A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women

Abstract

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.

Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

“…The current study findings show how midwives support women with high body mass index with weight management during pregnancy, consciously building relationships with women, and working with them to identify appropriate and achievable behavioural goals that benefit the woman's health in the long term. These findings add to the current literature in which midwives have often reported avoiding or not having time to discuss weight management [17,18].…”

“…Weight management support includes counselling on physical activity behaviour, which midwives sometimes identify as challenging [12]. Weight management also includes supporting healthy eating behaviours, which is rarely done in a standardised manner [13].…”

“They Just Need to Come Down a Little Bit to Your Level”: A Qualitative Study of Parents’ Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours

“…Barriers highlighted by parents in this study such as lack of time, knowledge, and resources may account for this and should be addressed within interventions. Indeed, health professionals themselves have identified lack of knowledge, confidence and/or relationships with women, time, continuity of care, and resources as barriers to them supporting women around a range of health behaviours [75][76][77][78][79][80]. Similarly, maternal and child health nurses in Australia raised concern about parental receptiveness to discussions about child weight in routine practice [81].…”

How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health?

“…These Australian midwives struggled however to find time within the existing care pathway to have effective conversations about nutrition. Time and resource constraints as well as a lack of confidence have all previously been reported as barriers to addressing diet and weight by U.K. midwives (Macleod et al, ; McCann et al, ). Current maternity care arrangements in the United Kingdom offer multiple opportunities for brief interventions; women will routinely be seen approximately 10 times during pregnancy and post‐birth.…”