Midwifery Education in PracticeAn investigation of Australian midwifery curricula for obesity management and health behaviour change training
Introduction
Fifty percent of Australian women enter pregnancy overweight or obese (Callaway et al., 2006, McIntyre et al., 2012), and in rural Victoria, prevalence is even higher at 65.6% (Cunningham and Teale, 2013). Many women entering pregnancy are thus at elevated risk of serious obesity related health issues during pregnancy and post-partum (Field et al., 2001, Rasmussen and Yaktine, 2009). Women counselled by their doctor on recommended weight gain are more likely to have a gestational weight gain goal in line with clinical guidelines that aim to reduce health risk for mothers and their newborns (Tovar et al., 2011). Unfortunately, few women receive weight management advice from health professionals during pregnancy (Brown and Avery, 2012, McDonald et al., 2012).
Health professionals are more likely to counsel patients when they feel that they have adequate experience in weight-loss counselling (Power et al., 2006). Studies suggest that midwives feel that they lack the knowledge and interpersonal skills required to provide pregnant women with weight management advice guidance, and that they require further training (Heslehurst et al., 2013, Wahedi, 2016). Enhancing health provider training is an important step towards improving motivation for providers to discuss women's weight during consultations (Chang et al., 2013). Consistent with this view, 78% of obstetric and midwifery staff in one Australian study considered their current levels of training regarding gestational weight management to be inadequate (Stewart et al., 2012).
In view of the increasing incidence of obesity in pregnancy (Dinsdale et al., 2016, Gaillard, 2015, World Health Organization, 2018), it is timely to assess the extent to which the education of emerging health professionals is preparing them to be able to effectively counsel women regarding appropriate gestational weight gain. As midwives are clinicians providing health education and promotion in pregnancy, this study focuses on how Australian university curricula equip midwives to communicate and manage weight-related risks during pregnancy, and effectively encourage women to be active agents of their own health. Using qualitative analysis techniques, a content analysis of Australian midwifery curricula will assess how students are taught regarding three main aspects: 1) the effect of weight, diet and physical activity on pregnancy outcomes; 2) the incorporation of weight management advice for differing populations; and 3) health behaviour change techniques in any context. The aim of this study was to identify the strengths and deficits of the current midwifery curricula with respect to antenatal weight management.
Section snippets
Data collection
Twenty-six midwifery courses were identified as scheduled to be taught in 2017 across all Australian universities (Australian Health Practitioner Regulation Agency, 2018). The courses included graduate degrees (N = 15 and post-graduate degrees (N = 11). A total of 568 units (subjects) were identified as being taught within these courses. Course convenors were contacted up to 3 times in an attempt to obtain access to courses.
Procedure
All accredited entry-to-practice midwifery programs in Australia were
Results
A total of 252 course outlines were obtained. Of the course outlines that were not obtained, 92 course outlines were not available due to universities’ sharing of information policies and concern for intellectual property, and nil response was received for 224 course outlines. In most cases, information on the three main aspects of interest (the effect of weight, diet and physical activity on pregnancy outcomes; the incorporation of weight management advice for differing populations; and health
Discussion
In the current study, thematic analysis was used to investigate a priori themes on weight management in pregnancy. We found that curricula contained a variety of teaching methods, skills and training exercises on health promotion throughout pregnancy, lifestyle management, and identification of risk factors. Students were taught about evidence-based pregnancy management, including the importance of BMI, weight gain in pregnancy, diet and physical activity on maternal health and pregnancy
Conclusion
There is a strong focus on health promotion throughout pregnancy in midwifery training in Australia. Current training includes risk identification and lifestyle management, and there is an emphasis on the importance of clinical judgment and autonomous clinical practice. More guidance, however, is required to effectively skill midwives to address weight gain during pregnancy, and to have a thorough understanding of the behavioural techniques that can be used to limit gestational weight gain
Declaration of interest
The authors have nothing to declare.
References (28)
- et al.
Midwives perspectives of their training and education requirements in maternal obesity: a qualitative study
Midwifery
(2013) - et al.
Comparison of midwifery, family medicine, and obstetric patients' understanding of weight gain during pregnancy: a minority of women report correct counselling
J. Obstet. Gynaecol. Can.
(2012) - et al.
Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis
PLoS One
(2014) Approved Programs of Study
(2018)- et al.
Healthy weight management during pregnancy: what advice and information is being provided
J. Hum. Nutr. Diet.
(2012) - et al.
The prevalence and impact of overweight and obesity in an Australian obstetric population
Med. J. Aust.
(2006) - et al.
Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives
BMC Pregnancy Childbirth
(2013) - et al.
A profile of body mass index in a large rural victorian obstetric cohort
Med. J. Aust.
(2013) Clinical Practice Guidelines- Pregnancy Care
(2018)- et al.
“As soon as you’ve had the baby that’s it…” a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways
BMC Public Health
(2016)