Working with women with at risk pregnancies in the Greater Montreal Area in order to reduce instances of low birth weight in babies was the goal of the Montreal Dietary Dispensary. To meet this goal, a method of nutritional intervention known as the Higgins Method was designed and implemented at the dispensary by counselors after receiving intensive training and months of supervision. A four-step process, this intervention started by assessing a client’s nutritional status around the fifth month of pregnancy. Based on this assessment as well as additional factors such as physical, financial, and emotional circumstances, counselors would offer clients deemed high risk an initial home visit, at which point living conditions would be reviewed and factored into the client’s personalized intervention plan. After the initial assessment and home visit was completed, a dietician would then create a nutritional prescription for the client ensuring that they would be able to receive adequate nutrition for themselves and their unborn child. This prescription was given to the client along with dietary education and support provided by the counselor. To minimize resistance to the plan and increase motivation to change, diets were designed to introduce as few changes as possible, and when discussing the plan with the client, counselors framed messaging in a way that emphasized that the fetus was an individual with real needs that only the mother was in a position to meet. To minimize guilt around the increased consumption of food, the “building of a baby” was compared to the “building of a house” and financially disadvantaged clients were given vouchers making key items like milk, eggs, and minerals easier to obtain. Once the nutrition plan was implemented, ongoing supervision was achieved through one-on-one meetings held every two weeks. At these meetings, eating habits were reviewed, the mother’s weight was recorded, and successes were celebrated. Visits to the Montreal Dietary Dispensary for these meetings also gave mothers the opportunity to be entered into monthly prize drawings, access to knitted baby wear, and hair styling sessions donated by volunteers to alleviate stress. To ensure clients could make scheduled meetings, childcare and transit passes were provided as needed. In the event a meeting was missed, counselors would reach out to the client expressing concern and either offer to schedule another appointment or visit the client at home. This methodology was successful in keeping program dropout rates as low as 5%, and in addition to seeing a reduction in medical problems, the Dispensary saw 27-50% reductions in the number of low-birth-weight babies born to clients.
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