Atkinson Sandra, McNamara Patricia Mannix
Department of Nursing and Midwifery, University of Limerick, Ireland.
Department of Education and Professional Studies, University of Limerick, Ireland.
Midwifery. 2017 Jun;49:54-64. doi: 10.1016/j.midw.2016.12.008. Epub 2016 Dec 16.
obstetric and midwifery literature continually emphasise incidence and consequence of obesity in pregnancy. However, they offer less consensus on how best to support women who are obese. Therefore, this study explores in depth the lived experience of women who have a Body Mass Index (BMI) ≥30kg/m². This exploration provides a bio-psycho-social understanding of the lived experience of women to identify how best to support them throughout their childbirth experience.
an Interpretative Phenomenological Analysis (IPA) design was adopted for this qualitative study. Purposive sampling of participants was conducted on the postnatal wards of a maternity hospital in the Republic of Ireland. In total, 15 participants volunteered to take part in semi-structured interviews conducted at six to ten weeks postnatally. Data were analysed utilising the IPA framework.
the results indicate that participants were conscious of the problematics of communicating obesity in pregnancy. The narrative data revealed an unconscious collusion between healthcare professionals and women as they navigate obesity related conversations. The behaviours related to unconscious collusion are incorporated in the sub-ordinate themes; 'just recorded and that's all', 'but what's eating healthy? 'pussy footing around' and 'I hate that word obesity.
the findings highlight a lack of information received by participants from healthcare professionals regarding increased BMI or weight management. The data suggests that healthcare professionals appeared to collude with women to avoid challenging discussions regarding obesity. This may be related to avoidance on participants' part and/or may be linked with healthcare professionals' reluctance to communicate issues relating to increased BMI. Although participants were generally unhappy with the communication skills of health professionals, they readily acknowledged the sensitive nature of obesity related communications. The findings provide healthcare professionals with an important insight into issues of effective communication and obesity related healthcare promotion from the woman's perspective in order to enhance provision of appropriate health information and maternity care to women who have an increased BMI.
妇产科文献不断强调孕期肥胖的发生率及其后果。然而，对于如何最好地支持肥胖女性，它们的共识较少。因此，本研究深入探讨了体重指数（BMI）≥30kg/m²的女性的生活经历。这种探索从生物-心理-社会角度理解女性的生活经历，以确定如何在她们的分娩过程中最好地支持她们。
本定性研究采用解释性现象学分析（IPA）设计。在爱尔兰共和国一家妇产医院的产后病房对参与者进行了目的抽样。共有15名参与者自愿参加产后六至十周进行的半结构式访谈。数据采用IPA框架进行分析。
结果表明，参与者意识到孕期肥胖交流存在问题。叙事数据揭示了医护人员与女性在处理与肥胖相关的对话时存在无意识的默契。与无意识默契相关的行为体现在以下从属主题中：“只是记录下来，仅此而已”、“但什么是健康饮食？”、“小心翼翼”以及“我讨厌肥胖这个词”。
研究结果凸显了参与者从医护人员那里获得的关于BMI增加或体重管理的信息不足。数据表明，医护人员似乎与女性达成默契以避免关于肥胖的挑战性讨论。这可能与参与者的回避有关，和/或可能与医护人员不愿交流与BMI增加相关的问题有关。尽管参与者总体上对医护人员的沟通技巧不满意，但他们也承认与肥胖相关的沟通具有敏感性。这些发现从女性的角度为医护人员提供了关于有效沟通和肥胖相关健康促进问题的重要见解，以便为BMI增加的女性提供适当的健康信息和产科护理。
