Senior Lecturer in Midwifery, School of Nursing and Midwifery, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
Professor in Perinatal Health, School of Nursing and Midwifery, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
Midwifery. 2023 Dec;127:103826. doi: 10.1016/j.midw.2023.103826. Epub 2023 Sep 12.
The prevalence and complications of maternal obesity are well reported; with a hegemonic medicalised view leading to women's pregnant bodies being 'managed'. We aimed to address current knowledge gaps by exploring the literature across research traditions and overtime to better understand the experiences of maternity care for women living with obesity, in relation to choice, consent and control.
A systematic review using meta-narrative methods. Identification of studies included a scoping phase involving experts, hand searching and database browsing and a systematic searching phase. Seven databases (MEDLINE, MIDIRS, CINAHLComplete, Scopus, SocINDEX, PsycINFO, SPORTDiscuss) were searched with no date or geographical restriction. Non- English language studies were excluded. Two authors appraised quality prior to data extraction and synthesis. Data were tabulated, and women's experiences conceptualised in relation to choice, consent and control, first, by research tradition to reveal the unfolding storyline, secondly emergent narratives were synthesised into meta-themes.
Twenty-four studies were included, from six research traditions. Of these, twenty-one were qualitative, two were quantitative, and one study utilised a mixed method design. Studies spanned twenty-six years from 1994 to 2020. Across research traditions, four themes were evident, 'women's beliefs and experiences of weight', 'social determinants', 'being risked-managed' and 'attitudes of caregivers'. Over time, management of maternal obesity has moved from a focus on weight gain and diet as a woman's issue, to weight being pathological resulting in increased medicalisation, to a renewed focus on lifestyle through the public health arena. It suggests that lack of choice over care can reduce women's perception of control over their pregnancy and birth experience.
Increased medicalisation of maternal obesity, which includes defining and managing weight as pathological can limit women's choice and control over their maternity care. There is a need for national and local policy development which includes women in the process. It is important that women's views are heard, understood and acted upon so that a balance can be achieved, avoiding over medicalisation, yet ensuring mortality and morbidity risks are minimised.
母体肥胖的流行和并发症已有大量报道；主导的医学观点导致孕妇的身体被“管理”。我们旨在通过跨研究传统和随时间探索文献来解决当前的知识空白，以更好地了解肥胖女性在生育护理方面的体验，包括选择、同意和控制。
使用元叙述方法进行系统评价。研究的确定包括一个涉及专家的范围界定阶段、手动搜索和数据库浏览以及一个系统搜索阶段。七个数据库（MEDLINE、MIDIRS、CINAHLComplete、Scopus、SocINDEX、PsycINFO、SPORTDiscuss）进行了搜索，没有日期或地理限制。排除非英语语言的研究。两位作者在数据提取和综合之前评估了质量。数据被制成表格，并根据选择、同意和控制的关系，首先按研究传统对女性的经验进行概念化，以揭示展开的故事情节，其次将新兴的叙述综合成元主题。
共纳入 24 项研究，来自六个研究传统。其中，21 项为定性研究，2 项为定量研究，1 项研究采用混合方法设计。研究跨越 26 年，从 1994 年到 2020 年。跨研究传统，有四个主题明显，“女性对体重的信念和经验”、“社会决定因素”、“被风险管理”和“护理人员的态度”。随着时间的推移，母体肥胖的管理已经从关注体重增加和饮食作为女性的问题，发展到体重成为病理性的，导致更多的医学化，再到通过公共卫生领域重新关注生活方式。这表明，对护理的选择不足可能会降低女性对怀孕和分娩体验的控制感。
母体肥胖的医学化程度增加，包括将体重定义和管理为病理性，可能会限制女性对生育护理的选择和控制。需要制定国家和地方政策，让妇女参与其中。重要的是要听取、理解和落实妇女的意见，以便达到平衡，避免过度医学化，同时确保将死亡率和发病率风险降到最低。
