Improving Midwifery Prenatal Care for Women with Obesity

Background. This project involved creation of a manuscript entitled Prenatal Care of Women with Obesity: An Effective Approach to Key Moments in Patient Counseling. The manuscript was created to enhance understanding of the communication needs of women with obesity during the prenatal period. Obese women are often stigmatized by providers of women's health and often receive less optimal prenatal care as a result. Some women with obesity may avoid prenatal care due to the anti-fat attitudes of providers. The manuscript was based on an extensive review of the literature regarding provider and patient perspectives on communication regarding weight management during pregnancy, background on current approaches to obesity management, strategies for effectively communicating risk to patients, and alternative, evidence based approaches to patient counseling that have been shown to improve the patient-provider relationship. The manuscript intervention provided strategies, tools, and resources to improve midwives' communication with women with obesity in the prenatal period. Methods. Fourteen actively practicing midwives (CNM) and women's health practitioners (WHNP) were recruited to review the manuscript and offer feedback to the author. Participants were asked to complete the NEW Attitude Scale, a valid tool that measures provider attitudes towards obese patients, before and after reading the manuscript. Pre- and posttest scores were compared using a two-tailed Wilcoxon signed rank test. Results. Participant's mean posttest NEW Attitude Scale scores were found to be significantly more positive than pretest scores (p < .05). The range of scores on the pre-test were 0 to 45 out of a possible range of -118 to +118. The range of scores on the post-test were 11 to 51. Participant feedback regarding content and utility of the manuscript was positive. Conclusion. Although the participant sample was small, review of the manuscript resulted in modest improvement in providers' attitudes about caring for toward obese prenatal patients. Pretest scores indicated that none of the providers held negative attitudes toward obese patients prior to reviewing the manuscript which may account for lack of large attitude changes on the posttest. Access to materials that provide a synopsis of current evidence regarding effective management of obesity in pregnancy, enhanced communication strategies, and available resources for clinicians and patients that are easily accessed and designed for clinical use, such as this manuscript, may enhance CNM and WHNP self-efficacy regarding communication challenges and appropriate treatment of women with obesity.