Supporting the individual needs of obese pregnant women: Effects of risk-management processes
Obesity is the UK's most prevalent antenatal comorbidity, and reducing rates of maternal obesity and risk management of complications in pregnancy and labour is a priority for the NHS. The emphasis on managing maternal obesity-related risks, rather than dealing with the causes of long-term obesity, is short-sighted and fails to consider the needs of the individual woman. This process of risk management is fuelled by the maternity services' costly litigation insurance that presents measures to manage obesity-related risks, leading to bureaucratic shaping of maternity services. This limits the choices for this group of women by standardising care rather than facilitating their individual needs. This article explores an alternative long-term strategy called Pregnancy Plus that facilitates the management of risk alongside supporting the needs of individual obese pregnant women, offering choice and equal access to maternity services while maintaining the safety of the women and their babies. Pregnancy Plus is an award-winning multi-intervention health education and weight maintenance programme that has presented promising outcomes to date. It utilises a salutogenic approach to health education and care-planning for obese pregnant women and adopts the principles of the US Institute of Medicine guidelines for the maintenance of gestational weight-gain in obese women.
Rates of obesity worldwide have doubled in the past 30 years (World Health Organization (WHO), 2013) and obesity in the UK is reaching epidemic levels. The Health and Social Care Information Centre (HSCIC, 2014) reported that over 60% of adults and 30.6% of children in England were classed as overweight or obese in 2012. Rates of maternal obesity in the UK saw an increase from 10% in 1990 to 30% in 2014 (Denison et al, 2014) and obesity-related maternal and infant deaths have mirrored this, with reported obesity-related maternal deaths of 23% in 2007 increasing to 49% in 2011 (Lewis, 2007; 2011). The negative impact of obesity on health, particularly in the childbearing population, should not be underestimated—obesity is now the UK's most prevalent antenatal comorbidity (HSCIC, 2010; 2011).
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