RESUMO
BACKGROUND: Overweight and obesity have multiple negative consequences for the health of both the mother and the child. Interventions to prevent excessive weight gain during pregnancy have had varying success, and the proportion of pregnant women who exceed national guidelines for weight gain continues to increase. OBJECTIVE: To investigate the impact of factors on weight management among pregnant women with overweight or obesity METHODS: This meta-synthesis of qualitative studies involved searching databases PubMed, Embase, Cochrane, Scopus, and Web of Science. The databases were searched on October 4, 2022 and the search was updated on April 21, 2023. The screening of titles, abstracts, and full texts was conducted utilizing the Covidence software. The quality assessment of the articles was performed using the Critical Appraisal Skills Programme (CASP) checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement was used to enhance transparency in reporting. A meta-aggregation approach was used to guide the data extraction and synthesis. RESULTS: A total of forty-six studies with appropriate CASP scores were included for qualitative synthesis. Findings were extracted and integrated into four themes: psychological factors (personally-driven negative emotions and society-driven negative emotions.), social factors (societal attitudes and beliefs and social support resources), factors related to education and counseling (information provision and communication), and factors associated to effective care (provided care components and the method of providing effective care). CONCLUSION: To improve weight management during pregnancy, health care professionals should provide tailored and individualized recommendations that take into consideration the factors influencing these women.
RESUMO
Background: In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP. Methods: In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria. Results: Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education. Conclusion: Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.