risks of placental abruption, placenta previa, premature rupture of membranes, preterm birth, congenital anomalies, low birth weight, and even death. Kentucky has the second highest rate of smoking in pregnancy in the nation at 26.3% and Pulaski County’s rate is even higher at 27.1%. The purpose of this project is to examine approaches to prenatal smoking cessation, examining the care provided to a prenatal client and comparing and contrasting this care with the evidence based practice of the 5A’s. Effective programs increase quit rates. Evidence supports prenatal smoking cessation programs that incorporate evidence-based approaches. Smoking cessation saves lives and lowers health care costs. Providing effective evidence based healthcare to the women and children of Kentucky fits the mission of Frontier Nursing University. The goal is to develop a written comprehensive evidence-based case study of the smoking cessation approach utilized with pregnant clients based on Columbia University guidelines of clinical case narratives utilizing the Stages of Change Theory as it applies to the 5A’s approach to smoking cessation. A clinical case narrative approach utilizing an in depth literature review and case study will be used to examine the care received and the evidence related to smoking cessation interventions for pregnant women. For the purpose of this Capstone, a client will be followed at prenatal and smoking cessation visits. Her experience will be explored in relation to the 5A’s (evidence-based) program and the effect on her effort to quit smoking.