Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
BMC Pregnancy Childbirth. 2024 Aug 23;24(1):552. doi: 10.1186/s12884-024-06751-1.
Pregnant women with obesity face heightened focus on weight during pregnancy due to greater risk of medical complications. Closer follow-up in maternety care may contribute to reduce risk and promote health in these women. The aim of this study was to gain a deeper insight in how pregnant women with obesity experience encounters with healthcare providers in maternity care. How is the received maternity care affected by their weight, and how do they describe the way healthcare providers express attitudes towards obesity in pregnancy?
We conducted in-depth interviews with 14 women in Trøndelag county in Norway with pre-pregnancy BMI of ≥ 30 kg/m, between 3 and 12 months postpartum. The study sample was strategic regarding age, relationship status, education level, obesity class, and parity. Themes were developed using reflexive thematic analysis. The analysis was informed by contextual information from a prior study, describing the same participants' weight history from childhood to motherhood along with their perceptions of childhood quality.
This study comprised of an overarching theme supported by three main themes. The overarching theme, Being pregnant with a high BMI: a vulnerable condition, reflected the challenge of entering maternity care with obesity, especially for women unprepared to be seen as "outside the norm". Women who had grown up with body criticism and childhood bullying were more prepared to have their weight addressed in maternity care. The first theme, Loaded conversations: a balancing act, emphasizes how pregnant women with a history of body criticism or obesity-related otherness proactively protect their integrity against weight bias, stigma and shame. The women also described how some healthcare providers balance or avoid weight and risk conversations for the same reasons. Dehumanization: an unintended drawback of standardized care makes apparent the pitfalls of prioritizing standardization over person-centered care. Finally, the third theme, The ambivalence of discussing weight and lifestyle, represent women's underlying ambivalence towards current weight practices in maternity care.
Our findings indicate that standardized weight and risk monitoring, along with lifestyle guidance in maternity care, can place the pregnant women with obesity in a vulnerable position, contrasting with the emotionally supportive care that women with obesity report needing. Learning from these women's experiences and their urge for an unloaded communication to protect their integrity highlights the importance of focusing on patient-centered practices instead of standardized care to create a safe space for health promotion.
由于肥胖孕妇更容易出现医疗并发症，因此在怀孕期间会更加关注体重。在孕产妇保健中进行更密切的随访可能有助于降低这些女性的风险并促进她们的健康。本研究的目的是更深入地了解肥胖孕妇在孕产妇保健中如何与医疗保健提供者接触。她们的体重如何影响所接受的孕产妇保健，以及她们如何描述医疗保健提供者在怀孕期间表达对肥胖态度的方式？
我们在挪威特隆赫姆郡对 14 名怀孕前 BMI≥30kg/m2 的孕妇进行了深入访谈，这些孕妇产后 3 至 12 个月。研究样本在年龄、婚姻状况、教育水平、肥胖程度和生育次数方面具有战略性。主题是使用反思性主题分析开发的。分析受到先前研究的情境信息的启发，该研究描述了相同参与者从童年到母亲的体重史，以及他们对童年质量的看法。
本研究包括一个由三个主要主题支持的总主题。总主题为“怀孕时 BMI 高：一种脆弱的情况”，反映了肥胖进入孕产妇保健的挑战，尤其是对于那些没有准备好被视为“异常”的女性。那些在成长过程中经历过身体批评和肥胖相关他者化的女性，更愿意在孕产妇保健中解决体重问题。第一个主题为“负载对话：一种平衡行为”，强调了有身体批评或肥胖相关他者化史的孕妇如何积极保护自己的完整性，防止体重偏见、耻辱和羞耻。这些女性还描述了为什么一些医疗保健提供者出于同样的原因平衡或避免体重和风险对话。去人性化：标准化护理的意外缺点表明，将标准化置于以患者为中心的护理之上的弊端。最后，第三个主题“讨论体重和生活方式的矛盾心理”代表了孕妇对孕产妇保健中当前体重实践的潜在矛盾心理。
我们的研究结果表明，在孕产妇保健中进行标准化的体重和风险监测以及生活方式指导，可能会使肥胖孕妇处于脆弱的地位，这与肥胖孕妇报告需要的情感支持性护理形成对比。从这些女性的经验和她们对不加载通信的渴望中吸取教训，以保护自己的完整性，这突显了关注以患者为中心的实践而不是标准化护理的重要性，以创造一个促进健康的安全空间。
