Starting the conversation

Wyong Powering group mothers, photograph by Lyndall MollartWyong Powering group mothers

In summary:

  • The NSW Department of Health is investigating an innovative new approach to educating expectant mothers on healthy eating and activity during their pregnancy
  • Aimed specifically at women who fall in to the obese weigh range, UTS Professor of Midwifery Maralyn Foureur says the program presents lifestyle information to antenatal patients in a much more vibrant and motivating manner than ever before

Obesity in pregnancy increases the risk of numerous problems and complications for mother and child, including gestational diabetes, hypertension and stillbirth. With 61 per cent of Australians now categorised as overweight or obese, the NSW Department of Health has recently invested $200 000 in the development of innovative programs to improve maternity outcomes for women with weight problems.

Having successfully competed for this seed funding, UTS and the former Northern Sydney Central Coast and South Eastern Sydney and Illawarra Area Health Services collaborated on an Australian first – a group-based antenatal care, education, motivation and peer-support program.

UTS Professor of Midwifery Maralyn Foureur says the program offers a very different model to current antenatal care. Standard practice consists of a 20-minute visit to either a midwife or a doctor who takes several physical measurements and asks questions about the baby’s movements and the mother’s general wellbeing.

Maralyn Foureur, Photograph by Joanne SaadMaralyn Foureur

“If you want to learn about healthy eating or healthy activity or anything to do with preparation for childbirth, you’re given an information leaflet to read or referred to books and articles,” she explains.

“In contrast, this group model of antenatal care provides all of this information in a way that’s very accessible to the women and fun for them to engage with.”

The program consists of a series of eight, two-hour sessions for groups of 10 to 12 women, facilitated by two midwives. In addition to the usual physical checks, women participate in discussions about a range of antenatal education, childbirth preparation and early parenting issues, healthy eating and healthy activity in pregnancy and beyond.

In this model, Foureur says the women set the agenda and help motivate each other to make a difference to their weight. “The midwives have a list of topics that are meant to be covered across the course of the whole pregnancy, but fundamentally, they enable the women to take the conversation where they want. They provide them with additional information based on fact and evidence about healthy eating and healthy activity in pregnancy.”

The women also have access to advice from dieticians, physiotherapists and obstetricians as part of the program.
The initial concept for the program was developed by Foureur and fellow UTS Professors of Midwifery Caroline Homer and Nicky Leap. Fellow UTS NMH researchers Jane Raymond, Cathy Adams, Vanessa Clements, Ali Teate and Professor Deborah Davis (now with the University of Canberra) also collaborated on the recently completed pilot.

Designed for women with a body mass index (BMI) over 30, the pilot included women with BMIs over 40. The aim for this group of women was to keep pregnancy weight gain to between a recommended five to nine kilograms rather than the 12 to 14 kilos recommended for women in the healthy weight range.

Participants were interviewed at the beginning of the program and again about six weeks after the birth to measure their weight, assess their eating and exercise habits and evaluate any changes. Participants rated their overall experience in the program very positively. On average, they managed to maintain their weight within the recommended guidelines, while many also saw positive changes in their family’s eating and exercise habits.

“They absolutely loved having access to conversations with a dietician to talk to them about what you look for when you go shopping, what you read on the labels, and how to put together interesting meals that are fundamentally healthy,” says Foureur. “You imagine people pick up those skills in life as they go along, but really a lot of us don’t.”

For the midwives leading the sessions, Foureur explains, the experience of facilitating a group was quite different to teaching an antenatal education class. They received training in facilitating groups around a particular agenda and in motivational interviewing.
While not involved in the program delivery, it was also a learning process for the doctors and midwives involved in recruiting participants. The resources developed to support the model, including a facilitator handbook, have also proven popular.

“Most healthcare providers are very reluctant to raise the issue of being overweight or obese with pregnant women, because they fear the women may feel embarrassed,” says Foureur. “Some women get very angry that you’re talking about their weight, and so many health providers just avoid the issue altogether. The program taught the midwives better techniques for initiating that conversation.”

In terms of reducing pregnancy and birth complications, Foureur says the results were less clear. “We didn’t find the participants did dramatically better than the women who didn’t have access to this program, the difficulty being we only had a small number of women in the pilot study.” 

The group now plan to set up a much larger randomised control trial with sufficient numbers of women to be able to establish if the program makes a difference to their childbirth outcomes.

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Rachael Quigley
Marketing and Communication Unit

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