Thursday, July 15, 2010
Weight gain during pregnancy
This blog is more in relation to a trend that I noticed during my OB rotation. I got to spend one day in L&D during my rotation, and that day I got to assist the midwife with a vaginal delivery. It was surprising that this mom was able to push this baby out on her own, since the baby weighed nearly 11 pounds. After the delivery I was talking to the midwife who told me that this woman had gained 100 pounds during her pregnancy. I nearly fell out of my chair! As I continued through my OB rotation, I began noticing that many of the women we saw were far above their optimal weight gain for their pregnancy. I would guess that nearly 50% of our patients were above their recommended weight gain. All of the preceptors that I worked with talked with their patients about their recommended weight gain, but it was almost like a side note. I didn't hear anyone talk about the possible side effects of gaining too much weight during pregnancy or having an 11 pound baby. I know obesity is a problem in our country and it will no doubt seep into the obstetrics world as well. But I truly wonder if these families know the risk they are putting themselves and their babies in. This is definitely a tough issue, because there is no easy way to talk with patients about being overweight. However, I feel like we are doing these patients a disservice if we don't address it.
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During my clinical rotation I did not encounter any patients that had as significant weight gain as this. However, I did notice how difficult it was to approach this subject with mothers that were bordering on too much weight gain in their pregnancies. It was uncomfortable for them and for me and my preceptor but what I found that most of them already knew they were pushing it. We discussed the excessive empty calorie snacking and not "dieting" in the pregnancy. I believe most women think that weight gain is a right of passage that goes along with pregnancy but have not been educated on the dangers during gestation as well as the potential increased risk for obesity for the child later in life. The common thread is that most mothers want what's best for their children and it's up to us to educate our patient populations and communities in laying this foundation before birth.
ReplyDeleteDuring my clinical rotations, I also noticed that most of our patients were gaining an excessive amount of weight. Usually by the 24th week, some patients had gained more than 50 lbs. I did note that to my preceptors, but as long as the fundal height was consistent and FHTs were okay, they were not too concerned. They would occassionally mention how much weight gain was recommended, but there was never an active plan to manage the weight. On the other hand there really wasn't any time during the appointment to thoroughly discuss dietary habits (15 min appts). We did give a couple of patients dietary consults, but one was for an underweight patient and pregnant teenager. I do agree though, that even with the limited appt time, most moms would appreciate knowing what they can do to make a better outcome for their children, and we should as providers make a stronger effort to include dietary guidance.
ReplyDeleteHooah, Ooh Rah, to all great USUHS GSN FNPs-AND my great preceptor. When counseling all our OB patients we reviewed weight changes with pt and then discussed "not eating for 2" (had to re-educate several vs mom and grandma's old-style "home advice"), and just needing that extra "1 sandwich per day", and when needed pt's were referred early to nutrition for further counseling/education. We also identified those pt's not gaining (a few actually losing?!) weight and discussed increasing (healthy) caloric intake (protein shakes/Q 2hr healthy snacks) and also referred them to nutrition early.
ReplyDeleteHave also learned that there are many good things I have learned from my preceptor(s) that I will incorporate into my practice as an FNP and there are some "other things" I will not be be using in my practice-I am learning the good/best practice skills and "filing away" the rest (of lessons learned) in order to provide high quality excellent primary care for my patients.