“If she wants to eat…and eat and eat…fine! It's gonna feed the baby”: Pregnant women and partners' perceptions and experiences of pregnancy with a BMI >40 kg/m 2

Abstract

A B S T R A C TIntroduction: women with a raised BMI are more likely to gain excessive weight in pregnancy compared to women with a BMI in the normal range. Recent behaviour change interventions have had moderate to no influence on GWG, and no effect on other perinatal outcomes. Evidence is required regarding the social and cultural contexts of weight and pregnancy. No studies to date have included the views of partners. Aims: to explore the experiences, attitudes and health-related behaviours of pregnant women with a BMI > 40 kg/m 2 ; and to identify the factors and considerations which shape their beliefs, experiences and behaviours, and how these may change during and after pregnancy. 2. To determine the impact, if any, of the beliefs and attitudes of significant members of the women's families and social networks upon the women's experiences, attitudes and health-related behaviours in relation to weight and pregnancy Methods: this was a prospective serial interview study. Semi-structured interviews were conducted with 11 pregnant women with a BMI > 40 kg/m 2 , during pregnancy and after birth, and once with 7 partners (all male) of women. Interview questions were designed to be appropriately but flexibly framed, in order to explore and gather data on participants' everyday life, lifestyles, views, experiences, relationships and behaviours, focussing more specifically on beliefs about health, pregnancy, weight and diet. Thematic content analysis was used to formally analyse and unearth patterns in the data. Findings: the findings can be grouped into six interrelated themes: the complexities of weight histories and relationships with food; resisting risk together; resisting stigma together; pregnancy as a 'pause';receiving dietary advice; postnatal intentions. These themes are interrelated due to the 'spoiled identity' (Goffman, 1963) that the large body represents in western culture and related stigma. Conclusion and implications: this study provides evidence that there exist deeply ingrained social and cultural beliefs among women and in particular their partners, regarding pregnancy diet and weight gain. Further, this study provides evidence that male partners may resist stigmatised risk on behalf of a pregnant partner. All women (and several men) expressed an intention to adopt healthy behaviours and lose weight once their baby was born. Further evidence is required regarding the means by which women who experience stigmatised risk during pregnancy, and their partners, might be engaged and receptive to health advice. Models which draw on ideals of relationship-centred care, and selfefficacy via open discussion with women and families, engaging women and partners by providing them with an opportunity to talk about their beliefs and concerns, could be explored to inform future research and practice.

Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change

“…21 Although extant research describes pregnancy as a motivator for behavior change, 18 our participants perceived pregnancy as a refuge from weight shaming. This finding is consistent with reports from small qualitative studies among pregnant women with obesity 14,15 and supports assertions that weight stigma increases obesity risk 22 by, in this case, thwarting motivation for behavioral change.…”

“…10 The effectiveness of these interven-tions in pregnant women who are obese is less clear, however, because extant GWG intervention and qualitative studies typically combine results from obese and overweight women, thus obscuring results and perceptions specific to women with obesity. 9,[11][12][13] Only 2 recent published studies focus solely on GWG perceptions of women with prepregnancy obesity, including one conducted in the United Kingdom (n = 11) 14 and one in the United States with participants from African American and Hispanic racial and ethnic groups (n = 16). 15 Women with obesity may respond differently to lifestyle interventions because of their distinctive demographic, physiologic, and psychological makeup.…”

Health policy and its unintended consequences for midwife-woman partnerships: Is normal pregnancy at risk when the BMI measure is used?

“…Further, such approaches as those referred to above, serve to heighten anxiety and increase weight-based stigma (Lindhardt, Rubak, Mogensen, Lamont, & Joergensen, 2013;Mills, Schmied, & Dahlen, 2013). Emerging evidence supports the view that focusing on healthy lifestyles rather than on gestational weight is likely to be more effective (Keely et al, 2017;Smith et al, 2015). For example, in her study of women's lived experiences of co-existing BMI >30 and gestational diabetes mellitus, Jarvie (2017) found women sought less directive, more collaborative care.…”

“…In common with biomedical approaches to weight management, the emphasis on "one size fits all" (Hill et al, 2017) seeks standardised care pathways, neglecting the multiple contexts within which women exist (Keely, Cunningham-Burley, Elliott, Sandall, & Whittaker, 2017). The International Confederation of Midwives (ICM; 2017a) argues that the provision of maternity care that is service-centred rather than woman-centred can contribute to the medicalisation of pregnancy and childbirth.…”

Tackling maternal obesity: Building an evidence base to reflect the complexity of lifestyle behaviour change

“…The paper by Keely et al (2017) offers a unique and novel exploration of the experiences of obese pregnant women and their partners. This UK based study illustrated that couple's views were similar, but not concurrent with healthy lifestyle advice.…”