My being denied access with my first-born is one of the reasons this blog even exists! I’d discussed it at every appointment, was promised a pool birth in the hospital (so long as the pool in the delivery suite wasn’t occupied when I needed it), taken on a tour of the pool room, but then repeatedly denied access to the pool while I was in labour until someone finally told me at 8cm dilated that I would not be allowed to use it after all. It’s also the reason I chose to have my second baby at home!
My second labour and birth, where I did have access to a pool, confirmed everything I had suspected. The warm water was incredible at helping me manage the pain of contractions! Coupled with that, the buoyancy provided by the water meant that I could move around with ease. I was so much more comfortable and relaxed – even during contractions!
The frustrating thing is there’s no evidence to support restricting access!!
To be honest, there’s not a lot of good-quality evidence about the use of birth pools full stop. But because so few women get access to water birth there’s no data to show it’s safe for larger mums. But because there’s no data to show it’s safe, we’re denied access! Anyone see a problem here?
I’m not alone in thinking this!
It turns out that Health Care Professionals are beginning to notice this. So I’m delighted to report that the Association for Improvements in the Maternity Services asked me to write an article for their journal, complete with oodles of references for you to wave in the faces of healthcare naysayers you may meet. Enjoy!
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)
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?
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
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!
But which came first, the chicken, or the egg? Did generations of children growing up being marketed the implausibly proportioned Barbie learn to love the lean, or is Barbie merely holding up a mirror to the attitudes already prevalent in society, and giving consumers what they want?
There are other dolls!
Of course, while Mattel is the biggest player in this market, I knew other, more realistically proportioned dolls like Lammily and Lottie existed. They’ve always been very much on the sidelines, however.
Lammily is supposed to mirror the proportions of an ‘average’ 19 yer old. She’s chunkier than Barbie, for sure, but still seems to be the average proportions of a slim 19 year old, if you ask me. Lottie is modelled on the proportions of a 9 year old, but with a bigger head to enable more ‘hair play’.
I didn’t really imagine then that Mattel, makers of Barbie, would manufacture a curvier doll. Who would have!?
So what happened next?
Since that time, Lammily seems to have become somewhat a recluse. I couldn’t find a UK retailer for her, just a few ‘first edition’ dolls listed as collectors items on eBay. To be honest, she always seemed duller and less fun than Barbie, with fewer outfits and scenarios. Understandable since she was decades behind in terms of accessories and marketing etc. but there was never any chance of her catching up if she didn’t seem to be any fun! Who wants a dull doll to play with?
Lottie, however is definitely still going strong, and seems to be having plenty of fun, with a variety of skin and hair colour options, and lots of accessories and outfits available to facilitate imaginative play, from astronomy, to zoology. My personal favourite has to be ‘Activist Lottie‘ complete with placard and loudhailer!
So, whether Mattel heard the criticisms, or saw the rising success of Lottie who, let’s be clear is still a very small player in the market, who knows?
Rise of the Plus Size Barbie – the Fashionistas range!
In 2016, Mattel did the unthinkable. They introduced the ‘Fashionistas’ range of Barbies with different proportions. This seismic shift even got them a Time magazine cover!
‘At last!’ I thought. Some diversity emerging in the Barbie doll market – now young girls can play Barbie parties where all the attendees aren’t just identikit featureless Melania Trumps in different outfits, distinguished only by who’s had their toes bitten off, or who’s got regrettable marker-pen make up!
But I’d forgotten my earlier prediction. Do girls actually want to play with a new ‘curvier’ Barbie? Some researchers decided to find out.
Plus Size Barbie – what the researchers discovered
Their article is published in the September issue of Science Direct; yes, I know it’s only July! Science is the future, don’t forget! The title probably tells you everything you need to know at a glance:
They worked with 84 girls between the ages of 3 and 10, asking them to assign positive and negative traits to the various dolls. Their findings make sad, but not unexpected reading.
Results generally demonstrated greater negative attitudes towards the curvy Barbie doll and more positive attitudes towards dolls with a thinner body size/shape (i.e., original, tall, and petite dolls). Girls identified the curvy Barbie as the doll they least wanted to play with. Additionally, girls with higher levels of body dissatisfaction demonstrated less negative attitudes towards the original doll.
Overall, findings demonstrate a preference for thin bodies and aversion towards larger bodies among young girls. Further, findings suggest that the simple availability of body-diverse dolls may not be a powerful enough intervention to overcome harmful weight attitudes, and highlight the importance of continued efforts to encourage exposure to and acceptance of diverse body shapes and sizes in young children.
Pregnancy is a time of information and advice overload. But is that information always delivered in the best and most helpful way? Are the messages consistent? Have you ever left a meeting with a health care professional feeling confused, or frustrated, or upset? Our voices and our experiences matter, so please, if you have a few minutes, follow the survey link and tell your story.
It’s great that we’re seeing so many researchers and surveys asking for our perspective lately; it’s the first step to making ourselves heard.
To take part, you need to be:
Living in the UK
Have been pregnant in the last 5 years (or are currently pregnant)
What The WRISK Project/Survey Hopes To Achieve
This survey hopes to learn more about women’s experiences of advice and information given before and during pregnancy. It’s open to anyone who has been pregnant in the last 5 years, irrespective of how that pregnancy ended.
Women who are planning a pregnancy or who are pregnant receive many public health messages that are intended to guide their decision making. For example, they receive advice about what to eat, drink, how much they should weigh, and what medications they should or shouldn’t take. These messages are intended to improve outcomes for babies and mothers.
However, there is growing concern that messages do not always fully reflect or explain the evidence base underpinning them, and that negotiating the risk landscape can sometimes feel confusing, overwhelming, and disempowering. This may negatively affect women’s experiences of pregnancy and motherhood, and be exacerbated by a wider culture of parenting that tends to blame mothers for all less-than-ideal outcomes in their children.
The survey is particularly keen to capture the experiences of women whose voices often go unheard; including BAME women, those receiving welfare benefits, and younger/older women.
The project will draw on your insights to understand and suggest improvements for the communication of risk messages in pregnancy.
Please share this survey amongst your networks and across all of your social media platforms. We want to reach as many people as possible!
Who Is/Are WRISK?
The WRISK Project is led by the British Pregnancy Advisory Service (BPAS), in conjunction with Cardiff University, funded by Wellcome. Membership of the project oversight group includes representation from many different organisations involved with pregnancy, which includes Big Birthas.