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Objective Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women's values and beliefs related to weight, nutrition and physical activity during pregnancy and to describe how these beliefs influence their behaviours. Methods As part of a larger randomized controlled trial, we conducted 20 focus groups with 66 pregnant women between 16 and 24-weeks gestation using a semi-structured interview guide. Focus groups were recorded and transcribed verbatim and analyzed using a grounded theory approach. Results Three personal health schemas emerged from the findings which illustrated women's diverging beliefs about their health behaviours in pregnancy. 'Interconnected health' described beliefs regarding the impact their health had on that of their growing baby and awareness of risks associated with inappropriate weight gain. 'Gestational weight gain as an indicator of health' illustrated perceptions regarding how GWG impacted health and the utility of guidelines. Finally, 'Control in pregnancy' described the sense of agency over one's body and health. Conclusions for Practice Our results showed that health-related behaviours in pregnancy are driven by personal health schemas which are often discordant with clinical evidence. Interventions and health care provider advice aimed at behaviour modification would benefit from first understanding and addressing these schemas. Tackling the conflict between beliefs and behaviour may improve health outcomes associated with appropriate weight gain in pregnancy., Author(s): Beth Murray-Davis [sup.1] , Lindsay N. Grenier [sup.1] , Stephanie A. Atkinson [sup.2] , Michelle F. Mottola [sup.3] , Olive Wahoush [sup.4] [sup.5] , Lehana Thabane [sup.2] [sup.6] [sup.7] [...]

Background: Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation. Methods: We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada. The survey contained validated measures of satisfaction including personal capacity and participation; perceived safety, control, and security; professional support; and satisfaction. Descriptive statistics and tests of significance were completed in SPSS. Results: A total of 193 responses were included in our analyses (pre-AMU n = 47, post-AMU n = 146). All participants had positive experiences in the four domains assessed. Compared to those who gave birth with midwives on the Labour unit, those who gave birth on the AMU indicated more positive experiences for some measures. Perceptions pertaining to being an active participant in care, to security and sense of control were more positive among those who gave birth on the AMU. Conclusion: The AMU in Ontario is associated with high levels of satisfaction during birth, particularly the perception of being actively engaged in decision making, having a sense of control and safety, and having confidence in the care provider team. Care received on the AMU does not compromise birth experiences or satisfaction and may be associated with greater autonomy and agency for the person giving birth. [ABSTRACT FROM AUTHOR]

Background: Canada's first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people's experiences. Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where "making space" for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction. [ABSTRACT FROM AUTHOR]

Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition and physical activity during pregnancy and to describe barriers and facilitators experienced in implementing physical activity and nutrition recommendations. In a substudy of the Be Healthy in Pregnancy randomized trial, 20 semistructured focus groups were conducted with 66 women randomized to the control group when they were between 16 and 24 weeks gestation. Focus groups were recorded, transcribed verbatim, coded and thematically analysed. The results indicate that women felt motivated to be healthy for their baby, but competing priorities may take precedence. Participants described limited knowledge and access to information on safe physical activity in pregnancy and lacked the skills needed to operationalize both physical activity and dietary recommendations. Women's behaviours regarding diet and physical activity in pregnancy were highly influenced by their own and their peers' beliefs and values regarding how weight gain impacted their health during pregnancy. Pregnancy symptoms beyond women's control such as fatigue and nausea made physical activity and healthy eating more challenging. Counselling from care providers about nutrition and physical activity was perceived as minimal and ineffective. Future interventions should address improving counselling strategies and address individual's beliefs around nutrition and activity in pregnancy. [ABSTRACT FROM AUTHOR]