Health professionals worried about the increasing number of obese pregnant women could learn lessons from successful smoking cessation campaigns, according to a study into how maternity services could be developed to effectively tackle maternal obesity.
With more than one in six pregnant women now classed as obese in the UK, the issue is of concern due to the added health risks for both the pregnant women and their future infants.
The recent study, funded by Public Health North East, was carried out by a team of academic researchers led by Dr Nicola Heslehurst from Teesside University and including experts in the field from Durham and Newcastle universities, and the North East Public Health Observatory.
The findings, published in the journal, Midwifery,* show substantial improvement in some areas of clinical practice such as health and safety, but slow progress in other areas of maternity services since earlier research by Dr Heslehurst and colleagues in 2005/06.
"In our earlier study we found women sometimes being taken out of maternity units because the units didn't have suitable beds and the right equipment to deal with obese pregnant women. We also found there were no clinical guidelines in the North East for dealing with maternal obesity.
"Theatres and delivery suites are now better equipped, and clinical guidelines in place throughout the region. But there are still gaps in terms of services to support the women and a lack of joined-up thinking among professionals," said Dr Heslehurst.
She says little is being done to address the actual obesity. "We found there were no weight gain guidelines in place, largely due to a lack of national guidance on this issue, and a lack of psychosocial input. Mothers were being told they were putting their babies at risk and then left to deal with it as there was an absence of support services available to help the women. This is an area that needs further development."
Co-author Professor Carolyn Summerbell, from Durham University's School of Medicine and Health, agrees, saying: "Pregnancy is a time when women expect to put on weight, so it's understandable that 'healthy weight gain' in pregnancy is a difficult message. However, it does need to be talked about with women. The question for many midwives is how to do this sensitively and constructively, and knowing which support services to refer the women onto."
Fellow author, Dr Judith Rankin, from Newcastle University, said: "Maternal obesity has major health implications for both the mother and her baby. Whilst the improvements in the management of obese women found in our study are very encouraging, there is still a long way to go if we are to maximise the health outcomes for this group."
Midwives told Dr Heslehurst they wanted training in how to talk to obese women about the clinical risks without upsetting their patients.
"There has been intensive training on alcohol and drug misuse and smoking and domestic violence, but obesity is still seen as a very sensitive issue. Women don't want to be stigmatised or patronized because of their weight. They know they are obese and need support," said Dr Heslehurst.
She says: "There is an urgent need for obesity training along the lines that midwives have for other health issues, and the research team is continuing to work closely with Public Health North East to identify how the training would be best developed in our region."
"There are lots of obesity public health services out there that are not being targeted at pregnant women. There's a real lack of communication between public health services and maternity services, and there is no continuity of care in the transition from the woman being pregnant to postnatal." In her research, she found many health care professionals saying pregnancy was a good time to intervene as midwives and others had a captive audience, but feared identifying obesity without appropriate support services could make matters worse. It could heighten stigma by drawing attention to the risks without offering any structured support.
Dr Heslehurst believes midwives and other health-care professionals could learn from successful smoking cessation campaigns about how to best tackle maternal obesity. The emotional aspects and the obesity itself are not being dealt with. With obesity being viewed negatively in society and by the media there is a need for obesity messages to be more positive rather than 'condemning', says the report.
One obstetrician quoted in the study said: "Everybody's very aware about the national obesity epidemic because the media's going on about it, but it doesn't seem to be in anyway encouraging, it's more critical and it actually reduces people's self-esteem........It's a bit like the smoking message, it doesn't engage the smoking population, it engages the anti-smoking population and the 'obesity epidemic is just a lot of hand wringing and not a lot of motivating'."
Dr Heslehurst said: "One midwife told me how in the past when they first started doing smoking cessation before there was a big national strategic drive with all the intense training and everything that it didn't work. But after the national drive for smoking cessation came in with all the training and support, the specialist midwives and smoking cessation coordinators and all the resources that maternity services had to deal with it they became really successful."
- Heslehurst et al. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery, 2010; DOI: 10.1016/j.midw.2010.01.007
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