Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) "If they eat healthily it will bring their weight down": Midwives Misunderstood; (b) "I don't think we are experienced enough": Midwives Lack Resources and Expertise; and (c) "BMI of 32 wouldn't bother me": Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives.

Background Muslim women of child-bearing age make up a fair part of the UK society, however, literature addressing their health needs or experiences of health services have not been extensively researched. The term ‘Muslim’ is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey. The little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this significant life event. The aim of this study was to investigate Muslim women’s perceived needs and the factors that influence their health seeking decisions when engaging with maternity services located in North-West of England. Methods The study used longitudinal semi-structured interviews with seven English-speaking first-time pregnant Muslim women receiving maternity care in North-West of England. Total of 21 interview; each woman was interviewed during the antenatal (29 to 40 weeks of pregnancy), immediate postnatal (within the first 2 months after birth) and later postnatal (4 months after birth) period. Audio-recorded interviews were transcribed and thematically analysed using Braun & Clark (2006) as a guide to forming a systematic approach to handling raw data. Results Muslim women associated most aspects of the maternity journey with their religious beliefs. Religion was not the primary reason for them becoming pregnant, yet it was an aspiration for them becoming mothers. Emerging themes include: 1) a spiritual perspective; 2) expression of religious requirements; 3) perceptions of healthcare professionals. Religious values and practices provided a positive resource for women during their maternity journey. They described how healthcare professionals approached their needs, while highlighting their concerns of the negative presentation of Muslims in Western media. Conclusion Muslim women need to feel confident to express their needs within a maternity setting. Lack of awareness amongst healthcare professionals around religious values and how Muslim women may feel when expressing their needs can inhibit them getting optimal care that acknowledges their needs. The study concludes that educating healthcare professionals about Muslim women’s worldview would enhance the quality of maternity care for Muslim women.

Background A growing Muslim population in the UK suggests the need for healthcare professionals (HCPs) to gain a better understanding of how the Islamic faith influences health related perceptions and healthcare seeking behaviour. Although some researchers have explored the experiences of Muslim women as recipients of healthcare, little attention has been paid to the challenges HCPs face as service providers on a day-to-day basis whilst caring for Muslim women. The aim of this study was to investigate HPCs lived experiences of providing maternity care for Muslim women. Method Data was collected through twelve semi-structured one-to-one qualitative interviews with HCPs in a large National Health Service (NHS) maternity unit located in the North West of England. Interview participants included Community and specialist clinic (e.g. clinic for non-English speakers), Midwives in a variety of specialist roles (7), Gynaecology Nurses (2), Breastfeeding Support Workers (2) and a Sonographer (1). The audio-recorded interviews were transcribed and analysed thematically. Results The majority of participants expressed an understanding of some religious values and practices related to Muslim women, such as fasting the month of Ramadhan and that pregnant and breastfeeding women are exempt from this. However, HCPs articulated the challenges they faced when dealing with certain religious values and practices, and how they tried to respond to Muslim women’s specific needs. Emerging themes included: 1) HCPs perceptions about Muslim women; 2) HCPs understanding and awareness of religious practices; 3) HCPs approaches in addressing and supporting Muslim women’s religious needs; 4) Importance of training in providing culturally and religiously appropriate woman-centred care. Conclusion Through this study we gained insight into the day-to-day experiences of HCPs providing care provision for Muslim women. HCPs showed an understanding of the importance of religious and cultural practices in addressing the needs of Muslim women as part of their role as maternity care providers. However, they also identified a need to develop training programmes that focus on cultural and religious practices and their impact on women’s health care needs. This will help support HCPs in overcoming the challenges faced when dealing with needs of women from different backgrounds.

Midwives provide the majority of lifestyle advice, including healthy eating, to pregnant women during routine antenatal appointments. Internationally, 50-60 % of women are either already overweight or obese prior to conception, with the UK having the highest rates in Europe (1) . Dietary intake directly influences pre-gravid BMI and gestational weight gain, both of which are implicated in poor pregnancy outcomes (2) . This presents major nutritional challenges to midwives due to time restraints and inconsistencies in knowledge, training and resources (3) .The aim of this study was to determine midwives nutritional knowledge and experiences of providing nutritional advice for pregnant women with obesity. Semi structured interviews were conducted with 17 midwives (n9 Liverpool, n8 Ulster). An inductive approach was utilised and the data was analysed thematically.Overarching themes that emerged from the study suggest that nutritional education and training for midwives was minimal, midwives did acknowledge sources of information such as NICE guidelines, however specific nutritional training was described as 'non-existent'."We don't have any training (laughs), we don't have any training or updates or anything about diet in pregnancy"Midwives were able to describe basic healthy eating advice such as food safety issues, referring to 'not eating for two' and promoting a 'balanced diet'. Although, such advice was delivered ad hoc, "You have very little time to talk about all those things. . .diet, sleeping and eating in general. . .because we are focused on the pregnancy aren't we and the risks"Overall the midwives demonstrated a lack of expertise with regards to specific nutritional advice for pregnancy "We should be able to hand that on to someone else, I do find it difficult for women who are obese to give them structured advice. . .I don't think we are experienced enough to do food diaries or really tailor diets"Furthermore, midwives did not view healthy eating as a priority, especially compared to issues such as domestic violence or safeguarding, they recognised their limitations and did not tailor advice to account for women's BMI status (e.g. obesity), cultural/religious influences, or restrictive diet practices (such as vegan/vegetarian/ medical disorders e.g. Crohn's disease). There are limited clinical guidelines covering maternal nutrition and therefore this topic is not currently prioritised within midwifery care.

Maternal obesity is arguably the biggest challenge facing maternity services with 50-60 % of women classified as overweight or obese on entering pregnancy (1) . Excessive gestational weight gain (GWG) can incur equivalent health risks to obesity (2) and is considered a significant predictor of long term obesity in women (3) . The lack of evidence-based guidelines on appropriate GWG may prove problematic to midwives when communicating weight management advice to overweight/obese pregnant women. Potential issues experienced by midwives in the translation of weight management advice must be explored to inform improvements in antenatal care.The aim of this study was to explore midwives' knowledge and experiences in the translation of weight management advice to pregnant women. Semi structured interviews were conducted with 17 midwives (n9 Liverpool, n8 Ulster) involved in antenatal care. An inductive data-driven thematic analysis was utilised in this study.Overarching themes that emerged from the study suggest that fear of causing offence was a barrier to initiating the difficult conversation surrounding weight management in pregnancy."Sometimes women will get offended even when you mention the word obese"This study observed that a major challenge faced by midwives is the socio-cultural acceptance and normalisation of obesity in pregnancy."BMI of 32 wouldn't bother me that much because most women are in this category"Midwives acknowledged their lack of expertise regarding weight management advice and referred to limitations in current clinical practice, resources and workload."We probably spend less time talking about diet and weight than anything else in pregnancy" "I think overweight women do need weight management advice throughout pregnancy. . .I don't think it's within the midwifery remit cause I think it's more specialised. . ..it's unfair to ask midwives to have that knowledge" Most midwives were hesitant or unsure with regard to what constitutes a healthy weight gain in pregnancy."That's a really hard one. . .because there is no UK guidance on what is a healthy weight gain"There is an urgent need to prioritise maternal health guidelines in relation to appropriate GWG recommendations. Provision of such guidelines would not only improve pregnancy health outcomes but would also be of particular relevance to the integral role of midwives in their delivery of personalised antenatal care.