New article on weight management in pregnancy in Nursing Practice magazine:
It highlights some interesting points:
- UK data suggests that between 40-65% of women gain too much weight in pregnancy.
- International research suggests that women who gain too much weight in pregnancy irrespective of pre-pregnancy BMI, have an increased risk of pre-eclampsia, caesarean section, and delivering larger babies.
So while we know that being overweight before pregnancy confers slightly higher risks, it is interesting to note that for any pregnant woman, controlling weight gain is important.
- A large UK trial recently found that limiting weight gain in pregnant women with obesity did not result in a lower risk for gestational diabetes, indicating that there is no strong evidence for what constitutes appropriate healthy or safe weight gain in pregnancy.
This is very interesting, because I have had concerns ever since the Royal College of Midwives started receiving income from Slimming World as a ‘partner’ and then the next thing I knew, larger pregnant women left, right, and centre were being packed off to Slimming World, despite the advice, from the Royal College of Obstetricians and Gynaecologists always having been to not try to lose weight while pregnant.
Now the argument for sending people to Slimming World is that by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount, which is not harmful. And I can hardly complain, I lost weight in both of my pregnancies through a variety of factors – more exercise (I LOVED aquanatal), consciously trying to eat more healthily, but predominantly because I felt sick as a dog for the first trimester and felt constantly full for the third!
My issue is – is sending pregnant women who are expressly advised not to try to lose weight to an organisation called Slimming World sending the right message? Given that the setting of Slimming World meetings and the entire focus for most of the rest of the participants in attendance is all about losing weight, is that the right environment for someone who is expressly not supposed to be trying to lose weight because it could be harmful to them and their fetus? Ho hum.
- Midwives often report feeling anxious or worried about discussing weight with pregnant women.
This is probably true for many midwives. And may actually be the cause of some of the tactlessness we encounter. If we already anticipate resistance before we discuss something (think of a dispute you’ve had to raise with a friend or significant other) often our anxiety about raising what we perceive will be a difficult topic clouds the way we deliver the message, and so we start off on a bad foot before we’ve even got anywhere. Phrasing difficult questions or topics sensitively and non-judgementally is an incredibly important and underestimated skill.
- NICE recommends that all women should be weighed at the start of pregnancy, but weighing should only continue throughout pregnancy if there is a clinical reason to do so; women should not be weighed repeatedly during pregnancy as a matter of routine.
So feel free to mention this if you’re seemingly getting on the scales every five minutes.
- As there are no UK guidelines regarding pregnancy weight gain, healthcare professionals are advised to focus on supporting women to eat healthily and keep active. This advice is the same for all women regardless of their weight category.
So if you’re feeling like you’re being nagged, remember, you may not be. The same advice is supposed to be given to all pregnant ladies.
- Moderate physical activity in 15 minute bouts three times a week is advised before increasing this activity to 30 minutes every day of the week. Women who have kept active regularly before pregnancy should be advised that they can continue this activity. If women struggle to keep active in pregnancy, they should be advised to avoid being sedentary, i.e. avoid sitting for prolonged periods of time.
This is another bugbear of mine, so glad there is an implication that questions should be asked about pre-pregnancy activity levels. It drives me bananas when women are automatically told they need to ‘get more exercise’ before the healthcare professional has actually ascertained what exercise level they are already at!
I know of fitness instructors who do a ton of exercise but are still overweight and even officially obese. Obesity does not necessarily mean inactivity. I got told to ‘slow down!?’ in a surprised manner when I galloped up the stairs ahead of my midwife once, and there were remarks at how sprightly I was at getting in and out of the birth pool too…
- This support needs to be delivered in a sensitive manner taking the woman’s circumstances into account.
Hurrah for them making this point! So don’t forget to remind your healthcare professionals of this if you feel they’re overstepping the line at any time.
Big Birtha x
For the full text, click here: