Keeping the Balance: promoting physical activity and healthy dietary behaviour in pregnancy

Gaining large amounts of weight during pregnancy may contribute to development of obesity and is associated with poor outcomes. Therefore managing gestational weight gain is important to reduce the risk of complications. This thesis aims to explore clinical and personal management of gestational weight gain and to discover how pregnant women can be best supported to maintain physical activity and healthy dietary behaviours. This is achieved through a programme of research comprising three related studies. Study One explored the antenatal clinical management of weight and weight gain through one-to-one interviews with Antenatal Clinical Midwifery Managers across Wales (n=11). Findings showed wide variation in management of weight from unit to unit. Although midwives believed pregnancy to be a perfect opportunity to encourage healthier behaviours, many identified barriers preventing them discussing weight with women. In Study Two semi-structured interviews with pregnant women (n=15) investigated views on personal weight management during pregnancy. Again pregnancy was seen as an ideal time to improve health behaviours due to a perceived increase in motivation and many women identified specific goals. However, in the face of various barriers, it was apparent that the motivation which initially identified healthy lifestyle goals was unable to sustain this behaviour throughout the pregnancy. Finally Study Three looked at the feasibility and acceptability of a midwife-led intervention informed by the two preliminary studies. The ‘Eat Well Keep Active’ intervention programme designed to promote healthy eating and physical activity in pregnant women (n=20) was based upon the Self Determination Theory framework for enhancing and maintaining motivation and utilised motivational interviewing. Results indicated that the intervention was received well by participants who reported that it positively influenced their health behaviours. The ‘Eat Well Keep Active’ programme may be a suitable intervention to encourage and facilitate women to pursue a healthier lifestyle throughout their pregnancy

Evaluation of iwi and hapū participation in the resource consents processes of six district councils

This working paper analyses the processes adopted by councils for involving hapū/iwi in plan implementation, including the resource consents process. Three topic issues were investigated to assess plan implementation — urban amenity, storm water, and issues of importance to iwi. Questions were asked about the capacity of hapū/iwi to engage in the resource consent process, which resource issues were of concern to them, their relationship with council and consent applicants, and their perception of the consent process. Most resources listed in the questionnaire were of concern to hapū/iwi, with water quality, wāhi tapu and heritage the most commonly cited. In conclusion, we found a general dissatisfaction on the part of hapū/iwi with councils’ performance with respect to both Treaty relationships and consent processing under the RMA. A further contributing factor to the poor relationships found between hapū/iwi and councils, was the lack of clarity over the role of hapū and iwi in resource management. In several districts, diverging responses from hapū/iwi and councils to questions about level of understanding and commitment suggests there is a need for more effective communication. These problems are compounded by the generally low capacity of hapū/iwi to participate in resource consent processes. These findings suggest that there is much to be done to improve relationships and behaviour of these key stakeholder groups in the plan implementation process if key provisions in the RMA related to hapū/iwi interests are to be fulfilled. The differences shown in reciprocal perceptions have serious implications for establishing a sound working partnership between councils and hapū/iwi in their areas. Making clear these discrepancies is a first step towards taking the measures needed for building a better partnership. Further, the capacity of hapū/iwi to participate could be better utilised if there was greater integration between regional and district councils on issues of significance and processes for iwi involvement

Resilience in UK midwifery: the importance of self-awareness and professional identity

Background: Midwifery is widely acknowledged as emotionally challenging work. Many midwives work in situations of adversity, with negative effects on wellbeing, morale and retention. However, not all midwives respond negatively to adversity. Some describe continued passion for their work, demonstrating resilience: the ability to respond positively and consistently to adversity. Aim: To explore UK midwives’ understanding and experience of resilience and identify factors involved in developing midwifery resiliency. This is the first study to focus directly on midwifery resilience. Method: A self-selected sample of midwives was recruited via the UK Royal College of Midwives (RCM) journal. Inclusion criteria were: participants in clinical practice for 15 or more years and self-identifying as ‘resilient’. A closed online discussion group was conducted between October- November 2012, facilitated by the research team. Eleven midwives actively participated in the discussions. Qualitative data were analysed thematically using NVIVO. Study rigour was enhanced by independent cross-checking of coding, and an Expert Group consultation assisted data interpretation and concept modelling. Ethical approval was obtained from School Research Ethics Committee at Cardiff University. Participation was voluntary. Participants received study information prior to consent and were guaranteed anonymity throughout. Key findings: Four major themes were identified: Challenges to resilience; Managing and coping; Self-awareness and self-identity; Building resiliency. This paper focuses on Self-awareness and Self-identity, which featured strongly in the data. Participants perceived that resilience could be developed over time; key factors in building resiliency were ‘knowing oneself’ and having well-integrated professional and personal identities. Implications: Insights from ‘resilient’ midwives indicate that it may be possible to develop educational and practice-based strategies to facilitate resiliency. This in turn should help midwives to manage the emotional demands of their work and may improve workforce retention. This has potential benefits for midwifery internationally

A wall of information? Exploring the public health component of maternity care in England

Midwives have traditionally had an important role in providing public health messages to women. The range and diversity of the public health remit within maternity services has expanded rapidly over the past decade and maternity support workers as well as midwives are now engaged in public health work in many areas. Given these changes a review of current practice was indicated

Eat Well Keep Active: Qualitative findings from a feasibility and acceptability study of a brief midwife led intervention to facilitate healthful dietary and physical activity behaviours in pregnant women

Pregnant women often find it difficult to follow recommendations for a healthy lifestyle and some women refer back to pregnancy as being the start of their problems with obesity. This paper reports the findings of a study designed to test the feasibility and acceptability of a brief, novel, midwifery led intervention to encourage healthy lifestyle in pregnancy. The intervention was theoretically driven, based on Self Determination Theory and utilised Motivational Interviewing to facilitate motivation to pursue a healthy lifestyle. This paper reports the qualitative finding from semi-structured interviews with a sample of 20 pregnant women. The findings suggest that the three psychological needs of Self Determination Theory are supported, the intervention was received well by participants who also reported positive change in lifestyle behaviours. Theoretically driven interventions for pregnant women, such as the novel intervention reported here are scarce. The Eat Well Keep Active has the potential to make a difference to women before, during and after pregnancy in motivating healthy lifestyle behaviour

District plan implementation under the RMA: Confessions of a resource consent

This report focuses on results from Phase 2 of PUCM - the quality of plan implementation in six district councils selected for their range of plan quality and capacity to plan. Only those results considered to be important for assisting the six councils (and others) to improve implementation of their plans are included in this report. The findings and recommendations, both specific and general, ought to be instructive for other councils, thereby helping to improve their plans and implementation processes. Since hapu/iwi interests formed a key component of the research, the outcomes will help enhance their case for better consideration of their interests when dealing with local government. As well, many of the findings and recommendations relate to matters of governance and capacity building that require Government action, which until done will make it difficult for councils to achieve quality plans and implementation processes