Research leads to better shaped services to help expectant and new mums

Changes are to be made to weight management services offered to expectant and new mums after gaps in support were highlighted by a Teesside University research study.

The study, Healthy Lifestyles in Pregnancy and Beyond, aimed to evaluate women’s experiences of the antenatal and postnatal care and support offered through three ‘BMI care pathways’ at South Tees Hospital NHS Foundation Trust. The research team identified gaps in lifestyle advice and support for all pathways following birth – and now issues raised by the women involved in the research are set to influence future support for mums-to-be. Their comments, views and concerns are helping to shape future local services to ensure women classified as obese at the start of pregnancy are given appropriate advice and support.

Funded by Middlesbrough Council Public Health, the study was undertaken by Professor Janet Shucksmith and Sarah Dinsdale from Teesside University’s Health and Social Care Institute in collaboration with Kay Branch, midwife consultant public health at South Tees Hospital NHS Foundation Trust and Lindsay Johnson, Health Improvement Specialist at Middlesbrough Council Public Health.

Plans are being drawn up regarding implementation of a community lifestyle group for pregnant women on the lower pathways. Women will also be informed about community weight management groups available after their babies are born, enabling mums to meet up.

Midwives will also receive training on raising the topic of weight and discussing the related risks and treatment pathways women may be placed on.

BMI (Body Mass Index) is often used to determine healthy weight. Being above a healthy weight at the start of pregnancy can lead to health issues for women and their unborn babies. Different treatment routes, or pathways, are in place at South Tees Hospitals NHS Trust for different BMI groups.

Pregnant women with a BMI of 30 or over are put on a BMI care pathway, so during pregnancy and after birth she should get extra checks, advice and support about her weight. Women with the highest BMI, 40 or over, go on a treatment pathway receiving the most intensive intervention, including extra growth scans and appointments at a healthy lifestyle clinic for consultant care and dietetics advice.

Women classified as obese but with a lower BMI, follow pathways where weight management advice is incorporated into their usual midwifery care. The research study focused the views and experiences of women who had been on one of these BMI pathways. 24 women were interviewed after they had given birth at The James Cook University Hospital in Middlesbrough.

The research team heard how supportive maternity staff and midwives had been. Some women said advice received during pregnancy helped them be more aware of their weight, to change their lifestyle, or would motivate them to make changes if they became pregnant again so that they could avoid birth complications.

The research also showed more could be done to make services effective. There were clear differences between the pathways in terms of communication levels and support.

Professor Shucksmith, of the University’s School of Health & Social Care, said: 'The most overweight women (BMI over 40) felt well informed about the pathways and the health risks associated with their weight. Most women with a BMI under 40, however, weren't actually told they were on a BMI pathway or of the risks associated with weight during pregnancy, even though the hospital was monitoring them more closely and their weight had implications for their health and their birth choices for example.'

Women on the more intensive pathway with a BMI over 40 found diet and lifestyle advice was useful. But some wanted more information on healthier eating for their family, not just themselves, or signposting to local activity services.

Meanwhile women with a BMI under 40 often found the diet and lifestyle information given to them was very basic. They were apprehensive about making radical changes to their behaviour, especially taking up new types of physical activity, without being advised what was safe for them in their condition. Women wanted peer group support to share experiences and tips with other mums-to-be.

Sarah said: 'Women on the lower pathways recalled being given advice they already knew, such as don’t eat for two or eat your five portions a day. Women can feel anxious about making lifestyle changes while pregnant, especially when advice is limited.'

When it came to talking about weight, most women with a BMI over 40 felt healthcare professionals were sensitive. However, a few felt 'nagged', or that weight was given too much focus. Women with a BMI under 40, on the other hand, often said the issue of weight was simply skimmed over or not raised at all.

The women also welcomed discussion on the approach healthcare professionals use to discuss weight. The term obese was perceived negatively, with women preferring BMI or overweight, which were seen as less offensive.

Sarah added: 'Midwives can find it difficult to raise the subject of weight because it’s so sensitive. The midwife has to find a balance between raising the issue that the mother could be putting her and her baby’s health at risk, whilst maintaining a good supportive relationship.'

Since completion of the research, Sarah has been involved in a steering group aimed at service redesign for women on the lower pathways. She has also been involved in the Middlesbrough Redcar and Cleveland ‘task and finish’ group for maternal obesity, which feeds into local strategy development for maternal and infant health.

Lindsay Johnson, Health Improvement Specialist at Middlesbrough Council, said: 'Rising rates of obesity remain a significant challenge in Middlesbrough. Maternal obesity is of particular concern as it presents a series of significant health risks to both mother and child. This piece of research has highlighted the need for additional lifestyle services to provide support for the mother before, during and after pregnancy.'

Kay Branch, midwife consultant, added 'The research has provided the evidence to support the education of midwives and improvements to the current service.'

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