Department of Public Health, Aarhus University, Aarhus, Denmark.
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.
BMC Pregnancy Childbirth. 2024 Nov 19;24(1):767. doi: 10.1186/s12884-024-06888-z.
In 2021, 15% of pregnant women in Denmark had a Body Mass Index (BMI) of 30 kg/m or more, which is associated with complications for both mothers and children. Healthcare professionals often feel insecure when discussing weight with pregnant women with high body weight, and people with high body weight are exposed to stigmatisation. To counter this, different tools have been developed to support respectful weight-related conversations, often recommending asking permission to talk about weight. This study explored the experiences of both pregnant women living with a BMI equally or above 30 kg/m and midwives when asking for permission to discuss weight during the initial midwife consultation.
We observed nine midwifery consultations and, by way of purposive sampling, interviewed six pregnant women with high body weight, while nine midwives participated in two focus group interviews. A hermeneutic-phenomenological approach by Max van Manen was applied for the analysis.
We identified three themes in this study. "Addressing weight triggers risk and ambivalence", which explores the lived experiences of pregnant women, their personal history with their body weight and midwives' hesitancy to initiate weight-related conversations with pregnant women who have a high body weight. "Asking for permission - for whose sake?" highlights the experiences of asking permission among midwives and that pregnant women with a high body weight did not perceive the question as an opportunity to decrease weight-related conversations. "Weight conversation - a cue to feel wrong and guilty or to feel recognised as an individual?" emphasising that trust and shared decision-making are crucial factors for a relevant weight-related conversation but also that the conversation might trigger feelings such as guilt and self-doubt.
Pregnant women with high body weight had a long history with their body weight that affected all aspects of their lifeworld and influenced weight-related conversations in the midwifery consultation. Some midwives hesitated to address weight, but seeking permission eased this challenge. Despite the midwife asking for permission, some of the pregnant women felt uneasy during the conversation, leaving them with a feeling of self-doubt. Relevant conversations occurred when women engaged in decision-making and trusted the midwife.
2021 年，丹麦有 15%的孕妇身体质量指数（BMI）达到或超过 30kg/m²，这会给母婴双方带来并发症。医疗保健专业人员在与体重较高的孕妇讨论体重时常常感到不自在，而体重较高的人会受到歧视。为了应对这一问题，已经开发出各种工具来支持尊重与体重相关的对话，通常建议在询问体重之前先获得许可。本研究探讨了体重指数相等或高于 30kg/m²的孕妇和助产士在初次助产士咨询中请求许可讨论体重时的体验。
我们观察了 9 次助产士咨询，并通过目的性抽样，采访了 6 名体重较高的孕妇，同时 9 名助产士参加了 2 次焦点小组访谈。采用 Max van Manen 的解释学-现象学方法进行分析。
本研究确定了 3 个主题。“讨论体重会引发风险和矛盾心理”探讨了孕妇的生活经历、她们对自己体重的个人历史以及助产士不愿与体重较高的孕妇开展与体重相关的对话。“请求许可——为了谁？”突出了助产士请求许可的经验，以及体重较高的孕妇并不认为这个问题是减少与体重相关的对话的机会。“体重对话——是感到错误和内疚的信号，还是被视为个体的认可？”强调了信任和共同决策对于相关的体重对话至关重要，但对话也可能引发内疚和自我怀疑等感觉。
体重较高的孕妇对自己的体重有着长久的历史，这影响了她们生活的方方面面，并影响了助产士咨询中的体重相关对话。一些助产士不愿讨论体重，但请求许可缓解了这一挑战。尽管助产士请求了许可，但一些孕妇在谈话中感到不安，让她们感到自我怀疑。当女性参与决策并信任助产士时，相关的对话就会发生。
