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Analysis

A weighty issue

26 September, 2012

A weighty issue

Pregnant women with high BMIs are more likely to experience complications, but midwives often feel uncomfortable addressing the matter with them. Rebecca Grant discovers how one RCM alliance partner is working to improve communications.
Midwives magazine: Issue 5 :: 2012

Pregnant women with high BMIs are more likely to experience complications, but midwives often feel uncomfortable addressing the matter with them. Rebecca Grant discovers how one RCM alliance partner is working to improve communications.

A weighty issue

Throughout a woman’s pregnancy, midwives make themselves available to offer support and advice to ensure both mother and baby make it through the antenatal period with minimal complications.

This means it’s vital for all midwives to be up-to-speed with current NHS guidelines that warn of the risks related to eating certain foods, smoking and drinking alcohol during the gestational period. However, as around half of UK women of childbearing age are classed as overweight or obese (NICE, 2010), midwives must also warn the women in their care of the dangers that a poor diet and lifestyle could pose to both themselves and their babies.

Maintaining a healthy lifestyle is important for all pregnant women, regardless of their weight, but for those with a body mass index (BMI) of 30 or higher, it is even more crucial, as they could be at greater risk of experiencing problems such as pre-eclampsia or gestational diabetes.

Current NICE guidelines recommend that midwives warn women with a high BMI about the risks that their weight may impose on themselves and their baby, and offer to refer them to a specialist who can give them personalised advice on adopting a healthy eating and exercise regime that’s suitable for them (NICE, 2010).

But pregnancy is a time when a woman often feels at her most vulnerable, and broaching the subject at this sensitive time can often prove tricky.

In August, the RCM, in conjunction with its alliance partner Slimming World, conducted a survey that invited midwives to share their experiences about how they address the matter with the women in their care.

‘We know that some midwives find talking about weight quite a difficult conversation to have, as can many other healthcare professionals,’ says Carolyn Pallister, public health manager at Slimming World. ‘The survey aimed to investigate that a bit further, so we could get a true picture of what midwives talk about with pregnant women, what they don’t talk about, and the reasons why, in the hope that we can help make that conversation easier for them.’

The survey closed at the end of August, and, although the responses are still being analysed, early findings suggest that nearly one quarter of midwives have difficulty discussing weight with women, despite finding that 70% of midwives were very often (on at least most shifts) seeing women with a BMI greater than 30.

The RCM and Slimming World are already taking action to assist midwives. In the coming months, both organisations will be distributing a leaflet containing comprehensive guidance to help steer midwives through the process of discussing weight issues. Although it contains the same BMI scale that’s used across the NHS, the leaflet has been carefully phrased to avoid words that could cause offence to a pregnant woman. For example, rather than classing the BMI of greater than 30 category as ‘obese’, as is standard, it is labelled ‘at greatest risk of developing weight-related health problems’.

Additionally, in some regions midwives have been distributing vouchers, which entitle women classed as ‘at highest risk’ to attend their local Slimming World group for free (see box).

Not a diet
Although achieving a healthier weight will benefit the mother, not only during this pregnancy but following birth and through subsequent pregnancies, NICE (2010) advises against pregnant women dieting. However, Carolyn insists that Slimming World has a strict policy relating to pregnant women who choose to use its services.
‘We don’t encourage weight loss or dieting during someone’s pregnancy,’ she says. ‘Instead, we support women to follow a balanced, healthy diet and encourage them to remain physically active with the support of their midwife.’
She adds that Slimming World’s main aim is to prevent excess weight gain during pregnancy. ‘We found that there was very little weight management support for pregnant women. Yet many members were joining our groups telling us their weight problems had begun in pregnancy and they are fearful that they will gain all of this weight back in a successive pregnancy. That’s why we have our policy, to help women to reduce possible weight-related risks and the chances of them gaining too much excess weight during pregnancy, which also means that they haven’t got as much to lose after the pregnancy.
‘It’s not about the restrictive diet approach, it’s all about healthy eating, which is something that is recommended anyway when pregnant.’

Chesterfield sees results
Obesity levels in Chesterfield are significantly higher than in other parts of England (DH, 2012). Concerned by the high proportion of obese women who were attending the antenatal clinic at Chesterfield Royal Hospital, project midwife Ruth Bramwell spearheaded a campaign to promote healthy eating in pregnancy back in 2010.

The two-year project, which was funded by the strategic health authority, saw the hospital join forces with Slimming World to provide women with practical advice about healthy eating and activity.

Those who had a BMI of 35 or higher were also offered a voucher, which entitled them to 12 weeks’ free sessions at their local Slimming World group, with a chance to obtain a second voucher for an additional 12 weeks should they wish to continue the programme.

Throughout the course of the year, 341 women were offered Slimming World vouchers by Ruth and her team, and around 18% attended group meetings for the full 24 weeks.

Ruth reports that the feedback she’s had from the women who have used the vouchers has been overwhelmingly positive.

‘It’s made a massive difference to their lifestyle,’ she says. ‘A number of women tell me they’re now doing the cooking, so they’re preparing family meals now and as a result of that, their partners have lost weight and their children are eating a more healthy diet.’

It has also improved birth outcomes for many of the participants. Ruth cites the example of one woman who took part, who was pregnant with her fifth child: ‘She’d had gestational diabetes in all of her pregnancies, but she’d managed to halve her insulin levels this time around because she’d been on the Slimming World plan, and had been eating more healthily and doing more exercise, so that was a much better outcome for her.’

Although not all women chose to redeem the vouchers, many were grateful that the hospital had a healthy eating project in place for them to turn to if they needed support.

‘A majority of women have been glad that we approached them [about the project] because it has given them an opportunity to address something that causes them anxiety. 

‘There are some women who have accepted one voucher and then weren’t able carry on, because of work commitments and childcare, but it has made them think about their lifestyle and their diet, and incorporating more exercise. And perhaps it is something that they’ll address themselves in the future.’


RCM Communities
What advice do you give to pregnant women in your care whose BMI is 30 or above? Join the conversation at: communities.rcm.org.uk


References

DH. (2012) Health profiles Chesterfield. See: www.apho.org.uk/resource/view.aspx?RID=117091 (accessed 1 October 2012).

NICE. (2010) Weight management before, during and after pregnancy (PH27). See: www.nice.org.uk/guidance/PH27 (accessed 1 October 2012).





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