Our PSG Research at the Medical Sociology Conference 2019

The best thing about ParentingScienceGang was discovering all the other articulate people passionate about the issues of high BMI pregnancy. One such woman is Dr Mari Greenfield, who presented our research at the Medical Sociology Conference in York in September. Mari has written a guest post about the experience:

Dr Mari Greenfield, who presented our PSG research at the Medical Sociology Conference 2019
Dr Mari Greenfield

Big Birthas: unpacking ‘choice’ for pregnant women with a high-BMI

I took part in the Big Birthas Parenting Science Gang as a Parent Scientist. I helped to decide the research question, design the methods we would use, and undertake some of the analysis.

When the project ended, we Parent Scientists had the data and the findings, but needed to decide what to do with them. My day job is a doula and researcher, and I’m passionate about choices in birth for all, regardless of BMI. Some of the stories women had shared with us were heartbreaking; stories of choice and power taken away, and of upset and trauma as a result.

Some of the stories were also uplifting, when women took power back; asserting their rights to make choices and decisions about themselves, their bodies, and their babies. Women had shared so much, giving time and investing themselves by telling their stories. I want to make sure we do justice to that. 

One way I can do that is to present our findings to a diverse range of audiences. In my day job, I frequently present research to conferences of academics, so I applied to the Medical Sociology Conference. Hosted by the British Sociological Association, it is a brilliant event which focuses not on what we do within health care, but how we do things, why we do things, and how we could do health care better.

our research at the Medical Sociology Conference 2019

Pecha Kucha!

My talk was accepted, in a format called Pecha Kucha. These presentations allow you to present 20 slides, and talk about each one for 20 seconds. It’s a challenging format because it makes you really focus on the key points you want to make. There is no room for waffle!

I wrote the both the initial application and the presentation collaboratively with Big Birthas and several of the other Parent Scientists, using the Facebook group to refine ideas and try things out, in the same way we had used it during the Parenting Science Gang project. It was lovely to have that very supportive and equal way of working. This is quite different from the creation of most other academic and medical presentations.

The high BMI ‘box’

I chose to focus on one of our findings, the idea of the ‘high BMI box’. Many women explained how, once in this category, BMI was the only thing anyone seemed interested in. They described having serious medical conditions ignored. One woman explained how the difference between her starting weight in her two pregnancies was objectively only 7 pounds, but in one this was ‘normal BMI’, while the other saw her put into the ‘high BMI box’. She eloquently described the differences this made to her care.

Programme excerpt about our research at the Medical Sociology Conference:

Big Birthas: unpacking ‘choice’ for pregnant women with a high-BMI

What does it mean to be labelled as having a high-BMI whilst pregnant? How does this label affect women’s experiences of navigating maternity services?

This presentation is based on a novel user-led Citizen Science collaboration between Big Birthas (peer information and support service) and Parenting Science Gang (Wellcome Trust funded user-led citizen science project).

The results described complex journeys, where interactions with healthcare professionals revolved around conversations of BMI-related risks to the exclusion of other factors, and ignored other events of the pregnancies.

Women also reported disrespectful and shaming language from healthcare professionals, and conflict if they asserted a decision that was not in line with the healthcare professional’s views.

This led some women to decline care that they actually wanted, or avoid attending appointments, to avoid conflict or denial of choice; a consequence which was particularly apparent when we examined how those women chose to approach their second pregnancies.

The presentation and our research at the Medical Sociology Conference was well received. Questions after the talk asked about both the Parenting Science Gang methodology, our methodology, and our findings. People spoke about how our research overlaps with work they are doing.

The Parenting Science Gang’s project is over, but the journey of the stories we collected is not. Next, I am hoping to work with some of the other Parent Scientists to turn our findings into a piece that can be published in a midwifery journal. Watch this space…

Dr Mari Greenfield

Academic researcher in maternity care, doula, birth activist. Special interests in traumatic birth and LGBTQ experiences.

Huge thanks to Mari for bringing our research to a wider audience, and for writing up the experience too!

Would you like to write a guest post for Big Birthas? Have you got experiences or a perspective that the Big Birthas audience might be interested in? Do you have a birth story you want to share? Please get in touch via the Contact Big Birtha page.

Fat Vaginas

I’m sorry. There’s no point beating around the bush. This happened yesterday, and now fat vaginas are on the agenda:

Milli Hill, author of Give Birth Like A Feminist, spoke on BBC Radio Scotland for a discussion about induction rates. With her was Dr Marco Gaudoin, brought in for the ‘expert’ perspective. However, it turns out that Dr Gaudoin’s expertise is in fertility, not obstetrics or gynaecology… which may explain why he said this:

‘With obesity you’ve got increased fat tissue in the birth canal, which makes the birth canal that much narrower, which makes it harder for the baby to squeeze through the birth canal. So you are more likely to end up with what is called an “obstructed labour”‘

Dr Marco Gaudoin, speaking on BBC Radio Scotland 12th November 2019

What’s worse was that this happened at the end of the interview! Milli had no opportunity to challenge the doctor on his statement, or ask for evidence.

Fat Vaginas – Fact or Myth?

It’s no surprise that Milli had never heard this before, because there is NO EVIDENCE for Dr Gaudolin’s words whatsoever. They echo a theory suggested in a research paper back in 1997, and no-one has provided any evidence for it since.

It’s just more fat shaming.

Fat Vaginas: a display of inside-out purses looking remarkably like a selection of vaginas.
Vaginas come in a plethora of different shapes and sizes… image courtesy of The Vagina Museum

Ugh. Makes me want to beat some people over the head repeatedly with a copy of Give Birth Like A Feminist. Shame it didn’t come out in hardback.

You’d really hope that a qualified doctor would stick to established, evidence-based information. Sadly (too often, in my experience) when some doctors feel under pressure, they dredge some half-truth they heard somewhere from the back of their mind and present it as fact, rather than admit they don’t know.

It’s why I recommend anyone embarking on a high BMI pregnancy journey do their research and ensure they’re informed.

I have spoken to countless midwives (who have extensive experience of actual vaginas giving birth) and most agree that with the right support, there is no reason why a high BMI pregnancy shouldn’t proceed as with any other. Indeed, most of them do.

What Happened Next?

On Twitter, plenty came forward to challenge the “expert’s” ill-informed and misogynistic statements.

Then to my surprise, for once, the print media responded positively to the story! This may be thanks to Milli Hill knowing the right people to approach, but it was a refreshing change! The resulting article was comprehensive and well written.

Screenshot of Grazia online article on fat vagina comments.

Then other media outlets picked up on the story, including the Sun, who got an actual expert in obstetrics and gynaecology to comment!

Dr Virginia Beckett, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists clarified that having an “obstructed labour” has nothing to do with “fat vaginas”. Which we knew, but it is nice that someone well qualified to address the issue has done so.

Screenshot of the Sun online article about fat vaginas

Next Up to fight our corner was the Daily Mail!?

Yes, really! Asking lots of people with much more experience and expertise… and me. So, yeah. That happened. I was tempted to be indecent and suggest that if our vaginas are so ‘restricted’, how lucky must our husbands and partners be? But I behaved myself. And contrary to my expectations, the journalist didn’t twist or change what I wrote at all, bar removing a paragraph that had already been covered by a previous interviewee. You can read what I wrote here:

https://www.dailymail.co.uk/femail/article-7680527/Doctor-claims-obese-women-fatter-vaginas-likely-experience-obstructed-births.html

Jaw on floor.

The article came with the usual stock headless belly image, naturally! But as soon as I realised and offered an actual picture to replace it, it was quickly swapped.

Of course, the article goes on to report the bloody relative risk stats rather than the true percentages, as always. So there’s still a way to go, but feeling strangely positive at how this story has turned out, for once!

As I have said before and seem to need to keep saying; having a higher BMI while pregnant is associated with a slightly increased risk of some less desirable outcomes. But there is also evidence that the precautionary way high BMI labours are managed may contribute to this.

There is no evidence that fatter people have fatter vaginas. There is no evidence that having a fat vagina (if such a thing exists) is a cause of birth obstruction.

If you want to read more about how micromanaging our births can cause a spiral of negativity and interventions – see article I wrote on The Impact of Negativity on Labour and Birth.

How To Submit an FOI Request for Maternity BMI Policies

If you’re pregnant or trying to conceive, you might want to know how to submit an FOI request (Freedom of Information) to your local maternity providers. It’s worth finding out as much as possible about your likely treatment beforehand, and it’s pretty simple to do.

How to Submit an FOI Request

  1. Find out which NHS Trusts cover your local area

    Quickest way to do this is to use the postcode location service on the NHS website. This will list all the local services, sorted by distance. https://www.nhs.uk/service-search/Maternity-services/LocationSearch/1802

  2. Check out the Trust websites you’re interested in.

    Mostly clicking through to the individual pages will display the website at the top under the name, if not, just Google it.

  3. Find the page on Freedom of Information requests.

    There always is one. Easiest way is to type “FOI” into the search box, usually found somewhere near the top. Somewhere on that page will list the email address you need to send queries to.

  4. Send your questions/request for relevant policies to the FOI email address.

    If you don’t want to write your own, feel free to use/adapt mine:

    “I would like to know with regard to your fertility, maternity, childbirth and post-natal services:
    1. Do you have a policy for the management of larger women? If so, what is the BMI cut off (or other criteria) where this policy comes into use?
    2. Please attach a copy of the above policy.
    3. Please could you attach any other policies/guidelines/protocols relating to fertility, maternity, childbirth and post-natal which address the management of higher BMI women. This could include (but not be limited to):

    Inclusion/exclusion criteria for use of midwife led unit, hospital birthing pool, home birth, IVF etc.
    Glucose Tolerance Testing and Gestational Diabetes,
    Clexane prophylaxis
    Pre-Birth Anaesthetist referral
    Additional growth scans

    Digital copies/pdfs preferred.

    Kind regards”

  5. Wait for a response

    The authority must reply to you within 20 working days.

    Anyone has a right to request information from a public authority. For your request to be dealt with according to the Freedom of Information Act, you must:

    Contact the relevant authority directly
    Make the request in writing, for example in a letter or an email
    Give your real name; and
    Give an address to which the authority can reply (postal or email)

    You do not have to:
    Mention the Freedom of Information Act
    Say why you want the information

    They can charge you for the costs of sending the information, such as photocopying and postage if you request a copy by mail, but not if you request copies by email. They must let you know any cost beforehand.

    By law they must provide the information unless there is good reason not to; e.g. if in the interests of public safety or security to withhold the information or they do not record that information. See the Information Commissioner’s Office page for more info.

  6. Send the documents to Big Birthas for inclusion on the website!

    If you do get copies of your local policies, please contact me via the form on http://bigbirthas.co.uk/about-big-birtha/contact-big-birtha/ to let me know, and I’ll email back (stops me being inundated with spam!). Then you can send me the documents so I can add them/update them here for the benefit of all.

Negativity in Pregnancy

Really interesting interview with Tracey Neville, former coach of England’s gold-winning netball team, about negativity in pregnancy. I’m not normally a follower of BBC Sport, but she makes some good points:

Tracey Neville speaking to BBC Sport about negativity in pregnancy

https://www.bbc.co.uk/sport/netball/49751520

Tracey, at 42, comes under the realm of a ‘geriatric’ pregnancy, i.e. ‘older than we’d like you to be’. While she’s not got a high BMI, she’s still subject to the same alarmist ‘high risk’ labelling. From her perspective as a coach, she points out how this negativity is unhelpful:

The thing that I’ve really found around this is the negativity that comes around older women having children… It creates a real fearful environment; they [the doctors] go down the route of “Well, we’re preparing you for the fail.”

I don’t prepare my team for the fail – I prepare them for the win! And if they’re not successful, we then look at other avenues, or other steps we can put in place…

Tracey Neville, former England Netball Team coach

She knows the pain of miscarriage, having suffered two, including one the day after leading England to Commonwealth gold. But, as she is pregnant again, due in March 2020, she highlights the difference she sees in approach:

I’d come out of a miscarriage and another consultant was giving me these stats again.

No, tell me what can I do…

We don’t sit down [with athletes] and quote stats at them, and quote how many times we’ve lost. We sit down and look at how we can win.

If only there was just a bit more positivity around health and wellbeing.

Why is pregnancy not targeted like that, why is it not given that positivity?

Tracey Neville

I probably should mention here that if the surname sounds familiar, it’s because Tracey is part of the Neville sporting family. You may have heard of her brothers Gary and Phil, who were reportedly quite good at kicking a ball around.

But she’s absolutely right – why is it in pregnancy, far more than with anything else, we have to look at the doom and gloom angle? Does negativity in pregnancy serve any useful purpose at all?