Reither Margi, Germano Elaine, DeGrazia Michele
J Midwifery Womens Health. 2018 May;63(3):273-282. doi: 10.1111/jmwh.12760. Epub 2018 May 19.
Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity.
Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity. Descriptive statistics were used to analyze data.
In a sample of 546 midwives, 87% of respondents reported observing an increase in perinatal complications associated with obesity. Midwives reported increasing discomfort with the care of pregnant women with obesity as body mass index (BMI) increased. For pregnant women with extreme obesity, the respondents reported less frequent use of physiologic birth guidelines only and increased use of interventions, referral to physician care, and transfer to a higher level of care. Approximately half (270, 49.5%) reported having a guideline that addressed the care of women with obesity. Of these, 145 midwives (53.7%) reported that extreme obesity was the BMI threshold for identifying an increased or high risk for perinatal complications. Sixty percent (339) of midwives who participated requested guidance for management of laboring women who are obese.
This study provides a greater understanding of midwifery management practices when caring for women with obesity and opportunities to improve care. The results suggest that midwifery management alters with increased BMI, specifically in the care of women with extreme obesity. Suggestions for future study include research on management of pregnant women with obesity and extreme obesity with outcome data examining management strategies that provide safe, satisfying care.
肥胖与肥胖女性及其婴儿在孕期及产后出现不良健康结局的风险增加有关。本研究旨在调查肥胖孕妇的助产管理情况。
向美国助产士学院的认证助产士和认证护士助产士发送了一份调查问卷。该调查问卷分为4个部分：人口统计学特征；实践指南和规程；2015年孕产妇护理分级指南中关于转诊（包括转至更高护理级别）的作用；以及影响肥胖孕妇管理的因素。采用描述性统计方法分析数据。
在546名助产士的样本中，87%的受访者报告观察到与肥胖相关的围产期并发症有所增加。助产士报告称，随着体重指数（BMI）的增加，照顾肥胖孕妇时的不适感也在增加。对于极度肥胖的孕妇，受访者报告较少仅使用生理分娩指南，而增加了干预措施的使用、转诊至医生护理以及转至更高护理级别。约一半（270名，49.5%）的受访者报告有针对肥胖女性护理的指南。其中，145名助产士（53.7%）报告称，极度肥胖是识别围产期并发症风险增加或高危的BMI阈值。参与调查的助产士中有60%（339名）要求提供肥胖产妇分娩管理的指导。
本研究有助于更深入了解照顾肥胖女性时的助产管理实践，并提供了改善护理的机会。结果表明，助产管理会随着BMI的增加而改变，特别是在照顾极度肥胖女性时。未来研究的建议包括对肥胖和极度肥胖孕妇管理的研究，并通过结局数据检验提供安全、满意护理的管理策略。
