Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

Abstract

Objective: To understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity.Design: A qualitative, interpretive approach using one-to-one in-depth interviews to explore the lived experience of pregnant women with obesity following referral to an antenatal dietetics service. Thematic content analysis was carried out by two researchers independently to develop data-driven themes.Setting: One NHS Trust maternity and dietetic services, North East England, UK Participants: Fifteen pregnant women with a booking body mass index ≥30kg/m 2 attending an obesity-specific antenatal dietetic service. All women were White, parity between 0-2, and BMI range 30-51kg/m 2 .Findings: Four themes were identified within this concept. 1) Women's overall experience of the service: experiences were predominately positive with only two negative cases identified.2) Process of referral: women placed importance on informative and in-person communication about the service, with health professionals, at the point of referral. 3) 2 Delivery of the service: dietitians were considered to be the experts and women wanted more frequent contact. 4) Content of the service: tailored advice enabled behaviour change, and women desired increased physical activity support and weight monitoring.Key conclusions: Women reported an overall positive experience and thought that dietitians were the expert health professionals to support them. Women in this study felt that tailoring advice specific to their personal circumstances helped them implement changes, and had a strong interest in the nutritional benefits for fetal development. Women considered weight monitoring to be a positive element of the service; however, further research is required given the limited and conflicting evidence-base.Implications for practice: It is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate personcentred care. Communication by health professionals at the point of referral is particularly important to provide accurate expectations of services and to reduce anxieties. Dietitians are considered to be appropriate experts to deliver these services, although they may need additional support to address women's physical activity needs in pregnancy.Keywords obesity, body mass index, dietetic, qualitative, experience, pregnancy IntroductionMaternal obesity (body mass index (BMI) ≥30kg/m 2 ) is increasing in prevalence internationally (Brynhildsen et al., 2006;Ray et al., 2007;Heslehurst et al., 2010;Fisher et al., 2013) and is associated with complex inequalities, including deprivation and ethnic minority groups (Heslehurst et al., 2010(Heslehurst et al., , 2012. There are significantly increased associations with adverse outcomes for women and babies including congenital anomalies, perinatal mortality, macrosomia, gestational diabetes, maternal infections and preterm birth (Heslehurst et al., 2008;Stothard et al., 2009;Tenn...

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

“…Normalisation of risks. Whilst any woman with obesity might have altered perceptions of risk due to the external influence of stereotyped thought, the following three themes refer to distinctly different ways in which women approach risk in pregnancy, which appears to be heavily influenced by the women's experience of antenatal counselling [29,32,33,[37][38][39]. https://doi.org/10.1371/journal.pone.0227325.g001 Table 1.…”

“…Moderate confidence: There are 2 papers with minor methodological concerns and are a few conflicting examples (women were counselled regarding risk and aware of potential complications) [19,20,29,32,[36][37][38]41].…”

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

“…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).…”

Tackling maternal obesity: Building an evidence base to reflect the complexity of lifestyle behaviour change

“…Heslehurst et al (2017), Atkinson and McNamara (2017) and Lingetun et al (2017) explored women's 'lived experiences' of being obese and pregnant. Heslehurst et al (2017) recruited women who had BMIs ≥ 30 kg/m 2 who attended specialist antenatal dietetic services, while Atkinson and McNamara (2017) recruited postnatal women. Heslehurst et al (2017) in a UK study reported women were satisfied with a service that offered tailored and individualised weight management support.…”

“…Heslehurst et al (2017) recruited women who had BMIs ≥ 30 kg/m 2 who attended specialist antenatal dietetic services, while Atkinson and McNamara (2017) recruited postnatal women. Heslehurst et al (2017) in a UK study reported women were satisfied with a service that offered tailored and individualised weight management support. Atkinson and McNamara (2017) in a study from Ireland reported that although women's weight was checked and documented in their maternity records, it was ignored by clinicians, resulting in women feeling anxious and confused.…”