Plus Size Friendly Care

Plus Size Friendly Care? What do we mean by it? If you’re a healthcare professional, how do you ensure you’re delivering it?

What is Plus Size Friendly Care?

I was lucky enough to attend the Primary Care and Public Health conference (PCPH) in Birmingham recently. (Thank you Parenting Science Gang and Wellcome for making that happen!) There I had the opportunity to speak to many midwives and other health professionals about the issues we face in the maternity system.

I took with me two big banners displaying the quotes we had gathered from our Parenting Science Gang Research. The white banner displayed what women wanted and expected from their care – i.e. plus size friendly care; the blue banner showed their real life experiences… which were less friendly. (Click here to read about our research)

Our stand at Primary Care and Public Health 2019 - talking to Health Care Professionals about Plus Size Friendly Care

Common themes arose in our study. Bigger women, (much like anyone attending maternity services!) are looking for choice being offered and having options available, feeling supported and heard, feeling respected, and for information to be presented clearly and sensitively.

Sounds sensible! Was this not the case?

Sadly not.

And this was reflected in the conversations I had at PCPH. Most Health Care Professionals I met are clearly are doing great work providing holistic, supportive, sensitive care, and continually reflecting on their practice in order to improve. A few think they’re doing a great job, but after a few moments conversation, the terminology and phraseology they use, and particularly the way they feel about maternal choice, betrayed subconscious biases and less than helpful attitudes.

As soon as a see a woman come in with a long birth plan of things she wants, I know she’s going to be a problem. Worse still if it’s laminated! Half the time, birth plans might as well go straight in the bin, I don’t know why people bother with them…

Comments of a midwife attending PCPH Conference

When having those sorts of conversations (while internally wincing!) I will try to subtly encourage reflection on words used and opinons held. Comments like “But don’t you find that women…?” or “Maybe people do X because they feel…?”, or “Perhaps that’s because they want…?” are ways to introduce a conflicting perspective, without outright challenging the position the HCP holds.

Changing people’s atitudes

Woman looking unimpressed at the lack of Plus Size Friendly Care she's receiving

In all honesty, I know that those who are most likely to have problematic attitudes are also likely to be the most convinced that their way is the right way – because that’s part of the problem! But you catch more flies with honey than with vinegar, as the proverb goes; telling someone with strongly held views they are wrong is just likely to make their views more entrenched. Making them consider the possibility of alternatives is the first step to changing their minds and showing them a better way.

Big Birtha’s Tips For Professionals Wanting To Deliver Plus Size Friendly Care

It’s easy to point out examples of bad practice, but how do we turn that around into a helpful guide for good practice?

I’m a big believer in solution-focused working. No point telling me there’s an issue, if you can’t think of a way of doing it better! So, I’ve written a page for professionals to help give some pointers on how to deliver plus size friendly care. Have a read. Share it, please, if you agree. If you don’t, or I’ve missed anything out, feel free to comment – it’s a work in progress!

BigBirthas PSG Research Results!

So, you’ll want to know what happened to the BigBirthas PSG research results? What did we get up to in collaboration with the Parenting Science Gang?

Well, we’re all done. We put out the initial calls to join our Facebook group back in March 2018. Thank you to everyone who joined in. 161 people joined the Facebook group, and we’re still actively discussing issues even now the research has concluded! We held dozens of expert Q&A sessions, and some of the experts sounded like they enjoyed it as much as we did!

Join our Facebook group!

The BigBirthas PSG Research Topic

Conversations within our group revealed that many of us felt our choices were unfairly limited during pregnancy and labour. Our experience suggested that a high BMI leads to health care professionals restricting the choices which are normally available. We also felt that often, there was no medical evidence to suggest that our preferences weren’t perfectly reasonable. Many of us had had very negative experiences, even when our pregnancies were otherwise uncomplicated.

We decided to research how choice is presented to mothers with a high BMI and how that affects maternity experience. Were our situations typical? Or had our negative experiences made us unaware of high-BMI women with less traumatic stories?

We recruited volunteers from anywhere and everywhere in the UK we could think to ask. We were then overwhelmed by the enthusiastic response! Almost immediately, 60+ women responded to our request for research interviewees. 20 of those swiftly completed the full-length responses we needed to do our qualitative study using thematic analysis methods.

Then we stopped asking for respondents, because 20 was about the limit we could manage! Especially with just a small group of first-time thematic analysts running the show!

But that’s the point of Parenting Science Gang; let the parents be in charge of asking the questions they want answered, and of working out how to do it!

The Full BigBirthas PSG Research Findings

Please be aware, that for some, reading other people’s stories can trigger upsetting memories of our own experiences at a time of our most intense vulnerability, so if you do read the full document, please bear this in mind.

You can read our BigBirthas PSG Research Results here: Big Birthas’ Findings

What did we find out?

We did not uncover any great surprises. Our results confirmed that the conversations our group had had were pretty typical. There were a few great stories about knowledgeable health care professionals treating mothers with dignity, but we also found clear themes of unsatisfactory treatment. Several reported observing an immediate change of tone after being 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.”

“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.”

First Pregnancies

In most cases, first-time around, mothers reported following the recommendations of health care professionals unquestioningly. This too echoed our experiences in the group. It was only after the first birth that many realised that they should have had a choice.

“I didn’t realise you could refuse induction”

“In both labours vaginal examination was presented as a non-option.”

Some mothers reported being ignored:

“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.”

Disagreements Between Health Care Professionals

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 the scapegoat for everything with a few professionals, but that others 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 professionals. This was both confusing and upsetting, and didn’t inspire confidence in the system to provide for their 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.”

Stress

This lack of consistency, coupled with feeling judged and unsupported had a strong 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!”

Second Pregnancies

Not unexpectedly, mothers prepared for subsequent pregnancies with care. No one mentioned losing weight, but many mothers talked about being much better informed. Many read up on guidelines and risks, were more confident in asserting their views and wishes, and challenged 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. This manifested itself in their making a concerted effort to form respectful and supportive relationships from the start, either by seeking out professionals they had found supportive in their first pregnancies, or by actively avoiding certain individuals. In several cases women said they had paid 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. 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 ideal for any mother, irrespective of medical needs, to be avoiding the service provided to support her. This did however, seem to be a common reaction to prior bad experiences.

Risk Presentation

We know (and I have complained many times!) that many of the risks 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 extreme, 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, such an approach is clearly not serving any weight-loss motivational purpose either.

There are examples of great care, but until we are able to universally provide larger mums with a respectful and compassionate experience, ensuring they feel in control, then many more mothers will suffer from unnecessary stress during pregnancy, with the result that some will avoid health care professionals altogether, potentially putting themselves and their pregnancies at greater risk.

Thank you to the Parenting Science Gang Team!

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’d like to join us, the BigBirthas Facebook group is still going. Feel free to come and pick our collective brains, have a chat, discuss unicorns, it’s all good! We 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.

xx

Big Birtha

Research on Social Networks for Pregnant and New Mums!

Hi lovely peeps!

I’ve agreed to share this information about a research study that’s relevant to BigBirthas who are pregnant, or gave birth 6-12 months ago.

I’m not involved with developing the research, nor am I a participant – had my babies too long ago now! But I’m always interested to hear of new research involving bigger mums and plus-size pregnancies. Certainly this one is taking an interesting new line in the ‘weight management’ sphere, might be interesting!

There’s more info about the study on the University of Glasgow website:

Maternal obesity is a growing public health issue, with one in five pregnant women classified as obese in the UK. Interventions to date have had modest impact on clinical outcomes. These have mainly focused on individual behaviour change and have methodological limitations.

There is growing evidence on the importance of social networks for obesity-risk behaviours. There are few trials using social networks to reduce maternal obesity and very few qualitative studies exploring social network influences on weight management in pregnancy and postpartum.

As part of this PhD study, we will explore the role of social networks in the development and maintenance of obesity in pregnancy and postpartum. We will also review current evidence related to interventions to help women manage their weight during pregnancy and/or postpartum, and take learning from this to inform the development of an intervention. The study aims to:

  • Complete a systematic review to investigate available interventions using social networks for weight management in pregnant and postpartum women

  • Explore the weight management experiences and the influences of social networks of first-time pregnant and postpartum women

  • Explore the social networks of interview participants to try to understand how these might be used to help them in their weight management attempts

  • Develop initial ideas for a theory-based intervention to support weight related behaviour change for pregnant and postpartum women that are overweight or obese.

     

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Time To Have Your Say!

The Royal College of Obstetricians and Gynaecologists is seeking feedback from women on its new leaflet ‘Being overweight or obese during pregnancy and after birth‘.

The closing date for comments is midday on Friday 18 May.

Click on this link to access the RCOG page where you can read the draft leaflet and then feed back your thoughts via their online questionnaire. Make sure you feed back on the right one – NOT the hysteroscopy one (unless you happen to be interested in that too!)

I don’t want to prejudice your thinking, so I’m not saying what I wrote, but I will say that it’s nice to be asked our opinion at last!

Aaand… while you’re busy having your say, let me do another shameless plug for our Big Birthas Parenting Science Gang over on Facebook. We’ve been discussing the topic and what we might research for a little while, spoken to some really interesting experts to get their views; this week we’re talking to experienced midwife and waterbirth expert Dianne Garland (SRN RM ADM PGCEA MSc) of www.midwifeexpert.co.uk. We’re nearly at the point of deciding what we’re going to research – come along and get involved, you don’t have to be a scientist (I’m not!) to get involved in citizen science!