A survey of the opinions, attitudes, and current involvement of UK dietitians in antenatal and maternity care services
Authors: McSherry C. , Belton E. A. 
Published: May 2009

Background:  Recent cutbacks in the NHS have led to the cancellation of antenatal services and closure of maternity beds in the UK (Healthcare Commission, 2007). This contradicts the standards set out by the Department of Health (2004). The aim of this research was to investigate the views of UK dietitians on the importance of maternal nutrition counselling and to assess the current provision of dietetic services in maternity care. Also explored were the views of dietitians on the Governments recently proposed Health in Pregnancy Grant, which provides payment to expectant mothers if they receive professional nutritional advice (Johnson, 2007).

Methods:  The survey method chosen was a postal questionnaire. A stratified sample of dietetic departments in hospitals with maternity units was undertaken, and 170 hospitals throughout the UK were selected. The questionnaire comprised two parts. Part one contained departmental questions directed towards the dietetic manager, whereas part two questioned the dietitian involved in maternity and antenatal care regarding service provision. Descriptive statistics, chi‐square analysis and nonparametric tests, including Kruskal–Wallis and Mann–Whitney, were carried out on the data. P < 0.05 was considered statistically significant.

Results:  The overall UK response rate was 45% (n = 76). Most dietetic departments (43%) reported providing 1–5 h month‐1 to maternity care; however, 27% reported allocating no specific time to these services. Seventy‐two percent of departments stated that there had been no change in dietetic provision to maternity care in the last 5 years, with 10% reporting a decrease. The majority (78%) of dietitians agreed that pregnancy was an ideal time to encourage dietary change, with 45% in favour of the Health in Pregnancy Grant. However, there were noted concerns regarding who was to provide this advice and funding. Dietitians felt that there should be extra funding for maternity services (77%) and more maternity and infant health dietitians (84%). Additional manager comments revealed that lack of funding allocated to this group was a key issue. Dietitians in multidisciplinary teams were more likely to have established referral guidelines (P = 0.02), be involved in training healthcare staff (P = 0.05) and have a larger caseload (P < 0.05).

Discussion:  The main limiting factor to increasing provision of dietetic service was funding, especially in providing a service for the rising number of obese and diabetic pregnant women. Overall, respondents were in agreement with the Health in Pregnancy Grant, and agreed that pregnancy was an ideal time for dietary education. Pregnant women have been shown to be motivated and receptive to advice (Szwajcer et al., 2005); therefore, this opportunity should be used by dietitians and other healthcare professionals to instil the importance of healthy eating during pregnancy, and where necessary advise on post‐natal weight loss or diabetic management.

Conclusions:  Dietetic respondents felt that maternal nutrition counselling was very important but that dietetic resources for specialist maternity services were inadequate; however, it was shown that multidisciplinary team working could be beneficial.

References Department of Health (2004) National Service Frameworks for Children, Young People and Maternity Services: Core Standards. London: Department of Health.

Healthcare Commission (2007) Women's Experience of Maternity Care in the NHS in England: Key Findings from a Survey of NHS Trusts carried out in 2007. Available at http://www.healthcarecommission.org.uk/_db/_documents/Maternity_services_survey_report.pdf (accessed on 17 November 2008).

Johnson, A. (2007) The Health Society – Speech in the House of Commons. Available at http://www.dh.gov.uk/en/News/Speeches/DH_078397 (accessed on 17 November 2008).

Szwajcer, E.M., Hiddink, G.J., Koelen, M.A. & van Woerkum, C.M.J. (2005) Nutrition‐related information‐seeking behaviours before and throughout the course of pregnancy: consequences for nutrition communication. Eur. J. Clin. Nutr.59, S57–S65.