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Barut S, Uçar T. Effects of motivational interviews on childbirth perceptions and childbirthself-efficacy in nulliparous pregnant women: a randomised-controlled trial. J Reprod Infant Psychol 2023; 41:540-555. [PMID: 35853131 DOI: 10.1080/02646838.2022.2102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/10/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Motivational interviews (MI) may change the perspective of birth in pregnant women by changing their negative thoughts and increasing their self-efficacy. OBJECTIVE This study was conducted to identify the effects of MI on childbirth perceptions and childbirth self-efficacy in nulliparous pregnant women who had traumatic childbirth perceptions. METHODOLOGY The research was carried out as a randomised-controlled trial wıth 166 pregnant women, including 83 experimental group and 83 control group. In the collection of data, the Traumatic Childbirth Perception Scale (TCPS) and the Childbirth Self-Efficacy Inventory (CSEI-C32) were utilised. Four sessions of MI were held with the pregnant women in the experimental group at weekly intervals whereas no initiative was applied to the pregnant women in the control group. RESULTS As per the measurements performed after the MI held with the experimental group, it was found that the experimental group had a significantly lower mean TCPS score than the control group (p < 0.001). The experimental group also had a significantly higher mean CSEI-C32 score than the control group (p < 0.001). CONCLUSION MI can be effective in reducing the traumatic childbirth perceptions and increasing childbirth self-efficacy. However, further research is required to assess the effectiveness MI on traumatic birth perception and self-efficacy.
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Affiliation(s)
- Sümeyye Barut
- Department of Midwifery, Fırat University, Elazığ, Turkey
| | - Tuba Uçar
- Department of Midwifery, Inonu University, Malatya, Turkey
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2
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Raju S, Cowdell PF, Dyson PJ. Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review. Midwifery 2023; 124:103750. [PMID: 37285752 DOI: 10.1016/j.midw.2023.103750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight. OBJECTIVE To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG. DESIGN This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration. FINDINGS Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG. KEY CONCLUSIONS Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice. IMPLICATIONS FOR PRACTICE Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
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Preventive Counseling in Routine Prenatal Care-A Qualitative Study of Pregnant Women's Perspectives on a Lifestyle Intervention, Contrasted with the Experiences of Healthcare Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106122. [PMID: 35627659 PMCID: PMC9140722 DOI: 10.3390/ijerph19106122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022]
Abstract
Maternal lifestyle during pregnancy and excessive gestational weight gain can influence maternal and infant short and long-term health. As part of the GeMuKi intervention, gynecologists and midwives provide lifestyle counseling to pregnant women during routine check-up visits. This study aims to understand the needs and experiences of participating pregnant women and to what extent their perspectives correspond to the experiences of healthcare providers. Semi-structured interviews were conducted with 12 pregnant women and 13 multi-professional healthcare providers, and were analyzed using qualitative content analysis. All interviewees rated routine check-up visits as a good setting in which to focus on lifestyle topics. Women in their first pregnancies had a great need to talk about lifestyle topics. None of the participants were aware of the link between gestational weight gain and maternal and infant health. The healthcare providers interviewed attributed varying relevance regarding the issue of weight gain and, accordingly, provided inconsistent counseling. The pregnant women expressed dissatisfaction regarding the multi-professional collaboration. The results demonstrate a need for strategies to improve multi-professional collaboration. In addition, health care providers should be trained to use sensitive techniques to inform pregnant women about the link between gestational weight gain and maternal and infant health.
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Ferrari N, Joisten C. Impact of physical activity on course and outcome of pregnancy from pre- to postnatal. Eur J Clin Nutr 2021; 75:1698-1709. [PMID: 33828239 PMCID: PMC8636258 DOI: 10.1038/s41430-021-00904-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/30/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
A healthy lifestyle that includes physical activity has numerous positive effects on the mother and child during and after pregnancy. In this context physical activity plays a central role due to its influence on body composition. While visceral fatty tissue has a pro-inflammatory effect via so-called adipokines, myokines seem to have a more anti-inflammatory effect and thus prevent numerous diseases such as gestational hypertension or gestational diabetes. However, many women show a decreased level of physical activity during pregnancy when compared to pre-gestation levels. The reasons underlying this change are manifold and include concern about the effects of physical exertion on the unborn child. Gynaecologists and midwives are also often uncertain about what specific advice to give regarding physical activity. The present review describes, besides the underlying mechanisms, current physical activity recommendations and corresponding evidence with a focus on weight development in terms of obesity, gestational diabetes and foetal outcome.
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Affiliation(s)
- Nina Ferrari
- Cologne Centre for Prevention in Childhood and Youth/ Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany. .,Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany.
| | - Christine Joisten
- Cologne Centre for Prevention in Childhood and Youth/ Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.,Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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5
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Christenson A, Torgerson J, Hemmingsson E. Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management. BMC Pregnancy Childbirth 2020; 20:755. [PMID: 33272237 PMCID: PMC7712607 DOI: 10.1186/s12884-020-03438-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management. Method A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, “Beliefs About Obese People” (BAOP), “Perceived weight bias in health care” and “Attitudes toward obese patients” was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic. Results 274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: “I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed”. Having had training in motivational interviewing seemed positively associated with midwives’ inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals. Conclusion Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03438-1.
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Affiliation(s)
- Anne Christenson
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden. .,Division of clinical epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Jarl Torgerson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Hemmingsson
- The Swedish School of Sports and Health Sciences, Åstrand Laboratory of Work Physiology, Stockholm, Sweden
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Larsen RT, Korfitsen CB, Juhl CB, Andersen HB, Christensen J, Langberg H. The MIPAM trial: a 12-week intervention with motivational interviewing and physical activity monitoring to enhance the daily amount of physical activity in community-dwelling older adults - a study protocol for a randomized controlled trial. BMC Geriatr 2020; 20:412. [PMID: 33081715 PMCID: PMC7576698 DOI: 10.1186/s12877-020-01815-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical Activity Monitors (PAMs) have been shown to effectively enhance level of physical activity (PA) in older adults. Motivational interviewing is a person-centred model where participants are guided using self-reflection and counselling, and addresses the behavioural and psychological aspects of why people initiate health behaviour change by prompting increases in motivation and self-efficacy. The addition of motivational interviewing to PA interventions may increase the effectiveness of PAMs for older adults. METHODS This motivational interviewing and PA monitoring trial is designed as an investigator-blinded, two arm parallel group, randomized controlled superiority trial with primary endpoint after 12 weeks of intervention. The intervention group will receive a PAM-based intervention and motivational interviewing and the control group will only receive the PAM-based intervention. The primary outcome is PA, objectively measured as the average daily number of steps throughout the intervention period. Secondary outcome measures include self-reported PA health-related quality of life, loneliness, self-efficacy for exercise, outcome expectancy for exercise, and social relations. The outcomes will be analysed with a linear regression model investigating between-group differences, adjusted for baseline scores. Following the intention to treat principle, multiple imputation will be performed to handle missing values. DISCUSSION A moderate effect of daily PA measured using PAMs is expected in this superiority RCT investigating the effect of adding motivational interviewing to a PAM intervention. According to the World Health Organization, walking and cycling are key activities in regular PA and should be promoted. To increase the general public health and lower the burden of inactivity in older adults, cost-beneficial solutions should be investigated further. If this RCT shows that motivational interviewing can enhance the effect of PAM-based interventions, it might be included as an add-on intervention when appropriate. No matter what the results of this study will be, the conclusions will be relevant for clinicians as the dependence on technology is increasing, especially in relation to public health promotion. TRIAL REGISTRATION NCT03906162 , April 1, 2019.
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Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Christoffer Bruun Korfitsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Gentofte, Denmark
| | | | - Jan Christensen
- Department of Occupational- and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Henning Langberg
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Dieterich R, Demirci J. Communication practices of healthcare professionals when caring for overweight/obese pregnant women: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1902-1912. [PMID: 32513475 DOI: 10.1016/j.pec.2020.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To synthesize existing research on communication practices between healthcare professionals and overweight and obese pregnant women. METHODS Following PRISMA guidance on conducting scoping reviews, we included original research addressing communication/counseling practices of healthcare professionals with overweight and/or obese pregnant women, published between 2008-2018, and available in English. Fourteen articles are included in this review. RESULTS Study findings were organized into three themes: (a) topics addressed during encounters, (b) providers' comfort/confidence, knowledge and methods in communicating with overweight/obese pregnant women, and (c) overweight/obese pregnant women's experiences in communicating with healthcare providers. The most prevalent topics addressed were gestational weight gain, physical activity, and nutrition. Healthcare professionals experience discomfort and are reluctant to address weight status with overweight/obese pregnant patients, use vague statements about weight gain and weight-related obstetric risks, and report low confidence when counseling obese pregnant women. Overweight/obese pregnant women perceive weight stigma when interacting with providers. CONCLUSION Weight-related counseling in obstetric care is suboptimal. Providers may benefit from training to more confidently and effectively counsel overweight and obese pregnant women about gestational weight gain, physical activity, and nutrition. PRACTICE IMPLICATIONS Patients perceive weight stigma in the obstetric setting, which may be prevented by effective, patient-centered communication.
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Affiliation(s)
- Rachel Dieterich
- University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, 15213, USA.
| | - Jill Demirci
- Department of Health Promotion & Development, Development of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, 15213, USA.
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Lindhardt CL, Maerkedahl M, Brandt CE, Madsen SR. The personalised discharge letter: the experience of patients and parents from the Filadelfia Epilepsy Hospital. Scand J Caring Sci 2020; 35:67-74. [PMID: 32240550 DOI: 10.1111/scs.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 03/11/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the experience of a discharge letter received by patients suffering from epilepsy and parents with children who suffer from epilepsy. DESIGN Qualitative research inspired by a phenomenological methodology approach. SETTING Face-to-face interviews with patients and parents of epileptic children in their own homes. SAMPLE Participants (total n = 11). METHODS In-depth interviews were recorded verbatim, transcribed and analysed. RESULTS Two themes were identified: (i) it was written about me and (ii) a sense of feeling secure. By being discharged with a personalised letter, the participants felt seen and heard. The discharge letter enabled them to contact their doctor and the Filadelfia hospital more efficiently if needed. Parents indicated that the discharge letter bridged the uncertainty that they often experienced when dealing with the child's school or authorities in general. CONCLUSIONS The discharge letter enables the participants to make the transition into everyday life with the best and most up-to-date information about themselves and their current condition as an epilepsy patient. The discharge letter empowers the patient or parents to face everyday life. The discharge becomes a kind of passport to the outside world when encountering the general practitioner, the school or other circumstances where the patient engages. The discharge letter becomes a patient-centred tool proving that enhanced communication and understanding between healthcare professionals, patients and parents succeeds. This example could be transferable to other hospitals to heighten the patient's self-efficacy and quality of life after being discharged from the hospital.
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Affiliation(s)
- Christina Louise Lindhardt
- University College Absalon, Sorø, Denmark.,Research Department of Geriatric Medicine, University of Southern Denmark, Odense, Denmark
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Sanders J, Channon S, Cannings-John R, Coulman E, Hunter B, Paranjothy S, Warren L, Drew C, Phillips B. Pregnancy and weight monitoring: A feasibility study of weight charts and midwife support. MATERNAL AND CHILD NUTRITION 2020; 16:e12996. [PMID: 32222041 PMCID: PMC7507507 DOI: 10.1111/mcn.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional cohort study was to incorporate individualised gestational weight monitoring charts supported by motivational interviewing (MI)-based conversations into midwifery-led antenatal care and assess potential of the intervention for further development and evaluation. The study setting was a community midwifery team within a large maternity unit. The study explored the facilitators and barriers to engagement with the intervention as experienced by women and midwives; 52 women were recruited, of whom 48 were included in the analysis. A single training session was found adequate to prepare midwives to use antenatal weight charts but was insufficient to result in the incorporation of motivational interview techniques into clinical practice. We did not find sufficient evidence to recommend effectiveness testing of this intervention, and there is currently insufficient evidence to support reintroducing regular weighing of pregnant women into UK antenatal care. Given the public health importance of reducing rates of obesity, future interventions aimed at controlling gestational weight gain should continue to be developed but need to include innovative strategies particularly for women who are already obese or gain weight above that recommended.
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Affiliation(s)
- Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Lucie Warren
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cheney Drew
- Centre for Trials Research, Cardiff University, Cardiff, UK
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"…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study. PLoS One 2019; 14:e0222543. [PMID: 31536545 PMCID: PMC6752788 DOI: 10.1371/journal.pone.0222543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.
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11
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Olander EK, Berg F, Berg M, Dencker A. Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:81-86. [PMID: 31084825 DOI: 10.1016/j.srhc.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 04/01/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives' support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain. METHODS Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis. RESULTS Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women. CONCLUSION These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes.
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Affiliation(s)
- Ellinor K Olander
- Centre for Maternal and Child Health Research, City, University of London, United Kingdom.
| | - Frida Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Maternity Ward, NU Hospital Group, Trollhattan, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, University of Gothenburg, Sweden
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12
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Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol 2017; 217:642-651. [PMID: 28549978 DOI: 10.1016/j.ajog.2017.05.040] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
Abstract
Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birthweight and failure to initiate breast-feeding whereas the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools to incorporate weight and other health behavior counseling into routine prenatal practices. Because many women are motivated to improve health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.
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13
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Jelsma JGM, Simmons D, Gobat N, Rollnick S, Blumska K, Jans G, Galjaard S, Desoye G, Corcoy R, Juarez F, Kautzky-Willer A, Harreiter J, van Assche A, Devlieger R, Timmerman D, Hill D, Damm P, Mathiesen ER, Wender-Ożegowska E, Zawiejska A, Lapolla A, Dalfrà MG, Del Prato S, Bertolotto A, Dunne F, Jensen DM, Andersen L, Snoek FJ, van Poppel MNM. Is a motivational interviewing based lifestyle intervention for obese pregnant women across Europe implemented as planned? Process evaluation of the DALI study. BMC Pregnancy Childbirth 2017; 17:293. [PMID: 28882133 PMCID: PMC5590191 DOI: 10.1186/s12884-017-1471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Process evaluation is an essential part of designing and assessing complex interventions. The vitamin D and lifestyle intervention study (DALI) study is testing different strategies to prevent development of gestational diabetes mellitus among European obese pregnant women with a body mass index ≥29 kg/m2. The intervention includes guidance on physical activity and/or healthy eating by a lifestyle coach trained in motivational interviewing (MI). The aim of this study was to assess the process elements: reach, dose delivered, fidelity and satisfaction and to investigate whether these process elements were associated with changes in gestational weight gain (GWG). METHODS Data on reach, dose delivered, fidelity, and satisfaction among 144 participants were collected. Weekly recruitment reports, notes from meetings, coach logs and evaluation questionnaires (n = 110) were consulted. Fidelity of eight (out of twelve) lifestyle coach practitioners was assessed by analysing audio recorded counselling sessions using the MI treatment integrity scale. Furthermore, associations between process elements and GWG were assessed with linear regression analyses. RESULTS A total of 20% of the possible study population (reach) was included in this analysis. On average 4.0 (of the intended 5) face-to-face sessions were delivered. Mean MI fidelity almost reached 'expert opinion' threshold for the global scores, but was below 'beginning proficiency' for the behavioural counts. High variability in quality of MI between practitioners was identified. Participants were highly satisfied with the intervention, the lifestyle coach and the intervention materials. No significant associations were found between process elements and GWG. CONCLUSION Overall, the intervention was well delivered and received by the study population, but did not comply with all the principles of MI. Ensuring audio recording of lifestyle sessions throughout the study would facilitate provision of individualized feedback to improve MI skills. A larger sample size is needed to confirm the lack of association between process elements and GWG. TRIAL REGISTRATION ISRCTN registry: ISRCTN70595832 ; Registered 12 December 2011.
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Affiliation(s)
- Judith G M Jelsma
- Department of Public and Occupational Health and, Amsterdam Public Health research institute, VU University Medical Centre, Van der Boechorststraat 7, 1081BT Amsterdam, Amsterdam, The Netherlands
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England, UK.,Macarthur Clinical School, University of Western Sydney, Campbelltown, NSW, Australia
| | - Nina Gobat
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | | | - Kinga Blumska
- Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
| | - Goele Jans
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology Division of Obstetrics and Prenatal Medicine Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universität Graz, Graz, Austria
| | - Rosa Corcoy
- Institut de Recerca de L'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fabiola Juarez
- Institut de Recerca de L'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Andre van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Timmerman
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - David Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | - Frank J Snoek
- Department of Medical Psychology, Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health and, Amsterdam Public Health research institute, VU University Medical Centre, Van der Boechorststraat 7, 1081BT Amsterdam, Amsterdam, The Netherlands. .,Institute of Sport Science, University of Graz, Graz, Austria.
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14
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Bick D. The challenge of obesity during pregnancy: When to intervene and what could work? Midwifery 2016; 31:655-6. [PMID: 26072148 DOI: 10.1016/j.midw.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Debra Bick
- King׳s College London, Florence Nightingale Faculty of Nursing and Midwifery, UK
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15
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Rasouli M, AtashSokhan G, Keramat A, Khosravi A, Fooladi E, Mousavi SA. The impact of motivational interviewing on participation in childbirth preparation classes and having a natural delivery: a randomised trial. BJOG 2016; 124:631-639. [DOI: 10.1111/1471-0528.14397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M Rasouli
- Department of Midwifery; School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
| | - G AtashSokhan
- Department of Midwifery; School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
| | - A Keramat
- Department of Reproductive Health; School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
| | - A Khosravi
- Centre for Health Related Social and Behavioural Sciences Research; Shahroud University of Medical Sciences; Shahroud Iran
| | - E Fooladi
- Department of Reproductive Health; School of Nursing and Midwifery; Mazandaran University of Medical Sciences; Sari Iran
| | - SA Mousavi
- Golestan Research Centre of Psychiatry; Golestan University of Medical Sciences; Gorgan Iran
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