Being and remaining active in pregnancy and beyond is an important public health message. In this article Jacque Gerrard MBE, member of the Active Pregnancy Foundation Scientific Advisory Board, outlines the support and resources midwives can access and provide.
Activity in Pregnancy: What midwives need to know
As midwives, part of our usual antenatal care is to discuss many aspects of lifestyle from a public health perspective with women and birthing people. This is to advise and ensure that both mother and baby are in optimum health in preparation for labour, birth and the post-partum period. The NICE antenatal care pathway we use in the NHS includes all aspects of antenatal screening , nutrition and diet, smoking and tobacco use, alcohol consumption ,recreational drug use and activity in pregnancy.
However, do midwives and HCPs truly discuss activity in pregnancy and are we really equipped to give appropriate and safe advice on activity in pregnancy?
A survey conducted by the ‘This Mum Moves’ project and funded by Sport England through ‘UKactive’ , asked 393 midwives and health visitors if they talked about or gave advice to pregnant women on activity in pregnancy. Although it was a very small sample size, results indicated that this was not a priority for Midwives or Health Visitors as it showed that 33% rarely or never talked about or gave physical activity advice to pregnant women. (1)
Midwives really need to get on board with having activity discussions with women throughout their antenatal care from a public health perspective. According to ‘Health survey for England 2016 Physical Activity for adults’, https://files.digital.nhs.uk/publication/m/3/hse16-adult-phy-act.pdf inactivity increases the risk of long term conditions including coronary heart disease, type 2 diabetes, breast and colon cancers.
The Health survey for England 2016 report is worth a read as it has a lot of detail on adherence to current physical activity guidelines for aerobic activity, muscle-strengthening activity, and for older people, activities to improve balance and co-ordination. It also examines participation in individual types of leisure activity as well as occupational activity and sedentary behaviour. It highlights that almost one in ten premature deaths are from coronary heart disease.
In addition to the health costs to the population, the report reminds us that there is also a financial cost directly to the NHS and this is estimated to be more than £900milion.
Just imagine what we could do for the NHS with that amount of money if we saved it and if all healthcare professionals, including midwives were successful at promoting the importance of staying active throughout life.
It is therefore in everyone’s interest to discuss and promote physical activity throughout pregnancy and beyond as midwives have an ideal opportunity as part of midwifery care.
The following paragraphs signposts midwives and future midwives to freely available resources that are easily accessed.
CMO’s Info Graphs
There are many resources available to midwives and HCP’s and most free to all. A good starting point are the Info graphs developed by the four UK Chief Medical Officers(CMO) which are easily available, evidence based and simple to understand. The most basic advice that we need to share with pregnant and post-partum women from the CMO’s advice is that throughout pregnancy women should aim for 150 minutes of moderate physical activity every week. Following birth and whenever the woman is recovered and ready to pick up on activity, the recommendation is also 150 minutes of moderate physical activity every week. This advice is straightforward , clear, and available online to print off and share with women at each antenatal visit.
What midwives need to know and the key advice to give
- If the woman is not active, then advise to start exercise gradually
- If she is already active, then advise to keep on going
- Part of activity is to encourage muscle strengthening exercise x2 per week
- Advise women to listen to their body and adapt activity as her pregnancy grows
- Every activity and every minute counts and more is better
- Always remember ‘DON’T BUMP THE BUMP’
Advantages of Activity in Pregnancy
There are many advantages of physical activity in the pregnant population, and these include helping to:
- control maternal weight gain
- reduce high blood pressure and the complications this has for pregnancy
- improve maternal sleep
- prevent gestational diabetes
- improve maternal mood and mental health
- improve overall fitness during pregnancy
The Active Pregnancy Foundation (APF)
The Active Pregnancy Foundation is a valuable and key place for midwives and HCPs to access evidence-based information and resources to help advise and support women on exactly what kind of activity they should be doing and what is safe throughout pregnancy and post birth.
https://www.activepregnancyfoundation.org/
The Active Pregnancy Foundation provide excellent free resources. They believe in ‘a whole systems approach’ which is based on clear and consistent evidence-based messaging shared by all professionals so that pregnant women feel reassured and empowered to make informed physical activity choices. Advice is freely available for mums to be, healthcare professionals and their support networks in the hope that they help women to stay active throughout pregnancy and beyond.
One example of a very effective resource available on the APF website is an e-learning module developed by the former Public Health England, Health Education England and the ‘This Mum Moves project’. This is a free module which will help to inform midwives about the current evidence base around physical activity in pregnancy and post birth and it takes around 60 minutes to complete. It also provides a certificate which can be used as part of Continuing Professional Development (CPD) towards the NMC midwifery revalidation process.
Active Pregnancy Foundation Top Tips leaflet
The Top Tips information was a unique and helpful leaflet produced to support pregnant women to remain active in pregnancy and post birth during the Pandemic and especially during lockdown times. The tips are still relevant and a useful reference for midwives which can be printed off and discussed with women.
https://portal.e-lfh.org.uk/Component/Details/604251
Find Your Active Resource
Another valuable resource available via the Active Pregnancy Foundation is an activity-based resource full of advice and guidance to help navigate through an active pregnancy. This is a delightful resource called ‘Find Your Active’ and written in collaboration with the experts. It includes guidance on Aquanatal, Cycling, Home Workouts, Personal Training, Pilates, Resistance Training, Running, Swimming, Yoga, Walking and Dancing. It’s an easy and fun to read resources whilst learning about the Do’s and Don’ts of all these specific activities which can help us to advise women who are involved in all of these.
Dance as an activity whilst pregnant
Dance is an interesting activity particularly if the mum to be is an elite dancer. In a follow up blog PhD student and member of the Active Pregnancy Foundation’s scientific Advisory Board Chloe Hillyar will share her research on the necessity for specialist guidelines for professionally elite dancers during their pregnancy. This is exciting research as midwives may struggle to provide the best evidence for pregnant elite dancers as part of their antenatal care.
Moving Medicine
Moving Medicine is another helpful and freely available resource. They provide midwives, clinicians, and allied health professionals with accessible, evidence based, condition specific information. They give advice on physical activity at all stages for children, young peoples, and adults treatment pathways as well as the pregnancy pathway.
A key resource that they have developed for pregnancy and post birth is the ‘1 minute’, ‘5 minute’ and ‘more minute’s’ conversations that midwives and HCPs can have. These are known as ‘Active Conversation’s’. These are easy to access and even easier to use. Their message is clear in that every conversation and every activity in pregnancy counts
Finally
It would be hugely advantageous if all midwives incorporated physical activity conversations during antenatal consultations. They could also signpost women to the freely available resources as mentioned above to help reinforce the importance of being active throughout pregnancy. Even very simple and brief advice can be effective.
Physical activity in pregnancy conversations can be as simple as 1, 5 or more minutes. It is over to us as midwives to make sure that every antenatal consultation and conversation counts, and we do our bit in helping to prevent future population long term conditions.
Reference
(1]spear (2018-2021), This Mum Moves Final Report, survey with 393 midwives and health visitors
Further reading
https://movingmedicine.ac.uk/patient_information/pregnancy-patient-information-leaflet/