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

Objectiveto understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity.Designa 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.Settingone NHS Trust maternity and dietetic services, North East England, UK.Participantsfifteen pregnant women with a booking body mass index ≥30 kg/m² attending an obesity-specific antenatal dietetic service. All women were White, parity between 0 and 2, and BMI range 30–51 kg/m².Findingsfour themes were identified. (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) 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 conclusionswomen 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 practiceit is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate person-centred 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.     

Women want proactive psychosocial support from midwives during transition to motherhood: a qualitative study

Objective

to explore low-risk pregnant women's views on their preferences for psychosocial support from midwives during their transition to motherhood.

Design

a qualitative design with focus-group interviews and thematic analysis of the discussions.

Settings and respondents

21 Dutch participants were included in three focus groups. Groups 1 (n=7) and 3 (n=8) consisted of pregnant women from four semi-urban midwifery practices, and group 2 (n=6) included participants from three urban midwifery practices.

Findings

the women wanted to take responsibility for their own well-being during pregnancy. In addition to informal support, they explicitly expressed a need for professional support from their midwives when undergoing the transition to motherhood. They wanted informational and emotional support from their midwives that addressed psychological and physical changes during pregnancy. They expressed a strong desire to be informed during pregnancy of how to prepare physically and psychologically for birth, recovery and motherhood. They also wanted help with sifting and interpreting information and, ultimately, wanted to make their own choices.

Key conclusions and implications for practice

during their transition to motherhood, healthy low-risk pregnant women want attentive, proactive, professional psychosocial support from midwives. They expect their midwives to oversee the transition period and to be capable of supporting them in dealing with changes in pregnancy and in preparing for birth and motherhood.     

Stressful childbirth situations: a qualitative study of midwives

Introduction: This study aimed to explore clinical life‐threatening childbirth situations, which midwives perceive as extremely stressful, and to identify how midwives cope with those experiences. Methods: Participants were 18 midwives employed in 6 labor and delivery units in Israeli hospitals. Individual semistructured, in‐depth interviews were conducted wherein participants were asked to describe an extremely stressful situation that they had experienced, their significant feelings associated with the event, their coping strategies, and their support systems. Results: Thematic content analysis revealed 2 themes, with each consisting of 4 categories. The first theme focused on reactions to stressful childbirth situations and their impact on midwives. Categories were: functioning professionally in an unexpected reality, emotional reactions, physical reactions, and long‐term effects. The second theme related to coping with stressful situations, focusing on coping difficulties, and suggestions for change. Categories were: midwives’ coping difficulties, their colleagues’ reactions, their feelings about supervisory staff support, and their suggestions for meeting expressed needs. Discussion: Stressful childbirth situations can have a long‐term impact on midwives’ professional and personal identities. Midwives need to feel supported and valued in order to deal with emotional stress. Incorporating clinical supervision by experienced midwives can serve as a supportive framework for other midwives.     

Maternal obesity and pregnancy: a retrospective study

Objectives

to establish the incidence of obesity in the pregnant population in a large city in the North West of England, identify links between obesity and social deprivation, and compare outcomes of pregnancy in obese and non-obese women.

Design

retrospective cohort study using maternal records.

Setting

largest maternity hospital in Europe.

Participants

8176 women who gave birth at the study hospital in 2006.

Findings

data showed that 17.7% of women were clinically obese. Obesity rates increased with advancing age. The incidence of pre-eclampsia, gestational diabetes, induction of labour, caesarean section and fetal macrosomia was significantly higher amongst the obese population. No relationship was found between obesity and social deprivation.

Conclusions

this study ascertained the exact incidence of maternal obesity in the local area and showed the increased risks associated with obesity and pregnancy.

Implications for practice

this study supports the need for a shared-care approach to antenatal care and that obese women should give birth in consultant-led units. The support of a named midwife should be available to these women throughout the childbearing experience, and preconception care advocated.     

Ethical problems of extreme prematurity: results of a qualitative study with obstetricians and midwives

OBJECTIVE: Our objective was to explore the practices, attitudes and feelings of obstetricians and midwives in case of extreme prematurity. POPULATION AND METHODS: A qualitative study was conducted as part of a European Concerted Action (EUROBS) in 1999 and 2000 in three tertiary-care maternity units, located in three cities in the northern, southern and central areas of France respectively. Semi-structured, tape-recorded interviews were conducted and were independently analysed by two different researchers using a content analysis. All full-time obstetricians and half of the full-time midwives were eligible for the study. Overall, 17 obstetricians and 30 midwives participated. RESULTS: Both obstetricians and midwives considered that decision-making in case of very preterm births raised ethical problems concerning the mother and the foetus. Despite some birth weight and gestational age criteria defined in advance, management around delivery appeared to be decided on a case-by-case basis. At birth, the neonatologists made the decisions. They were perceived as more inclined than the obstetrical team to initiate intensive care. If the child was born alive, intensive care was started, knowing that it could be withdrawn later, if appropriate. Parents were sometimes involved in decision-making during pregnancy, less frequently at birth or after birth. DISCUSSION AND CONCLUSION: Compared with obstetricians, midwives tended to have a less favourable perception of the neonatologists' practices, and to deplore the lack of parental information and involvement in decision-making. Decisions about the obstetrical management and resuscitation of extremely preterm infants are essentially always made on a case-by-case basis. Parents are sometimes involved in decision-making. Midwives express serious concerns about the current practices.     

Primary health care by midwives: comprehensive and competent health services for women

The concept of primary care … cuts across all disciplines within the medical profession and across other professions, such as nursing, midwifery, and social work. Health care providers must articulate what the shared content of primary care is so that they can meet their obligation to society: improving the health of all persons. 1     

Midwives' experiences of doula support for immigrant women in Sweden--a qualitative study

Objective

to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden.

Design

qualitative study, analysed using content analysis. Data were collected via interviews.

Setting

interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe.

Participants

ten midwives, who participated voluntarily and worked in maternity health care in western Sweden.

Findings

the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support,’ has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’.

Key conclusion and implications for practice

The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women's confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.     

Exploring health education with midwives,as perceived by pregnant women in primary care: A qualitative study in the Netherlands

Objectiveto explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives.Designqualitative semi-structured interview study, using thematic analysis and constant comparison.Setting and participantstwenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013.Findingswomen considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them.Key conclusions and implications for practicehealth education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits.     

Midwives' and doulas' perspectives of the role of the doula in Australia: a qualitative study

Objective

to explore midwives’ and doulas’ perspectives of the role of the doula in Australia.

Background

doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives’ and doulas’ perspectives of the role of a doula in Australia?

Design

qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis.

Setting

New South Wales, Australia.

Participants

11 midwives and six doulas.

Findings

the key theme that emerged was that ‘the broken maternity system’ is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are ‘filling the gap’ and midwives feel that doulas are ‘taking our role’. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the ‘broken’ maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births.

Implications for practice

despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women.     

Maternal obesity and pregnancy complications: a review

Obesity in women of reproductive age is increasing at an unprecedented rate in western societies. Maternal obesity is associated with an unequivocal increase in maternal and fetal complications of pregnancy. Excessive maternal weight gain in pregnancy also appears to be an independent risk factor, regardless of prepregnancy weight. Few guidelines exist regarding appropriate weight gain in pregnancy in obese women. We review the association of maternal obesity with pregnancy complications. We also suggest that appropriate diet and lifestyle intervention can enable women with severe prepregnancy obesity to safely achieve quite strict targets for limited weight gain in pregnancy.     

Maternal obesity and risk of stillbirth: a metaanalysis

We conducted this metaanalysis to summarize the available epidemiologic evidence on the relationship between maternal overweight and obesity and the risk of stillbirth. We identified studies from 3 sources: (1) a PubMed search of relevant articles that were published between January 1980 and September 2005, (2) reference lists of publications that were selected from the PubMed search, and (3) reference lists of review articles on obesity and maternal outcomes that were published between 2000 and 2005. We used a Bayesian random effects model to perform the metaanalysis and metaregression. Nine studies were included in the metaanalysis. The unadjusted odds ratios of a stillbirth were 1.47 (95% CI, 1.08-1.94) and 2.07 (95% CI, 1.59-2.74) among overweight and obese pregnant women, respectively, compared with normal-weight pregnant women. The metaregression analysis found no evidence that these estimates were affected by selected study characteristics. Maternal obesity is associated with an increased risk of stillbirth, although the mechanisms to explain this association are not clear.