The attending physician, midwife, or nurse should be capable of providing the basic nutritional care measures identified in Chart 3-1. Contacts with a dietitian are encouraged because these health care providers are specially qualified to provide a full range of nutrition services—including the extensive assessment, individualized diet modifications, or other specialized approaches required for a number of nutrition problems. In many instances dietitians are neither members of the obstetrical practice nor on site in the care delivery setting. Thus, it is essential to have a method for identifying women who need special nutrition services and referring them to a dietitian. If referral is not possible because of transportation barriers or other obstacles, alternative methods of consulting with the dietitian should be arranged.
Through in-service or continuing education programs, dietitians can assist health care team members with the basic nutritional care activities listed in Chart 3-1. This is especially important if a dietitian will not be directly involved in the care of women with gestational diabetes mellitus or lactose intolerance. Dietitians can also provide guidance concerning appropriate nutrition education materials for use in waiting rooms, prenatal classes, parenting classes, hospitals (e.g., on closed-circuit television), or other venues.
The effectiveness of nutritional care may be substantially increased by an expanded health care team that provides outreach activities, home visits, and streamlined services, or that uses other strategies to increase the utilization of prenatal care by disadvantaged women. 8 Such activities involve visiting nurses, social workers, dietitians, case managers, trained community health workers, peer counselors, and others.9
The support of breastfeeding needs special attention. Because breastfeeding support has not been a standard part of the curriculum for health care providers, the provider who is best qualified in a particular setting is likely to be one who has participated in a program that provides specialized training and guided experience. (For more information about breastfeeding support, see Chapter 4.)
If none of the health care providers in a particular setting is bilingual, trained interpreters should be available by special arrangement to assist with assessment, counseling, and educational activities for patients who are uncomfortable communicating in English. Often, community health workers can be trained to provide this service. With proper training, such workers may also perform a variety of outreach activities and other services for expectant and new mothers (see, e.g., Tindall 10).