Enhancing Postpartum Health With Dietitian Video Consultations

By Lily Mercer

Postpartum women require a considerable amount of healthcare in the months following childbirth. In addition to attending to basic medical needs, it is also important that postpartum women optimize their weight status. Returning to a healthy weight after pregnancy can positively influence lifelong weight status, chronic disease risk, and offspring health.

Managing Weight After Pregnancy

While most women realize the importance of returning to a healthy weight after pregnancy, many are overwhelmed with responsibilities during the postpartum period. Numerous barriers to healthcare and nutritional support exist during this complex time. Having to see a specialist requires a new mom to travel and also find childcare for her newborn. The complex life circumstances that occur after childbirth make it difficult for women to receive the support they need.

These barriers to care can impede a woman's ability to manage her weight after pregnancy. A recent study from the UK found that 73% of women retained some weight at 6 months postpartum. Additionally, an Australian study found that 77.5% of women were above their pre-pregnancy weight at 6 months postpartum and 67.5% of women were above their pre-pregnancy weight at 12 months postpartum.

Overcoming Barriers To Postpartum Care

A study published in 2018 sought to establish a solution to these care barriers. The study examined the use of video consultations as a means of helping women manage their weight after childbirth. The authors hypothesized that telehealth would have the potential to override the limitations that make it difficult for women to return their pre-pregnancy weight. Their goal was to deliver remote care interventions to women after pregnancy in order to provide them with the care they need during this complex time.

The study intervention consisted of individualized video consultations with a dietitian and an exercise physiologist. The goal of the consultations was to drive behavioral change and positive lifestyle modifications among the postpartum women.

The authors of the study specifically explored video conferences as the mode of care delivery because they felt video would best mimic in-person consultations. They also hoped that the ability to take part in remote care would be more convenient for women during this period.

The study participants included 30 postpartum women 3-12 months after childbirth. All participants took part in an 8-week intervention that included up to 5 video consultations with a dietitian and an exercise physiologist. In order to be eligible for the program, the women needed to have a postpartum BMI ≥ 25 or a > 2 kg weight retention from their most recent pregnancy.

Technology Enhances Postpartum Health

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The five video consultations included two consultations with the dietitian, two consultations with the exercise physiologist, and one optional consultation with either practitioner. Each participant was provided with an iPad for video conferences, a resistance band, and a physical activity tracker. Participants were also asked to fill out the Australian Eating Survey Food Frequency Questionnaire as well as complete a 3-day image food journal that the dietitian would use to deliver individualized nutritional counseling.

After completion of the 8-week program, the researchers interviewed the participants over the phone about their experiences with the video interventions. The researchers aimed to gain insight into the women's experiences of the video consults by asking about their motivations and expectations for participation in the program, their experiences with the mode of delivery, and their perceptions of the components of the program.

Upon analyzing the qualitative results, the researchers identified specific themes among the the participants’ reports. The majority of women expressed that their motivation for participation stemmed from their desire to lose the weight they had gained during pregnancy. They felt that the program would arm them with the proper knowledge and skills to lose weight, while also providing the necessary motivation and accountability to keep them on track.

Common expectations for the program included that the content should be well delivered and appropriate for mothers of young children. Additionally, they were hoping that the program would instill confidence in their ability to take control of their health.

With regards to the mode of delivery, the participants expressed that they preferred video conferencing over standard in-person consultations. This was largely due to the convenience of being able to conduct these consultations at home.

Lastly, the participants were asked about the timing and frequency of the video consultations. They found the consultations to be of appropriate length and they appreciated the flexibility of scheduling the consultations. However, they did express that they would have liked an increased frequency of sessions.

Overall, the majority of participants expressed that they were more confident in their ability to manage their weight. Some participants even expressed that they felt better equipped to handle weight challenges in the future as a result of participation in the program.

Capitalizing On Digital Integration

This study demonstrates the power of video conferencing as a means of reaching patients with unique life circumstances. It is often the fear of healthcare providers that technology will erase the human aspect of care. This study proves the contrary. The participants did not think the video consults compromised the integrity of their care - in fact, they found them preferable.

The results of this study can be generalized to many patients and a wide variety of care practitioners. The increasing availability of technology and Internet connectivity grants healthcare providers endless opportunities to reach more patients with more services. There are countless patients who would benefit from receiving care in the home and there are many care providers who can capitalize on video technology to deliver speciality services. Patient care models that capitalize on digital integration can deliver high quality care to patients, regardless of their life situations and geographical locations.

 

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References:

Vincze L, Rollo ME, Hutchesson MJ. Postpartum Women’s Perspectives of Engaging with a Dietitian and Exercise Physiologist via Video Consultations for Weight Management: A Qualitative Evaluation. Healthcare (Basel). 2018 Jan 19;6(1).

Martin, J.E.; Hure, A.J.; Macdonald-Wicks, L.; Smith, R.; Collins, C.E. Predictors of post-partum weight retention in a prospective longitudinal study. Matern. Chil. Nutr. 2014, 10, 496–509.

Hinman, R.S.; Nelligan, R.K.; Bennell, K.L.; Delany, C. “Sounds a bit crazy, but it was almost more personal”: A qualitative study of patient and clinician experiences of physical therapist-prescribed exercise for knee osteoarthritis via Skype™. Arthritis Care Res. 2017, 69, 1834–1844.

Lawford,B.J.;Bennell,K.L.;Kasza,J.;Hinman,R.S.Physicaltherapists’perceptionsoftelephone-andinternet video-mediated service models for exercise management of people with osteoarthritis. Arthritis Care Res. 2017.

Burns, C.L.; Ward, E.C.; Hill, A.J.; Kularatna, S.; Byrnes, J.; Kenny, L.M. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. HeadNeck 2017, 39, 932–939.

 

Tags: telehealth, remote patient monitoring, communication, introducing telehealth, postpartum, video conferencing

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