“As soon as you’ve had the baby that’s it…” a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways

Dinsdale, Sarah; Branch, Kay; Cook, Lindsay; Shucksmith, Janet

doi:10.1186/s12889-016-3289-1

Cited by 29 publications

(44 citation statements)

References 46 publications

(55 reference statements)

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“…13 However, women have highlighted a need for additional weight management support during the postpartum period as little is currently provided. 17,49,50 Systematic review evidence 49,[51][52][53][54] and the National Institute for Health and Care Excellence (NICE) public health guidance 45 both highlight gaps in knowledge about effective and appropriate weight management interventions for women during the postpartum period. There is systematic review evidence to suggest that diet and physical activity interventions delivered post partum have a moderate but positive influence on maternal weight, [51][52][53][54] and that interventions combining diet and activity behaviour change may be more successful, 49,52,53 as well as interventions that included selfregulatory behaviour change techniques (BCTs), such as self-monitoring of weight.…”

Section: Evidence-based Strategies To Support Postpartum Weight Managmentioning

confidence: 99%

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

et al. 2020

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Background There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period. Objective The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period. Design Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control. Setting This study was set in Northern Ireland; women were recruited via community-based approaches. Participants A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited. Interventions The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months. Main outcome measures The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context. Results The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period. Limitations The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data. Conclusions An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met. Future work Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial. Trial registration Current Controlled Trial ISRCTN90393571. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.

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Section: Evidence-based Strategies To Support Postpartum Weight Managmentioning

confidence: 99%

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

et al. 2020

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“…In only one study, women believed it was the increased weight which inflated the risk and did not blame the provider's stigma [35]. As a result of these stereotyped attitudes and perceived judgements, women felt that they were 'boxed in' with other women affected by obesity [18,33,40], penalised for their weight [33,34] and blamed for complications which arose [29][30][31]33].…”

Section: Study Findings-themes For Perceptions Of Risk During Pregnanmentioning

confidence: 99%

“…Only one woman stated the opposite, because the counselling was "backed up by evidence" [41]. Another woman appreciated being identified within a group, because it made her feel that she was not at fault; risk happened to other women too [29].…”

Section: Study Findings-themes For Perceptions Of Risk During Pregnanmentioning

confidence: 99%

Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research

et al. 2020

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Background Between 7-35% of the maternity population are obese in high income countries and 1-40% in lower or middle-income countries. Women with obesity are traditionally limited by the choices available to them during pregnancy and birth because of the higher risk of complications. This evidence synthesis set out to summarise how women with obesity's perceptions of pregnancy and birth risk influence the care choices that they make. Methods A search of medical and health databases for qualitative studies written in the English language, published Jan 1993-April 2019 and reporting on pregnant women with obesity's perception of risk and influence of pregnancy and birth choices. Data was extracted by two reviewers onto a questions framework and then analysed using a thematic synthesis technique. Confidence in the qualitative findings was assessed using GRADE-CERQual. Results 23 full texts were included. The common themes on perception of risk were: 'Self-blame arising from others' stereotyped beliefs ', 'Normalisation', 'Lack of preparation', 'Fearful acceptance and inevitability' and 'Baby prioritised over mother'. For influence of choices, the themes were: 'External influences from personal stresses', 'Restrictive guidelines', 'Relationship with healthcare professional' and 'Perception of Risk'. Conclusions Evidence on what influences women with obesity's pregnancy choices is limited. Further research is needed on the best methods to discuss the risks of pregnancy and birth for women with obesity in a sensitive and acceptable manner and to identify the key influences when women with obesity make choices antenatally and for birth planning.

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“…This is unfortunate since women who are aware of their own BMI and individual weight gain recommendations are more likely to gain adequate gestational weight (Shulman and Kottke, 2016;Whitaker et al, 2016). In some previous studies, pregnant women were positive to healthcare professionals bringing up weight (Atkinson et al, 2016;Dinsdale et al, 2016) and to being weighed (Brownfoot et al, 2016b;Heslehurst et al, 2017), while other studies showed that women with obesity wished that weight should not be in focus for caregivers, and perceived weight controls as uncomfortable (Nyman et al, 2010). These findings suggest a potential communication problem that is largely unexplored and may leave pregnant women unaware of risks with excessive gestational weight gain and thereby less able to make well-informed lifestyle choices (Christenson et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study

et al. 2018

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Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weight guidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices.

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“As soon as you’ve had the baby that’s it…” a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways

Cited by 29 publications

References 46 publications

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research

Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study

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