The development of maternal obesity maternity services in the north east of England: a qualitative study

The results of this follow up study have identified that there has been some significant development in maternal obesity services since the previous study conducted in 2005/2006. There are routine referrals for consultant led care and anaesthetics for obese women, and also to dietetics services in a number of maternity units. Maternity units are also in various stages of developing and implementing guidelines across the region. Overall Health Care Professionals (HCP) felt that the benefits of maternal obesity services were in safeguarding the health of the mother and her baby, and the majority of maternity units had the necessary equipment to manage the care of the obese pregnant woman safely. HCPs also felt that implementing obesity services during pregnancy meant that women were a captive audience, and may be more motivated to address obesity during pregnancy. However there is more scope for the development of services relating to maternal weight management, and addressing the psychosocial issues of maternal obesity. The needs of service users must be considered when developing services, and research is required to identify how to engage obese pregnant women with services to ensure that: * Service development meets the needs of obese pregnant women. * To ensure that resources are not wasted implementing interventions that wont be utilised by service users. * To ensure that women dont feel stigmatised during pregnancy. * To ensure that women dont disengage from maternity services altogether through feeling stigmatised. It was acknowledged that maternity services could not address this issue alone, and that additional expertise was required. In particular, the lack of communication between maternity services and public health services was identified as a barrier in establishing the necessary support pathways to effectively utilise existing expertise. HCPs felt that addressing obesity in pregnancy was bigger than us, and that it needed to be on the wider agenda to be addressed effectively, and that a national and strategic drive was required. The need for long term solutions to address maternal obesity were discussed, and how results would not necessarily be seen straight away as there was a need for services to break the cycle of obesity for the next generation. HCPs felt that there was also a need for the public health messages relating to obesity to include the impact on pregnancy, and how they needed to be more engaging of the obese population. HCPs identified areas of training that would be required in order to provide effective services for obesity. It was stressed that flexibility was required to ensure all HCPs that required training could attend, that midwives could potentially learn from dietitians, and there may be training needs for dietitians relating to the maternal and foetal needs of obese women during pregnancy. The specific training needs identified included: * How to broach the subject of maternal obesity with women. * A need to address the language barrier between HCPs and women. * How midwives didnt have the necessary expertise on obesity. Recommendations: Overall this study has shown that maternity services to address maternal obesity have developed significantly over the last two to three years in terms of the obstetric requirements of obese women, and there are improved multidisciplinary relations throughout maternity units in the majority of the region, especially in relation to anaesthetics services, and to a lesser extent, dietetics services. However, there is still a substantial amount of work to be done in terms of having a more holistic and strategic service that looks at the wellness of obese pregnant women rather than just health and safety aspects. HCPs have identified that to address maternal obesity effectively, services need to: * Consider the transition of care between the pregnancy and postnatal period to maximise engagement with services. * Address the identified training needs of HCPs who care for obese pregnant women. * Focus on improving communication between hospital maternity services and public health services. * Ensure the issue of maternal obesity is on the wider obesity agenda to facilitate the strategic and national support that is likely to be required to effectively address maternal obesity. * Be involved in further research to identify how to engage pregnant women with services to address their obesity.