MoreLife MUMS2B (expecting parents) and 4MUMS (new parents)

We aim to provide a service which is holistic, accessible and flexible for pregnant women and new parents. We promote participation and engagement with this population by practicing a person-centred approach to the design and delivery of our programmes.

We offer flexible ‘one to one’ appointments for women, delivering specific topics relevant to balanced health in pregnancy and successful postnatal weight loss. We deliver all our sessions remotely with the aim to promote accessibility for women and encourage active and motivated participation.

We also endeavour to provide consistency of care for patients by ensuring they are assigned to a single practitioner. All information is consistent with advice provided by their midwives.

Additionally, to avoid confusing patients with confliction or saturation of messaging, we also keep all our resources in line with current NHS messages and advice for obstetric populations.

We do all this with the aim to provide a service for women which works for them and suits their needs so that we can provide them with support to reduce the risks associated with excess weight in childbearing.

We wanted to provide a forum for non-judgmental support, in which women will be listened to and treated as individuals. In line with guideline PH27, our programme aims to help medical professionals address weight with pregnant women at the earliest opportunity.

The availability of the MoreLife service in the medical professional’s local area makes brief intervention easier for them, as they are able to refer the women to a free and specialist service. MoreLife has the time to listen to women in regular appointments, where we can promote balanced health behaviours during pregnancy and weight loss after giving birth.

Being able to dedicate time to speak with patients we can also ensure women have the support they need through signposting. This may be referral to our own postnatal service or signposting complex needs to dietitians and mental health services.

Also mirroring the aims of guideline PH27, the MoreLife Obstetrics programme was developed using evidence-based behaviour change techniques. The programme is psychologically informed, drawing on proven therapies such as cognitive behavioural therapy, acceptance and commitment therapy, mindfulness and motivational interviewing.

As an established company specialising in psychologically informed weight management intervention, we feel we have been best placed to develop an effective programme.

Excess weight in obstetric populations is associated with many negative health outcomes, for example, increased prevalence of gestational diabetes. Long term impacts include increased risk of type 2 diabetes and an increased likelihood of childhood obesity in the infant. Statistically, a BMI of 30 or above also increases the risk of miscarriage or stillbirth to 25%, along with being associated with recurrent miscarriage. All of which have long-term devastating impacts on women and families.

Weight management services for pregnant women and postnatal weight loss are limited nationwide. A body of research over the past decade indicates engagement with this population is the biggest challenge. Providers offering free services report poor outcomes relating to attendance and report to experience high dropout rates from patients. Research investigating engagement barriers with this population suggest women experience challenges attending multiple appointments in person, struggle to trust health professionals and become frustrated with conflicting health messages.

The current MoreLife programmes for pregnant and postnatal patients were created in line with a PhD project at Leeds Beckett University. Before designing and launching the programmes, evidence-based research was conducted alongside the execution of focus groups with both women and local health professionals, including midwives and obesity specialists from Public Health England. An evaluation of this data then drove the design and approach of the current programmes. The PhD project is ongoing, with the aim of continued work and data collection in this area to continue to promote best practice. Additionally, the MoreLife team is made up of multiple health professionals with relevant expertise, such as, a full clinical team of professors, clinical psychologists, health psychologists and dietitians who all contribute to the development and delivery of the programmes.

MoreLife’s programmes include MUMS2B for pregnant women and 4MUMS for women up to a year after giving birth. Both programmes are currently being implemented within a commissioned tier 2 public health service across Bedfordshire and Milton Keynes.

Key stakeholders of the programme include the local hospitals; Bedford Hospital Trust, Milton Keynes University Hospital and Luton and Dunstable Hospital. MoreLife works closely with both obstetric and dietetic departments at all these hospitals. **References available upon request.

The developed curriculum echo’s the advice of NICE guideline PH27, including sessions on balanced diets, physical activity and myth busting. With the guidelines in mind, MoreLife do not promote active weight loss in pregnant women, nor weigh the patients or report statistics on weight. Measurable outcomes for pregnant women include participation in the programme and feedback provided by the women after they have participated in the programme. A tool is also used to monitor the participants’ wellness scores, comparing self-reported scores, pre and post intervention.

Consistent with NICE advice for women after giving birth, MoreLife commence monitoring of weight in our postnatal intervention, promoting sustainable and realistic postnatal weight loss. With the aim to reduce the common build-up of weight women experience when having multiple pregnancies. Therefore, MoreLife’s 4MUMS programme for postnatal weight loss also considers factors relating to weight loss prior to conception.

As previously described, a significant identified challenge to delivering a successful programme for obstetric populations is engagement and participation. Historically, programmes for weight management may include weekly group sessions including physical activity while adopting a health educational approach.

MoreLife wanted to take the opportunity to empower the women to have some control over their own attendance. Our approach is completely flexible, allowing the practitioner and woman to decide on meeting times and regularity together. Also allowing the women to tailor her own content and curriculum to ensure they are access the information most important to them and their family. This is achieved by offering them a selection of session topics and using therapeutic skills such as listening and motivational interviewing to identify the women’s preferred programme structure.

Another challenge we faced in the design and implementation of the programmes was the limited budget of the local public health contract, along with responsibilities to deliver on additional interventions within the same budget. Therefore, the programme was developed with very modest financial input. MoreLife were able to commit internal staff resources to the project including the professional time of the clinical team, weight management leads, marketing coordinators and operations staff. Due to the success of the programme on this scale, MoreLife are excited to continue work in this area.

As a programme, our outcomes have become a reflection of the hard work and consideration that went into programme development. A benefit of the development stage was the collaboration with local health professionals that facilitated the building of relationships between MoreLife and local key stakeholders.

The health professional’s role in the development stage promoted a feeling of ownership for them in the MoreLife programmes. We also spent time to explain to participants of the focus groups how their feedback contributed to the final design. We are happy to report 80% of our patients were referred to us by midwives, we celebrate the emerging relationships between ourselves (the service provider) and these important health professionals.

We have built strong referral pathways with local hospitals and primary care and are seeing rates of women referred increase each month since the launch. These relationships with trusted health professionals have been a key priority for the MoreLife team, ensuring to also feedback outcomes to local teams of midwives. This allows them to know what is happening to their patients once a referral to MoreLife has been made. 77% of the women who are directed to us by a health professional have engaged with our term and most have these have taken up the offer to participate in one of our programmes.

Furthering this, 60% of the women who have started a MoreLife MUMS2B programme, have finished it. We are excited to see more and more women engage with us and go on to receive support from our team. After birth, almost half of the women who have completed a MUMS2B programme in pregnancy have taken us up on the offer to participate in our postnatal weight loss programme, so far.

We have received positive feedback from women who have taken part in the programmes, below are some examples demonstrating they found the programmes flexible, accessible and supportive:

1. "I found the sessions helpful as they made me accountable for my diet. They also made me more aware of the choices I make to ensure a healthy pregnancy and baby".
2. "Naz was very good, she was knowledgeable about the subjects and she was very keen to help. She was able to empathise and she was very helpful".
3. "Sarah was very accommodating and happy to work around me which I appreciated as I also have a toddler. She was very friendly and positive".
4. "Overall lovely experience and I look forward to hopefully taking part in the postpartum programme as well".

One of the key things learnt from this project was the importance and power of going out and listening to people. The success of the programme design was possible with the input of multiple individuals involved in the world of obstetrics, either personally or professionally. The adaptability of the programme has also allowed us to launch the programmes in a further two of our commissioned contracts, Greater Manchester and Suffolk.

This was possible with limited resources and we can only imagine what success we could achieve in this area if provided with the opportunity. MoreLife was proud to be approached and asked to attend working groups across the North West and North East of England. These working groups focus on tackling the challenge of excess weight in obstetric populations.

It has been a pleasure to attend these groups and offer our support to multiple Local Maternity Systems who are involved in the project. We have also been accepted by the British Dietetics Association as an example of good practice when working with this population and will be shooting example videos for dieticians to use as a training tool. We are excited to continue our work, collaborating with other networks in health to ensure obstetric populations are supported in this area.