Optimal Bariatric Obstetrical Care: Investigating Existing Practices and Women’s and Health Care Providers’ Perspectives Helen Brown RN, PHD, Amy Cronmiller RN, MSN & Jenna Baumgartner RN, BN, IBCLC Background: • The incidence of obesity* has spread to almost every demographic group in industrialized nations, the health-associated impacts indicate that obesity is one of the greatest public health challenges in the 21st century. • For childbearing women, the need to reduce fetal and maternal risks and facilitate positive outcomes is giving rise to a new medical specialty, which is referred to as “bariatric* obstetrics.” • Data from the Community Health Survey estimate rates of obesity between 11 % and 21% for Canadian women of childbearing age, however, a paucity of information exists to describe the prevalence of obesity specific to the pregnant population. • Consistent with research and anecdotal evidence, and at St Paul’s Hospital (SPH) specifically, the issues of critical concern care to nurses in the Maternity Centre include the need to: (a)identify women in the antenatal period; (b)connect women with appropriate consultations; (c)generate effective and individualized care planning; (d)liaise across departments; and (e)ensure appropriate weight and size equipment for assessment and care during labour. • Given the paucity of research in the field of maternal obesity, specifically care during labour and birth, and the complexity and depth of the identified practice issues, there is a need for comprehensive study of existing practices and women’s and health care providers’ (HCP) perspectives. *Body Mass Index (BMI) is weight in kilograms divided by height in meters squared (kg/ m²). The Society of Obstetricians and Gynecology of Canada cite Canadian guidelines for appropriate BMI aligned with the World Health Organization’s categories for BMI classification. Obesity is defined as having a BMI ranging from 30-39.9 kg/ m² and morbid obesity is categorized as having a BMI of 40 kg/ m² or higher. *Bariatric patient is defined as anyone regardless of age who has limitations in health and social care due to their weight, physical size, shape, width, health, mobility, tissue viability, environmental access with one or more of the following area, BMI of 40 or exceed the work load limit and dimensions of the support surface, equipment or facilities (Southey, 2009).
Review of Relevant Literature: •During pregnancy, women who are obese are at risk for myriad maternal, fetal and negative neonatal outcomes on many levels simultaneously: Pre-existing physical condition Pregnancy Complications Labour and Delivery Complications and Management Postnatal Complications Psychological Risks •While studies exist to inform models of care and clinical guidelines for medical management of risk, there is a need for context specific data about what women need and what HCPs require to provide effective and safe care.
Purpose of the Study: •To generate knowledge to: • Inform optimal care* during labour and birth for women who have a body mass index of ≥ 40 •Develop interdisciplinary practice guidelines for Providence Health Care Maternity Centre. *Optimal care is defined as care that meets women’s physical and psychological needs to ensure healthy maternal and neonatal outcomes.
Methods: The research will be conducted using a qualitative design informed by the principles of Interpretive Description. The study will employ qualitative methods to collect and analyze retrospective data from women and Health Care Professionals during individual interviews. Data collection and analysis for investigating existing Canadian bariatric obstetrical practices will employ telephone interviews and document analysis.
Proposed Timeline: Steps
Timelines
Ethics Approval Advertisement/recruitment Phase 1 Data collection: Women HCP Transcription Research Team Meeting (Full day) -Data Analysis - Refine Survey Phase 2 Data Collection Maternity Centre phone in and document collection Transcription Data Analysis (Full Day) Practice guideline development Final Report development PHC Practice-Based Research Day
Oct 16-Nov 30, 2011 Dec 1-30, 2011 Jan-Feb 2012 Jan- Feb, 2012 March, 2012 April, 2012
May, 2012
June, 2012 Sept-Oct, 2012 Nov, 2012
Reality & Interim Insights: •As new researches our team has been fortunate to be mentored by Helen Brown, Assistant Professor, UBC Nursing School •Our team originally consisted of SPH’s Maternity Clinical Nurse Specialist (CNS), two RNs and one LPN. During the process of ethical application the LPN member resigned from the project, one RN took a leave of absence to pursue an overseas posting and the CNS is currently preparing for maternity leave. •The Ethical approval process has been lengthily and complex: •The original application was submitted in full June 11, 2012. After the submission of a number of provisos our team received full approval on Oct 19, 2012. •The provisos focused on potential conflict of interest concerns verses potential harm to the women participants. •Work to date: •Health Care Provider Focus Group is scheduled to meet Nov 6, 2012. •Interviews with women are currently ongoing. •Letters for participation to other health care centres have been sent.