The views of first time mothers completing an intervention to reduce postpartum weight retention: A qualitative evaluation of the mums OnLiNE study
Introduction
Maternal postpartum weight retention (PPWR) has implications for weight related health of the mother and the child in both the short and long term. Increased body mass index (BMI) from one pregnancy to the next is associated with increased risk of multiple, serious obstetric (Wolfe and Gross, 1994, Edwards et al., 1996, Lu et al., 2001, Sebire et al., 2001, Roberts and Lain, 2002, O’Brien et al., 2003, Kuhlmann et al., 2008, Ramachenderan et al., 2008, Addo, 2011, Dodd et al., 2011) and neonatal outcomes (Lucas et al., 1988, Cedergren and Kallen, 2003, Watkins et al., 2003, Cedergren and Källén, 2005, Chu et al., 2007, Rankin et al., 2010, Ruager-Martin et al., 2010, Tennant et al., 2011) during subsequent pregnancies. In the longer term, up to 20% of women retain 5 kg or more above their pre-conception weight at 12 months post partum (Gunderson, 2009, Abebe et al., 2015). Weight retention at 12 months has been shown to predict maternal overweight 15 years later (Linne et al., 2004) and could contribute to the development of obesity and associated conditions including heart disease and diabetes (Rooney et al., 2005, Shrewsbury et al., 2009, Phelan et al., 2010).
Women have described the overall experience of attempting to lose weight during the postpartum period as one of achieving a balance between their various life roles (Montgomery et al., 2012).Yet, they are frequently confronted with new demands of caring for their infant whilst adapting to potential physical and emotional changes in themselves (Leahy Warren, 2005, Ong et al., 2014). New mothers often give precedence to care giving responsibilities and put the health of their baby first, even at the expense of improving their own health (Carter-Edwards et al., 2009). As such, their priorities for support are likely to differ to those of the general population and, therefore a detailed understanding of their views and attitudes towards postpartum support is of vital importance, in an effort to promote positive health overall.
To date, relatively few interventions have been conducted, aimed at limiting PPWR and promoting healthy lifestyle behaviours in new mothers. Moreover, results of these interventions have been mixed (van der Pligt et al., 2013) with few interventions having been shown to be successful in limiting maternal weight (van der Pligt et al., 2013). In fact little is known about which strategies are likely to be the most effective to women during this time (van der Pligt et al., 2013).
In building the evidence base for suitability of interventions, not only is effectiveness of the intervention important to assess but the acceptability and appeal to participants is key, in understanding why a program was or was not successful and how any effects were achieved, via process evaluation for example (Saunders et al., 2005, Olstad et al., 2016). However, detail regarding evaluation of postpartum interventions with new mothers is lacking. Consideration for the needs of this important population group is key in understanding intervention outcomes, potential challenges and barriers to participation and intervention engagement. Such information is necessary to refine design and childbirth of future postpartum interventions.
The aims of the current study were to describe the perspectives of women who completed the mums OnLiNE pilot intervention, regarding acceptability, effectiveness and usefulness of the intervention and to explore how women feel they might be best supported to attain a healthy weight and lifestyle behaviours following childbirth.
Section snippets
Methods
The Consolidated reporting criteria for Qualitative studies (COREQ) (Tong et al. 2007) was used to outline methods described. The mums OnLiNE pilot intervention was conducted from June 2012 to December 2013 and was nested within the cluster-randomised controlled trial, InFANT Extend. Details of the InFANT Extend methodology have been described elsewhere (Campbell et al., 2016). To be eligible to participate in mums OnLiNE, women needed to be 18 years or older and be first-time mothers with
Participants
A total of 13 women (46%) out of 28 women invited, responded to the invitation letter and took part in the study. One woman scheduled an interview but was then non-contactable and therefore did not participate in the study. A total of 12 women took part in the study. Data reached saturation (the interview responses had effectively addressed all aspects of the emerging themes) by the tenth interview, however two further women had already been recruited, having made scheduled telephone interview
Discussion
This study showed that women felt supported being part of the mums OnLiNE intervention and valued the care provided to them during a demanding and vulnerable life stage. This is one of only few qualitative studies to have explored the views and perspectives of women who took part in a postpartum intervention aimed at limiting PPWR and promoting healthy lifestyle behaviours.
Overall women found the one-on-one telephone calls to be the most valuable component of the intervention. Mothers reported
Conclusion
This study has shown that first time mothers are supportive of practical online and telephone delivered strategies to assist them in attaining healthy lifestyles during the postpartum period. Whilst women face many challenges to attaining a healthy weight and healthy lifestyle behaviours following childbirth, planned appropriately, interventions aimed at targeting PPWR have the potential to be well received and adequacy of support is possible. Recommendations such as those offered by mothers in
Ethical statement Conflict of interest
The authors declare no conflict of interest.
Ethical approval
Ethics approval for this study was obtained from the Deakin University Human Research Ethics Committee.
Funding sources
The InFANT-Extend study, within which this study was nested was funded by a World Cancer Research Fund grant (2010/244). At the time of this study PV was supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship; KB is supported by a NHMRC Principal Research Fellowship, ID 1042442 (the contents of this work are the responsibility of the authors and do not reflect the views of NHMRC); KDH is supported by an Australian Research Council Future Fellowship (
Trial registry
No applicable.
Acknowledgements
We acknowledge and thank the staff and research team who worked on the InFANT Extend project and thank the women who took the time to take part in the interviews for this study.
The InFANT-Extend study, within which this study was nested was funded by a World Cancer Research Fund grant (2010/244). At the time of this study PV was supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship; KB is supported by a NHMRC Principal Research Fellowship, ID 1042442 (the
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