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New Zealand LMC midwives' approaches to discussing nutrition, activity and weight gain during pregnancy

Abstract:

Background: Excessive weight gain during pregnancy can lead to increased retention of weight postpartum and the risk of becoming overweight or obese later in life. Obesity is an increasing problem within New Zealand society and being overweight or obese during pregnancy increases risks for both the mother and the baby. In New Zealand, primary maternity care is largely provided by midwives in the role of Lead Maternity Carer (LMC). These midwives provide continuity of maternity care and information to women to support informed decision making and healthy lifestyles choices. Aim: To explore how LMC midwives discuss nutrition, activity and weight gain when providing primary maternity health care to pregnant women in New Zealand. Method: A nationwide survey was undertaken with a cohort of LMC midwives in New Zealand to identify what advice and information were being provided to pregnant women about nutrition, activity and weight gain. An electronically administered survey was distributed to eligible midwives through the New Zealand College of Midwives membership database. Descriptive statistics were used to describe survey responses; the large volume of free text data were analysed using a qualitative inductive approach. Results: A total of 428 LMC midwives responded, giving a response rate of 42.9%. Nearly all these midwives discussed nutrition (97.6%) and activity (94.3%) with women during pregnancy. The majority of midwives (70%) calculated the woman’s body mass index (BMI) at pregnancy registration. Recommendations for weight gain varied dependent on the woman’s BMI; the respondents in this study generally recommended lower weight gain targets than the updated Institute of Medicine (IOM) (2009) published guidelines. Free text data themes identified that midwives customized their care to the individual woman. Midwives discussed weight gain and obesity as a sensitive issue which needed an individualised approach. Obesity was considered to be a wider societal issue that requires a broader national response. Conclusion: Midwives in New Zealand are discussing nutrition, activity and weight gain during pregnancy with women. Changing established lifestyles requires a wider societal approach.

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exercise, gestational weight gain, midwifery care, nutrition, Obesity