Midwives’ management of gestational weight gain: Clinical practice behaviours and determinants using Normalisation Process Theory

Problem: Despite national guidelines for managing gestational weight gain (GWG), little is known about their integration into routine midwifery practice. Background: Unhealthy GWG is associated with serious outcomes for both mothers and babies. Despite established guidelines, and midwives being well-positioned to manage GWG, many women do not achieve healthy GWG. Understanding the factors that influence GWG care is critical to improve midwifery practice. Aim: To examine midwives’ implementation of GWG-related practices and key factors associated with adherence to national guidelines. Methods: A cross-sectional survey of Australian registered midwives was conducted. Questions assessed midwives’ knowledge of GWG guidelines, their clinical practices, and factors that influence implementation which were informed by Normalisation Process Theory (NPT). Findings: National guidelines for GWG-related clinical practice are inconsistently implemented, with variability in midwives’ knowledge of BMI and recommended GWG ranges. More than 60 % of the midwives could not correctly identify the recommended GWG range for each BMI category. The multiple regression model using NPT constructs to predicted adherence to guidelines (adjusted R-square=0.33, p < 0.001) identified cognitive participation (β=0.30, p < 0.01), individual specialisation (β=0.19, p = 0.02), and reflexive monitoring (β=0.23, p = 0.04) were significant predictors. Discussion: Despite known risks, unhealthy GWG is rarely identified or monitored. Supporting midwives with training that targets key NPT constructs has potential to improve adherence to guidelines. Conclusion: National guidelines to manage GWG are inconsistently adopted by Australian midwives. Supporting midwives to better understand their role, engage with guidelines and recognise the importance of appropriate care is essential to embed GWG guidelines into routine antenatal care.<p></p>