Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

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

Physical activity during pregnancy and its influence on delivery time: a randomized clinical trial

Introduction. During pregnancy, women often change their lifestyle for fear of harmful effects on the child or themselves. In this respect, many women reduce the amount of physical exercise they take, despite its beneficial effects. Objective. To determine the duration of labor in pregnant women who completed a program of moderate physical exercise in water and subsequently presented eutocic birth. Methods.Arandomized trial was performed with 140 healthy pregnant women, divided into an exercise group (EG) (nD70) and a control group (CG) (nD70). The women who composed the study population were recruited at 12 weeks of gestation. The intervention program, termedSWEP(Study of Water Exercise during Pregnancy) began in week 20 of gestation and ended in week 37. Perinatal outcomes were determined by examining the corresponding partographs, recorded by the Maternity Service at the Granada University Hospital Complex. Results. The intervention phase of the study took place from June through October 2016, with the 120 women finally included in EG and CG (60 in each group). At term, 63% of the women in EG and 56% of those in CG had a eutocic birth. The average total duration of labor was 389.33 +/- 216.18 min for the women in EG and 561.30 +/- 199.94 min for those in CG, a difference of approximately three hours (p<0:001). Conclusions. The women who exercised in water during their pregnancy presented a shorter duration of labor than those who did not. The difference was especially marked with respect to the duration of the first and second stages of labor

Effects and experiences of exercise during pregnancy

Background: Recommendations regarding intensity, duration and type of exercise during pregnancy vary worldwide. Most research on exercise during pregnancy investigates the effects of aerobic exercise while only a few trials have studied the effects of resistance exercise. Obesity is a growing public health problem and little is known about obese pregnant women´s experiences of participating in a lifestyle intervention focusing on diet and physical activity. Specifically, in four studies, this thesis aims to: 1) describe experiences of exercise during pregnancy among women engaged in regular resistance training; 2) evaluate the health effects, in healthy pregnant women, of moderate to vigorous-intensity resistance exercise with free weights; 3) investigate and compare blood pressure (BP), heart rate (HR), body temperature and ratings of perceived exertion (RPE) during and after two single sessions of light to moderate continuous exercise, Nordic walking and resistance exercise, in healthy women in the second trimester of pregnancy; and 4) describe the experiences of women with obesity related to participating in a lifestyle intervention, and its experienced impact on health and lifestyle. Methods: A combination of quantitative and qualitative methods was used to elucidate different aspects of interest. Study I was assumed to complement studies II (a randomized controlled trial) and III (a cross over design) by adding a wider variety of viewpoints and experiences of resistance exercise as qualitative studies can. Study IV was considered to complement a range of quantitative studies evaluating the effects of lifestyles interventions in pregnancy. Results: Exercise was perceived to have a positive impact on body and mind and was thus described as generating both immediate and short-term health benefits. The women experienced that exercise led to a sense of control in pregnancy; problems related to pregnancy such as weight gain, poor posture, nausea, fatigue, headache, insomnia and back pain were perceived to be resolved and/or addressed. Performing resistance exercises generated an experience that their body was capable of many types of exercises, and they also found it valuable for acquiring good posture. The women considered that resistance training was a suitable type of exercise during pregnancy (Study I). The women’s functional status deteriorated during the intervention in both the intervention and control groups and pain increased. There were only significant differences between the groups for birthweight. Newborns delivered by women who underwent resistant exercise during pregnancy were significantly heavier than those born to control women; 3561 (±452) g versus 3251 (±437) g (p=0.02), a difference that disappeared when adjustment was made for gestational age (p=0.059). Both groups showed normal health related quality of life, blood pressure and perinatal data (Study II). During exercise, there was a significant increase in systolic BP and HR (p<.001). Diastolic BP increased, slightly more during aerobic exercise (p=.01) than resistance exercise (p=.03). Resistance exercise was perceived as more intense than aerobic exercise during 15 minutes (p=.02) and 30 minutes (p=.001) of exercise. After both types of exercise, BP quickly reverted to normal, although HR was still increased five minutes post-exercise (p=.001). There was a moderate but non-significant correlation between HR and RPE during 15 minutes of aerobic exercise, (rs=.43; p=.06), but the other correlations were weak (rs<0.2) and non-significant. Orally measured temperature decreased during aerobic exercise (p=.008) (Study III). The essence of the women’s experiences of participating in a lifestyle intervention during pregnancy was their expressed need for support to implement new habits, provided by midwives, partners, relatives and friends—as well as by obese pregnant women in the same situation. The midwives’ support was experienced as non-judgmental with a balanced outlook on weight. The essential structure of participation can be described with the following constituents: ‘‘pregnancy encourages change’’; ‘‘non-judgmental support’’; ‘‘from bad habits to conscious choices’’ and; ‘‘barriers to change’’ (Study IV). Conclusion: Among healthy women who exercise regularly, from walks to moderate-to-strenuous exercise, regular moderate intensity resistance exercise appears to be appropriate during the second trimester of pregnancy. Pregnant women who perform this type of exercise considered it as suitable. Aerobic and resistance exercise corresponding to 13¬–14 on the Borg RPE-scale seems to be safe with regard to blood pressure and heart rate responses in second trimester healthy pregnancies. In order to implement new habits, participants of a lifestyle intervention express a need for support, given with a non-judgmental attitude and a balanced outlook on weight. For controlling gestational weight gain, lifestyle interventions focusing on healthy eating patterns are probably of major importance

Women's experiences of living with increased inter-recti distance after childbirth : an interview study

Background Although an increased inter-recti distance, also known as diastasis recti, is common after pregnancy, evidence-based knowledge about the condition is relatively limited. In particular, little is known about the consequences as perceived by the women. The objective of the present study was to describe how postpartum women with increased inter-recti distance experience the condition as well as the contacts they have had with healthcare providers regarding their symptoms. Methods A purposeful sampling approach was used to recruit 19 participants from an existing study cohort of 144 women. All participants had an inter-recti distance of at least two finger widths and at least one child, with the youngest child between the ages of 1 and 6 years. Individual interviews based on a semi-structured interview guide were performed and subsequently analysed using qualitative content analysis. Results Four categories emerged from the interviews: the body’s function and ability has changed; the body does not look like it used to; uncomprehending attitudes and treatment in their surroundings; and trying to acquire an understanding of and strategies to cope with the diastasis. The findings reveal that women with increased inter-recti distance might experience fear of movement and engage in avoidance behaviour. In combination with feelings of physical instability in the midsection of their bodies and body dissatisfaction, many of the women restrict their everyday lives and physical activities. Conclusions The findings indicate that increased inter-recti distance is a complex phenomenon that affects the women in a multitude of ways, highlighting the importance of considering the condition for each individual in her own context from a biopsychosocial perspective