Helping women and birthing people with nutrition in pregnancy is important for their wellbeing and that of the unborn fetus. Yet, there is little attention given to education to enable students to have meaningful conversations. Dr Julie Abayomi, RD, Associate Head of Medicine & Nutrition, Edge Hill University, who will be speaking on Maternity and Midwifery hour this week, shares how specific nutrition education impacted on students confidence
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Introduction
UK antenatal guidelines state that midwives should discuss nutrition, diet and vitamin supplementation at booking-in appointments (NICE, 2021). Our earlier research (McCann et al., 2018), found that none of the midwives we interviewed had received any training about nutrition in pregnancy, either during pre-registration training or as continuous professional development (CPD). They reported a lack of confidence and skills regarding advising pregnant women about diet and weight during antenatal care. Moreover, despite recognising these discussions as part of their role, they admitted that conversations about nutrition were not prioritised: “We probably spend less time talking about diet and weight than anything else in pregnancy” (McCann et al., 2018). Postnatal women have also expressed disappointment with their experiences of receiving healthy eating advice. We interviewed previous antenatal service users and found that they described the advice they received as unhelpful, inconsistent and lacking depth (Abayomi et al.,2020).
Other research has shown that delivery of nutrition education can improve the knowledge and skills of midwives (de Jersey et al., 2018), but there is no evidence that improved knowledge leads to a change in practice. The aim of this study was to evaluate nutrition education sessions for second year and third year midwives, delivered by a dietitian and to determine if they could lead to a change in practice.
Methods
Student midwives were recruited during a second-year (Y2) and final-year (Y3) taught nutrition session at their university. The content of the taught sessions is indicated in Figure 1 below; all sessions were delivered by a registered dietitian with expertise in maternal nutrition.
Figure 1: Outline of taught nutrition sessions, per year of study.
On each occasion, they were asked to provide free-text feedback on anonymous post-it notes, regarding the following:
- Second year – How do you feel about offering healthy eating and weight management advice during antenatal care?
- Final year – Are these taught sessions likely to result in a change in your midwifery practice?
The comments were collated and analysed thematically, guided by Braun et al (2019).
Results
Twenty-three Y2 and thirty-three Y3 students were recruited and provided feedback.
Two main themes were identified by Y2: 1) confidence about delivering healthy eating advice and 2) nutrition knowledge. Regarding confidence, about half of the students stated that they had ‘increased confidence’ about giving healthy eating advice after taught sessions, however some also stated that it could be ‘difficult to broach [the] subject with some women’ and expressed concerns about ‘causing offence’, particularly in relation to providing weight management advice. In terms of nutrition knowledge, despite the nutrition education session, the students still felt that they ‘don’t have enough knowledge’ and ‘need to know more’ about nutrition as a midwife. Some also felt ‘embarrassment’ or ‘hypocritical’ about giving healthy eating advice, due to a lack of nutrition knowledge, or by reflecting on their own poor eating habits.
Three themes were identified by Y3: 1) Nutrition as a priority, 2) Personalised Nutrition, 3) Sources of information and signposting. Most Y3 students commented that they now viewed maternal nutrition as ‘important’ and intended to prioritise discussions about nutrition in future practice. Encouragingly, they realised that messages needed to be personalised ‘It has made me aware to tailor advice to different women’. They also appreciated that signposting women to reliable sources of information or other health professionals was an important part of their role ‘The additional resources and signposts were really helpful’.
Discussion
The results from this convenience sample of Y2 and Y3 student midwives corroborates out earlier findings that there is a gap in the education and practice of midwives about nutrition during pregnancy (McCann et al., 2018). However, delivering pregnancy-specific nutrition knowledge, via a dietitian with specialist knowledge of maternal nutrition, appears to be well received and could help students to develop increasing confidence to communicate healthy eating messages to women during antenatal consultations. Positively, nutrition now appears to be viewed as more of a priority and Y3 students recognise the need to focus on different areas of advice, to meet the individual needs of women in their care. Furthermore, they appear to appreciate the need for multi-disciplinary teamwork and the need to refer more complex cases to dietitians for additional support.
Conclusion
This feedback provides further insight into how midwifery nutrition education needs to be tailored, to benefit student midwives and improve antenatal care. Pregnancy-specific nutrition education which is delivered by a dietitian and focuses on case studies and care pathways appears to have empowered student midwives to consider incorporating some of this practical advice into their practice.
References
J C Abayomi, M S Charnley, L Cassidy, M T Mccann, J Jones, M Wright, L M Newson, A patient and public involvement investigation into healthy eating and weight management advice during pregnancy, International Journal for Quality in Health Care, Volume 32, Issue 1, February 2020, Pages 28–34, https://doi.org/10.1093/intqhc/mzz081
Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: ed. Liamputtong P. Handbook of Research Methods in Health Social Sciences, 2019, Singapore, Springer. 843–60.
de Jersey, SJ., Tyler, J., et al.,(2018) Does a mandatory training education session improve knowledge and confidence of midwives? Midwifery. doi.org/10.1016/j.midw.2018.06.025 https://www.sciencedirect.com/science/article/abs/pii/S0266613818301980?via%3Dihub
NICE (2021) Antenatal care guidelines [ Available at: https://www.nice.org.uk/guidance/ng201
McCann MT, Newson L, Burden C, Rooney JS, Charnley MS, Abayomi JC. A qualitative study exploring midwives’ perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women. Matern Child Nutr. 2018 Apr;14(2):e12520. https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.12520
Dr Julie Abayomi, RD
Associate Head of Medicine & Nutrition, Edge Hill University
October 2024