Elsevier

Nurse Education in Practice

Volume 36, March 2019, Pages 54-57
Nurse Education in Practice

Midwifery Education in Practice
An investigation of Australian midwifery curricula for obesity management and health behaviour change training

https://doi.org/10.1016/j.nepr.2019.03.003Get rights and content

Highlights

  • More than 50% of women enter pregnancy at over recommended weight.

  • Few women receive advice on managing weight during pregnancy from health professionals.

  • Health professionals have considered their current levels of training for gestational weight management to be inadequate.

  • This study found that explicit teaching about advising women on weight management during pregnancy was minimal.

  • Midwifery courses should explicitly teach midwifery students about how to address weight gain during pregnancy.

Abstract

Introduction

Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management.

Methods

Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context.

Results

Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula.

Discussion

A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

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.

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