Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management

Anne Christenson,Jarl Torgerson,Erik Hemmingsson

doi:10.1186/s12884-020-03438-1

Abstract

BackgroundGestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management.MethodA web survey was emailed to Swedish maternity care clinics. Existing questionnaires, “Beliefs About Obese People” (BAOP), “Perceived weight bias in health care” and “Attitudes toward obese patients” was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic.Results274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: “I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed”. Having had training in motivational interviewing seemed positively associated with midwives’ inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals.ConclusionSwedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation.

Highlights

Gestational weight interventions are important in maternity care to counteract adverse pregnancy events
Qualitative findings indicate that some midwives perceive weighing and gestational weight management in women with obesity as difficult [5], more so than addressing, e.g. alcohol or tobacco use [6]
48% of maternity care providers thought that women with obesity do not always tell what they really eat, and one third of respondents believed that pregnant women with obesity would prefer not to be weighed

Summary

Introduction

Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management. Obesity in pregnancy and excessive gestational weight gain are associated with increased risks for several adverse events, such as gestational diabetes, pre-eclampsia, cesarean, intrauterine fetal death, as well as future obesity in the offspring [1]. These health risks are acknowledged in Swedish national recommendations, where the importance of qualified support during pregnancy, defined as person-centered advisory conversations, adapted to the woman’s specific age, health, and risk levels, is emphasized [2]. The topic of body weight is sometimes avoided for fear of inflicting shame or worries, especially in women with overweight or obesity [6]

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