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Learning Objective 1: The learner will be able to recognize the risks associated with excessive weight gain in pregnancy and the need for change in our current practices.
Learning Objective 2: The learner will be able to understand how group prenatal care was implemented and what tools were used to optimize prenatal weight gain.
Group prenatal care was adapted to assist women in maintaining weight gain within the 2009 Institute of Medicine (IOM) Prenatal Weight Gain Guidelines.
Significance/Background:
Women who gain excessively in pregnancy have increased risk for macrosomia, gestational diabetes, hypertension, prolonged labor, instrumental birth, shoulder dystocia, cesarean birth, lactation complications, and raising obese children. Weight gain within IOM guidelines lowers risk for complications and childhood obesity.
Project Description:
Over four meetings, registration and scheduling for group meetings was developed, group meeting space was reserved, and medical assistants were prepared for group prenatal visits. Referrals come from nurse-midwives and obstetricians. A CNM organizes and facilitates the group.
Women of any pregravid weight without chronic disease and under 20 weeks gestation are eligible for group participation. Women are given a detailed personalized nutrition plan from the MyPyramid.com website. They plot weight gain at each visit and set a goal for the next month. A physical therapist discusses physical activity in pregnancy. A lactation consultant presents the benefits of breastfeeding in return to pregravid weight. Group size is limited to eight women with similar due dates.
Findings/Outcomes:
Six groups are currently in progress with an average of 5 participants. We are continuously recruiting for new groups. Members have used techniques learned in group although weight management is still challenging. Group members have gained within IOM recommendations or have slowed weight gain when excessive.
Leadership Journey:
Creating change through this project has required me to build on personal strengths such as modeling the way to recruit participants, enabling others to suggest changes and recognizing contributions. Challenging the current process and inspiring a shared vision required me to work outside of comfort zone and was more of a personal stretch. The journey has included many ups and downs but always with a sense of moving forward.
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