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.
Experts from the Royal College of Midwives and Slimming World say that not speaking to overweight women about their weight during pregnancy is a missed opportunity. They 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.
As it stands, this is a significant missed opportunity to share healthy lifestyle messages and guidance.
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.”
Liz Evans, a midwife and mum-of-two who lost more than 5st with Slimming World, has a unique understanding of the challenges both mums and midwives face when it comes to maternal obesity.
At her heaviest, Liz weighed more than 14st and found her weight affecting both her work and overall health. She says: “I’d feel like a sweaty, exhausted mess by the end of every shift. I had high blood pressure and palpitations, and I felt more like a 56-year-old than a 26-year-old.
Liz, now 32, from Liverpool, adds: “Also, I was expected as part of my job to advise new mums about nutrition. Nobody ever asked why someone my size felt she was entitled to talk to them about healthy eating – they were too polite. Even so, I felt like the biggest hypocrite in Liverpool.
“I wasn’t a comfort eater, just a disorganised one – with 40 hours a week spent at the hospital and another two days in my admin job, I thought I didn’t have time to cook. Inevitably, I would just grab something high in fat and low in freshness.”
Liz decided to join Slimming World and in 2013 she won the national ‘Miss Slinky’ award after losing 5st in eight months. She went on to marry her husband Fran wearing a size 8-10 dress.
“As I started losing weight steadily, my confidence increased. I lost 2st in my first two months, then settled into a healthy pattern of 1-2lbs a week. For me, it’s all about having a quick solution for when I’m hungry: if I’ve got a hearty meal with me I don’t get tempted by ready meals, sandwich bars or takeaways.
“Once I’d lost the weight, it was no problem dashing around the ward or to the operating theatre for a potential emergency, where when I was bigger I’d be out of breath and have a mad scramble to find scrubs big enough to fit.
“Since then I’ve qualified as a midwife at Liverpool Women’s Hospital and had two beautiful babies of my own. While I’ve gained a little weight since I got married – I’m now 11st – I’m happy, healthy and enjoy being active day to day. It feels amazing to be setting a healthy example to my children. I was so glad to have a healthy weight when carrying my babies. It’s great to be able to talk to mums about their weight with a real understanding and empathy of what it’s like to be overweight and how great it feels to lose weight. I tell them if I can do it, anyone can!"
NHS data shows that one in five (21%) pregnant women have a BMI in the obese range by the time of their booking appointment at 8-12 weeks. Excess weight in pregnancy is linked to increased risk of miscarriage, premature birth, gestational diabetes and stillbirth, among other serious health issues.
About the RCM
The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/.
About Slimming World
Slimming World was founded by Margaret Miles-Bramwell (OBE, FRSA) in 1969. There are now more than 18,000 groups held weekly across the UK and Republic of Ireland via a network of 5,000 community-based Slimming World Consultants, who receive specific training in the role of diet and physical activity in weight management, as well as sophisticated behaviour-change techniques.
Slimming World’s healthy eating plan, Food Optimising, is based on the science of satiety and energy density. Our phased activity programme, Body Magic, eases members into activity until it becomes an intrinsic part of their daily routine. The principles behind Slimming World’s philosophy are based on a deep understanding of the challenges faced by overweight people and a recognition that those who struggle with weight carry a double burden, the weight itself and a burden of guilt and shame about their weight. Slimming World’s programme integrates practical, up-to-date advice with a highly developed support system based on care and compassion, and Consultant training focuses on facilitating behaviour change in a warm and friendly group environment. Consultant training is delivered through the Slimming World Academy. Slimming World also invests in a comprehensive research programme to develop its support for long-term weight management. The group support provided by Slimming World is recognised as effective by the National Institute for Health and Clinical Excellence (NICE) and the NHS.
Slimming World is the only national weight-loss organisation to support women through their pregnancy and while breastfeeding. It worked with the Royal College of Midwives to develop its policy for new mums and mums-to-be. For more information and expert advice about eating well, staying active and managing weight before, during and after pregnancy at slimmingworld.co.uk/rcm
For more information about Slimming World’s approach visit www.slimmingworld.co.uk or call 0344 897 8000.
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