1. Dr Christine Furber School of Nursing Midwifery & Social Work
An exploration of the psychosocial experiences of obese women during childbearing
Dr Christine Furber
School of Nursing Midwifery & Social Work

2. Latest estimates:
England has one of highest prevalence rates of obesity in adults around the world
Estimates indicate that 24% of > 16 year olds are obese in England
Around 25% of women in England are obese
Overweight prevalence seems static but obesity is increasing
2.9% of women are morbidly obese
Source: NHS Health Profiles 2007, National Statistics 2008

3. 1980 – around 8% of women were obese and 6% of men
Overall trends:
Forecasts from ‘Foresight Modelling future trends in obesity and the impact on health 2007’(McPherson et al 2007):
Estimated that by 2050, 50% of women will be obese along with 60% of men NB
1980 – around 8% of women were obese and 6% of men

4. Maternal risks of obesity :
Latest CEMACH report (Dec 2007):
Of the 231 women who died who had their BMI recorded, 45 were obese and a further 19 were morbidly obese.
‘Obesity trajectory’ – women find it hard to lose weight after giving birth and so weight gain continues slowly until middle age – risks of heart disease and diabetes

5. An exploration of the psychosocial experiences of obese women (those with a body mass index greater than 35) during the childbearing process.
A qualitative study design using a framework analysis method for data analysis.
Women were interviewed in the third trimester of pregnancy and again, 4 – 6 weeks after the birth.

6. Semi structured interviews that explored ….
In the third trimester of pregnancy:
Feelings about weight, experiences thus far, reactions from health professionals, family etc, expectations of weight gain now that they are pregnant and exploration of any plans to lose weight in the future

7. Postnatal interviews explored
4-6 weeks after the birth
Birth experience, feelings about weight now, any worries about weight, eating and exercise patterns after the birth, plans to lose weight, desires to help lose weight, improvements to services for obese women, experiences with health professionals and advice and support given about losing weight.

8. Recruitment to the study:
At the study site, obese women with a BMI greater than 35 were offered a glucose tolerance test at 28 weeks of pregnancy.
Women attending the clinic were invited to take part in the study by the health professional in attendance .

9. Recruitment process:
57 information packs about the study were taken away by women.
26 women responded and were happy for the researcher (CF) to contact them.
19 women subsequently agreed to take part in the study.
18 women were interviewed during pregnancy and 18 women were interviewed after the birth
(Two women were interviewed once – one during pregnancy only and one after the birth only)
Recruitment took place between beginning of November 2007 and end of July 2008.
Interviews complete end of October 2008

10. Characteristics of 19 women interviewed
BMI ranged from 34.6 – 54
Age from years
Physical complications reported include:
Gestational diabetes (3), Hypertension (3),
Reduced mobility (7), severe nausea / vomiting (5), preterm birth at 29 weeks (1)

11. Mode of birth ►Emergency CS 4 ►Elective CS 4 ►Ventouse birth 2
►Normal birth with
Complications 3
►Normal birth and no
Complications 6

12. Five stages of data analysis
Familiarisation
Identifying a thematic framework
Indexing
Charting
Mapping and interpretation

13. Weight profile of participants
Women interviewed rarely weigh themselves (or weighed by health professionals) but perceive that they put on little weight during pregnancy
PN – majority not weighed but thought they were at pre-pregnancy weight at time of interview
Most had changed eating habits somewhat during the pregnancy
PN – some maintained ‘healthy eating’ but others reverted back to habits from pre-pregnancy
Activity levels limited in pregnancy due to back / joint pain
PN – many had increased walking

14. Reasons for their BMI being high
Stopping smoking
Previous pregnancies
Good living / lifestyle
Feeling comfortable now have a partner
Serial dieters – tried lots of diets in the past.
Grazing all day because of a tendency not to eat three main meals each day

15. Perceptions of health professional care
Mixed reports – supportive to feeling victimised
Dietary advice related to safety of food, not related to healthy eating now pregnant
Care focussed on medical screening rather than supportive and being helpful about eating / exercise
AN – focus on epidural which was not forthcoming in labour
Feeling stressed by the amount of attendances at the hospital – GTT, see anaesthetist, scans for fetal size

16. Attitudes towards losing weight in the postnatal period
►Strong desire to lose weight and change lifestyle
(Several had already started)
►Some conflicts with diet and breastfeeding

17. Psychological issues reported
Body image – disappointment if not recognised as being pregnant
Anxiety – about developing diabetes, giving birth to a large baby
Feeling isolated – stigmatised by being overweight

18. Some implications for clinical practice
More recognition of the psychosocial aspects of being obese and pregnant – women know they need to lose weight but want appropriate support, not to be blamed
Improved information about weight gain and healthy eating / exercise during pregnancy from health professionals

19. Implications for clinical practice continued …
Be aware of communication especially during antenatal care when assessing fetal growth and size
►Midwives
►Ultrasongaphers

20. Thank you for listening!
Thanks to the School of Nursing Midwifery & Social Work for funding this study
Thanks also to Dr Linda McGowan and Professor Karina Lovell for their continued support