Maternal obesity support services: a qualitative study of the perspectives of women and midwives

Abstract

BackgroundTwenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2), reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development.MethodsA purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically.ResultsTwo overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women.ConclusionsWomen need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation.

Midwives' experiences of referring obese women to either a community or home-based antenatal weight management service: Implications for service providers and midwifery practice

“…This corroboration should provide further impetus for service providers to overcome pragmatic barriers to participation in WMS, for example, scheduling sessions outside of working hours and providing childcare. Additionally, these results are consistent with previous findings which suggest that a significant number of obese women are not motivated towards weight management during pregnancy, either due to not believing that their weight carries a risk, because they have other priorities or find the prospect of change too challenging (Furness et al, 2011, Olander et al, 2011.…”

“…The present results also reflect other findings that weight management may be perceived by pregnant women as a self-motivated activity, unrelated to the welfare of their baby (Furness et al, 2011). Thus it is important to identify ways to change this perception and develop women's understanding of the benefits to their baby of weight management and a healthy lifestyle during pregnancy.…”

“…The difficulties of discussing weight management at the booking appointment are commonly reported (Furness et al, 2011;Davis et al, 2012), as is the sensitivity of weight as a topic, and concerns that raising the issue with some women may risk damaging the womanmidwife relationship (Foster & Hirst, 2014;Heslehurst et al, 2015). The differing approaches to referring women reported by the midwives in the present study reflects different interpretations of facilitating this informed choice, and highlights an important question around the midwife's role as a gatekeeper to these and other antenatal services.…”

Talking about weight in pregnancy: An exploration of practitioners' and women's perceptions

“…[35] Our previous work in this town has identified women's need for unambiguous advice regarding healthy lifestyles in pregnancy and midwives' difficulties in communicating with their clients about their weight. [19] Population diversity, high rates of obesity and variations in maternal obesity service provision led us to choose this area as a starting point for exploration of professionals' and women's experiences in maternal obesity management and identification of the requirements for practitioners in dealing with this rising public health challenge.…”

“…Despite National Institute for Health and Care Excellence [18] recommendations, midwives describe lacking skills and confidence to discuss public health issues, such as weight and lifestyle, with pregnant women, for which more training is needed. [19,20] Identifying maternity health care providers' training needs for communicating health behaviour change particularly related to dietary and physical activity would help tackle this growing public health challenge.…”