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.

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.