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, 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?
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?
This aims to identify the most important questions for future pregnancy research in the UK. It is part of a wider study on pregnancy research funding. You can choose what matters most to you from the suggested research questions.
The aims of the study are to review current research funding in the UK and to identify pregnancy research needs, priorities and gaps which should be addressed in the future. The researchers have organised the questions into different areas (e.g. managing conditions such as gestational diabetes, mental health, etc). Every question is optional: if you do not want to give an answer, you can just skip the question.
Why are they seeking so many different people’s views?
The researchers particularly want to hear from women and their partners, from researchers already conducting pregnancy research, and from health care professionals working in maternity services. Collating all these views is important when it comes to defining future priorities; this survey hopes to identify the research questions that are most relevant to and might affect different groups of people.
How long will it take to complete the survey?
If you provide answers to all questions, it should take you about 15 minutes to complete.
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.
Well, that sure was an exhausting but very worthwhile couple of days!
As my first experience as a conference exhibitor it was possibly a bit of a baptism of fire doing two days @PrimaryCareShow, plus set-up and take down. Definitely a steep learning curve, but really excellent to have the opportunity to put our Parenting Science Gang Research findings before a wider (and very receptive) audience!
Met many, many lovely healthcare professionals across the two days, the vast majority of whom are totally sympathetic to the rough deal bigger mums often experience, and are all too aware of some of the hurtful and unnecessary things that can be said and done while navigating maternity services; some of whom knew from personal experience!
Some interesting discussions too with healthcare professionals who clearly thought their practice was empathetic, encouraging, and open, but whose use of language belied a weight bias, or a propensity to be dictatorial in their provision of care…
Did they notice my (hopefully subtle) efforts at positively reframing their words? Who knows, but I didn’t get into any heated debates, so my challenging of attitudes was at least successful in that I seemingly didn’t make any enemies or get anyone’s backs up, I just hope my words didn’t fly completely undetected under the radar!
We did raise some eyebrows with some of the quotes from the research, even from very experienced midwives, and hopefully prompted some thoughts and reflective practice. Also gained a few new followers on Twitter and some new sign-ups to the Facebook chat group, hi if you’re reading!
Although most of the time was spent in the exhibition hall speaking to delegates, I did manage to get along to 4 conference presentations across the two days – two in the Mother & Baby programme and two of the Obesity & Weight Management sessions, with mixed reaction!
I was shocked and frustrated to listen to Judith Stephenson, a Professor of Sexual and Reproductive Health, waxing lyrical about a 2018 study which promoted a ‘drink only semi-skimmed milk for 8 weeks’ diet in order to facilitate rapid weight loss and thus be in a better position to enter into pregnancy – when all studies I have ever encountered suggest that restrictive diets and rapid weight loss do more harm than good, and while seemingly effective in the short term, are rarely successful in the medium to long term.
I was also frustrated that she feels that obese women planning pregnancy need to be told that they would decrease risks by losing weight. “This isn’t about blaming women” (except it sounds a lot like it!!). In my experience women are VERY aware that we should lose weight, and it’s not that bloody simple; repeatedly telling us this fact does nothing to help us, and just increases blame, guilt, and disengagement. If you actually want to help us, just ask if we’d like to do something about weight management/fitness or like to hear about local options available to help, and if we say no, move on!
I was at least able to put these points in questions after the session, and several attendees came and sought me out afterwards to thank me/agree/discuss further, so definitely glad I attended that one!
On the plus side, I do agree with her that healthcare services are missing a trick when women attending a family planning clinic for removal of a long-term contraceptive device are not given basic information about preconception health, e.g. to take folic acid, and offering signposting to services available to help with weight loss, smoking cessation etc. given that pregnancy is a very pivotal moment in a woman’s life and the likelihood is that we are at our most receptive and motivated to change any perceived negative behaviours, for the benefit of the planned-for baby.
I later attended an excellent talk by Debra Bick of the University of Warwick on the Care of Women with Obesity in Pregnancy which was far more supportive in the use of language, remembered that there’s often a husband or partner in this equation, and a really useful review of recent studies and their results – which I now need to seek out and read!
The following day was more of the same – firstly a really aggravating talk on Weight Management During Pregnancy and the Post-Natal Period by Dr Amanda Avery… who was billed as the chair of the BDA Obesity Specialist Group and an Associate Professor in Nutrition and Dietetics, but just so happens to be on the payroll of Slimming World and who uses a LOT of ‘they’/’other’ and presumptive-generalisation-speak when talking about women with obesity. Very judgemental/dictatorial/patronising – pregnancy is a “teaching opportunity”. All right, we get it: you’re not and never have been a fatty, and those of us who are overweight just need you to swoop in and educate us! Grrrrrr. Haven’t we moved on AT ALL?!?
She then went on to minimise the risks to the unborn of weight loss while pregnant, recommend Slimming World (of course!), push for encouraging obese women to lose weight while pregnant, and advocate for a return to weighing women at every antenatal appointment to encourage this – “it’s a low-cost intervention – you only need a set of scales!” – yes, that was dropped because it was stigmatising, anxiety inducing, disengaging, and showed no benefit to fetal and neonatal health!?! Then she suggested that the reason that childhood obesity has increased since the 1990s is because that’s when we stopped doing regular antenatal weighing! For goodness’ sakes – oversimplification maybe!?! I think quite a few other things may have changed in those two decades!?!
So. Many. Issues… I was really struggling to work out which points I was going to challenge about her talk when it came to question time – would it one of the above concerns, the persistent conflation of pregnancy weight gain with obesity, or for failing to adjust macrosomia figures to account for gestational diabetes… but no need – there was no opportunity for questions unless you stayed to listen to the following talk too! Arrrgh!
Fortunately my confidence was later restored by a lovely talk by Karen Gaynor, a senior dietitian from Dublin, talking about The Impact of Stigma and Bias in Obesity Treatment, who totally gets it: You want to build an inclusive empowering dietician service? Then ask your patients what they want and involve them in designing it!
Don’t push for dramatic and unachievable weight loss goals – 10% is about the realistic limit! Remember that around 85% of obesity is due to genetic factors – only 15% down to environmental factors, with only a proportion of that down to personal willpower. Never forget we’re in an obesogenic environment and change is a massive uphill struggle and life-long commitment! Don’t use shaming imagery – there are plenty of online free-to-use gallery images featuring empowering pictures of overweight and obese people (try https://easo.org/media-portal/obesity-image-bank/ ) – and if you see stigmatising imagery or language used in practice or the media, call it out!! Honestly, the talk, and the questions/comments from delegates which followed were so uplifting! What a great session to end on!
Most special thanks go to (in order of appearance) the wonderful El, Serena, Mawgen, and Dani; who worked charmingly and tirelessly along with me (with the aid of sugar and caffeine) in talking to dozens? hundreds? (wish I’d had the foresight to bring a tally counter – lesson learnt) of healthcare professionals across the two days.
Lastly (this is starting to feel like an Oscar acceptance speech, I’m sure someone somewhere is frantically gesturing me to get a move on as the orchestra pipes up!) huge thanks have to go to The Parenting Science Gang for making this happen, and Wellcome for funding it!
Lots of contacts made, lots of thoughts provoked, lots of ideas forged, lots of avenues opened.