So, you’ll have been wondering what happened to the research BigBirthas was doing in collaboration with the Parenting Science Gang?
Well, we’re all done. Thank you to everyone who joined in and got involved. 161 people joined the Facebook Group in the end, we took part in dozens of Q&A sessions with experts, some of whom sounded like they enjoyed it as much as we did!
Conversations within the group revealed that many of us felt that we were given no choices during pregnancy and labour; that our high BMI led to health care professionals failing to offer choices normally available to pregnant mothers, and that often, there was no medical evidence to suggest that these choices weren’t perfectly reasonable. Many of us had had very negative experiences, even when our pregnancies themselves were uncomplicated.
This led us to decide to research the way that choice was presented to expectant mothers with a high BMI and how that affected their experiences. Were our experiences typical? Or had our negative experiences drawn us together in a way that precluded us from being aware of high-BMI women who’d had less traumatic pregnancies and births, and made us wrongly assume negative experiences were universal?
We invited volunteers to be interviewed by email, recruited from anywhere and everywhere in the UK we could think to ask, and were then overwhelmed at what an enthusiastic response we received! Almost immediately, we got 60+ responses to our request for research interviewees, and 20 filled in the full-length responses we needed to do our qualitative analysis using thematic analysis methods. Then we stopped asking for more respondents, because 20 was about the limit we could manage with a small group of first-time thematic analysts running the show!
But that is the whole point of Parenting Science Gang; letting the parents be in charge of asking the questions they want answers to, and then working out how to do it!
What did we find out?
None of our findings were a great surprise to us; they confirmed that the conversations our group had had were pretty typical. Although there were some great stories about knowledgeable health care professionals who treated mothers with dignity, we also found clear themes of unsatisfactory treatment. Several reported that they saw an immediate change of tone as soon as they were weighed:
“When I’d been weighed and measured she immediately started saying things like “Oh, there will be a problem because of your weight” but wouldn’t explain what the problem was. She wasn’t as friendly then and wouldn’t explain things to me”
Language changed, and some mothers felt lectured and patronised. There were almost constant warnings about potential problems (most of which never transpired), repeated tests for conditions (many of which never developed), with some health care professionals resorting to “persuading” mothers using guilt tactics.
“I felt that I was coerced and guilted into an additional scan by one particular midwife.”
“I felt that I didn’t have a choice, I was scared into decisions.”
“I was told ‘Well you must have known the risks when you decided to get pregnant, being the weight you are.’”
In most cases, where mothers were pregnant for the first time, they went along with the recommendations of health care professionals without question. This too echoed our experiences in the group. It was only after the birth that many of our respondents realised that they should have had a choice about the decisions made, and these decisions may have made due to an assumption of problems emerging, rather than a careful consideration of the individual mother’s situation.
“I didn’t realise you could refuse induction”
“In both labours vaginal examination was presented as a non-option.”
Some mothers felt that they had been actively ignored if they challenged recommendations. Many of our group found reading these testimonials too difficult to manage. They triggered memories of our own experiences of being ignored and in some cases basically assaulted, for want of a better word, at a time of our most intense vulnerability, so if you do read the full findings, please be aware of this.
“I was given all the interventions including an epidural that I had refused”
“First time round I agreed to one [vaginal examination] and the midwife swept me without my consent.”
Worryingly, many mothers reported finding a great discrepancy between health care professionals, in terms of knowledge and subsequent behaviour. Sometimes mothers found that their weight was blamed for everything by a few professionals, but that other heath care professionals didn’t agree.
“The first sonographer very harshly said that the reason she had trouble was because I was quite fat so it was harder to get a good picture. During other scans I was told that weight doesn’t necessarily come into it and it really does depend on the competency of the sonographer and the position of the baby/womb/placenta”
Many mothers received conflicting messages about risk and options from different health care professionals, which was both confusing and upsetting, and didn’t inspire confidence in the system to provide personalised care for their own situation and needs.
“I felt that people knew best, but when professionals are literally disagreeing about the well-being of your unborn baby, it’s a bit disheartening.”
This lack of consistency, coupled with feeling judged and unsupported by health care professionals had a great effect on mothers, many of whom reported that pregnancy had been an extremely stressful time for them.
“I found it scary and confusing during my first pregnancy.”
“I left some midwife appointments afraid that I might die in labour!”
Not unexpectedly, mothers prepared for subsequent pregnancies with care. No one mentioned losing weight, but many mothers talked about being much better informed; reading up on guidelines and risks, and being much more confident in asserting their views and wishes, and in challenging health care professionals to explain themselves, their actions and their recommendations.
“I had the confidence (or some might say bad attitude) to say, I’m not having all of those scans – they aren’t necessary and are a waste of my time.”
Many approached their relationships with health care professionals differently second time around, either making a concerted effort to form respectful and supportive relationships from the start, seeking out professionals they had found supportive in their first pregnancies, or by actively avoiding certain individuals, and in several cases paying for independent midwives or doulas to support and advocate for them.
Sadly, in several second pregnancies, mothers also reported avoiding health care professionals wherever possible; engaging as little as possible and refusing appointments where necessary. More than once, mothers reported needing to do this for the sake of their own mental health. This is clearly a very worrying result; it cannot be positive for any mother, irrespective of their medical needs, to be making an effort to avoid the health service provided to support them, but did seem to be a common response to prior bad experiences at the hands of the health care professionals.
We know (and I have complained many times!) that many of the risks that arise from having a high-BMI in pregnancy are delivered in terms which make them sound excessively alarming. For example, where a risk changes in likelihood from 0.1% to 0.3%, it is often represented as “THREE TIMES THE RISK” in big, bold letters, which makes the difference seem very alarming, when it is actually still very low risk. These alarm bells are also usually rung when the mum is already pregnant, so NOT a safe time to diet or do anything about it, and just increases the stress and feelings of guilt. This is not helpful, and given that no respondents mentioned consciously trying to lose weight between pregnancies, clearly not serving any weight-loss motivational purpose either.
There are examples of great care out there, but until the NHS is able to universally provide larger mums with a respectful and compassionate experience of pregnancy and labour, and ensure that mothers feel in control of what happens to them at this fundamental time, then we feel that many more mothers will suffer from unnecessary and unhelpful levels of stress during pregnancy, and some will avoid health care professionals altogether, potentially putting themselves at even greater risk.
You can read our full findings here: Big Birthas’ Findings
Huge thanks to the Parenting Science Gang Team for bringing this project to fruition, for being such lovely, patient, intelligent, enthusiastic ladies, and particularly to Sophia for birthing PSG in the first place. Long may PSG continue gaining funding and doing Citizen Science into all sorts of topics, because it’s bloody ace.
Go and have a look at the Parenting Science Gang page! This link says pretty much everything I’ve said above, worded pretty similarly, but if you have a mooch around, there’s all sorts of fascinating information about the other groups and their experiments on breastmilk, baby wearing, picky eating, homeschooling and more: http://parentingsciencegang.org.uk/experiments/big-birthas-findings/
If you’re interested in joining a groups of likeminded people, the BigBirthas Facebook group is still going, https://www.facebook.com/groups/bigbirthaspsg/, feel free to come and pick our collective brains, have a chat, discuss unicorns, it’s all good. We’re just now talking about how we might want to distribute our research findings, but we also chat about all topics BigBirthas related, and anyone can post a question for the wisdom of the hivemind to respond. You’d be very welcome.