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Call for clear guidance on healthy weight management in pregnancy

Research by the Royal College of Midwives and Slimming World found that 43% of midwives are not confident about advising women on weight management during pregnancy, and 79% would feel more confident if they had more training.
 
A quarter of midwives (24.7%) don’t have the facilities to weigh pregnant women in all of the settings in which they provide antenatal care.

The Royal College of Midwives and Slimming World are calling for clearer guidance on healthy weight management for expectant mothers, and more support, training and equipment for midwives.

NHS data shows that one in five women (21%) start pregnancy with a BMI in the ‘obese’ range. Yet there are no national guidelines for women, midwives or health professionals on weight management during pregnancy. Excess weight in pregnancy is linked to increased risk of miscarriage, premature birth, gestational diabetes and stillbirth, among other serious health issues.

Surveys of 110 midwives and 740 women, led by both Slimming World and the Royal College of Midwives, revealed that overweight expectant mothers are left feeling confused by the lack of clear information. Not only this, midwives are also concerned that they cannot offer the best support to these women in the absence of clear guidelines.

Nearly all of the women surveyed (91%) said that pregnancy was a time during which they were potentially more open than usual to healthy lifestyle messages, yet less than half discussed their weight with their midwife.Half of the women surveyed (48%) said that their midwife never spoke to them about their weight and more than one in 10 (11%) said they were not weighed throughout the duration of their pregnancy. Women are normally weighed at their first appointment with a midwife, usually between week eight and 12 of the pregnancy.

The survey of midwives showed that they also have some concerns about this issue. Almost half (43%) of midwives surveyed said they were not very confident or not at all confident about advising women on their weight management during pregnancy. A similar number (around 40%) said they were very worried or fairly worried about asking women to be weighed when it is not their first appointment.

Nearly two-thirds of midwives (62%) said they were worried about causing offence if they asked women to be weighed and almost a quarter (24.7%) said they did not have facilities to weigh women in all of the settings in which they provide antenatal care. Almost four-fifths of midwives (79%) said they would feel more confident talking about weight management with women if they had more training. The vast majority (90%) also said they would feel more confident if they had formal guidance on healthy weight gain in pregnancy.

Carolyn Pallister, Slimming World Public Health Manager and Dietitian, said: “The women who participated in this survey told us that they were more open to talking about a healthy lifestyle when they were pregnant so we need to make sure that midwives feel that they have the right training and resources to support that. As it stands, this is a significant missed opportunity to share healthy lifestyle messages and guidance.

“As part of our partnership with the Royal College of Midwives, Slimming World welcomes pregnant members; however our service is very different for those that are expecting. We do not suggest any significant weight change – gain or loss – during pregnancy. Instead, we support members to eat a healthy, balanced diet and remain physically active where appropriate. Our priority is a happy, healthy, mum-to-be!

“Currently though, in the UK, women aren’t routinely weighed while pregnant and, in fact, not all midwives even have access to weighing scales at their clinic sites. Midwives are further held back by the absence of guidelines on how much weight is safe to gain during pregnancy, and by the lack of training on how to raise the issue of weight with women.

“The current situation is that women are left feeling confused and unsupported at this most important of times and that needs to change.”

Gill Walton, Chief Executive and General Secretary of the Royal College of Midwives, said: “There is strong evidence of the risks of obesity and excess weight gain in pregnancy and yet there are no UK guidelines on what constitutes a safe weight gain, and many midwives have to use their own initiative and refer to American guidance.

“There is a clear need for midwives to have the tools, guidance and training they need so that they can offer women the best possible support and care. This is especially pressing because of the potentially serious complications that can arise in pregnancy as a result of women being overweight or obese. It is a real concern that some midwives do not have access to that most basic piece of equipment, scales.

“We are calling for clear guidance on healthy weight management in pregnancy and will be looking at how we can take this forward so that women and midwives have the information, support and resources needed.”

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