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

Help us with our research!!

Exciting news! For a few months now, I’ve been working with an organisation called Parenting Science Gang – we are a group of mums (there may be a few dads, but it’s mostly mums) doing research into what interests us – and we’ve got a special Big Birthas Parenting Science Gang Group.

We’ve discussed what research we’d like to see, researched what science and data is already out there, and we’ve interviewed other scientists to get their views on what we should research and how to go about it, and now we’re finally ready, have received ethics approval, have volunteers ready to send out, receive, and analyse questionnaires – all we need are a few individuals who fit the criteria we’ve set to answer our email questions!

Could you help us?

We need people who:

  • are over 18
  • have had 2 or more pregnancies where their BMI was over 29
  • whose youngest child is under 3
  • whose births took place in the UK
  • are happy to be interviewed by email about their experiences

If you can say yes to all three, please follow this link for more information and sign up here to be interviewed –

http://parentingsciencegang.org.uk/experiments/big-birthas-research/

your thoughts could really make a difference!

Now For The Science Bit…

There’s a real lack of good quality research into high BMI pregnancies. There are few studies done specifically on the topic. Those that do exist are often with very small sample sizes, conflate being overweight with medical conditions, or have flawed methodology.

Yet we’re supposed to accept recommendations based on their results?

Pregnant Woman in front of windowEven given the state of some of it, I definitely prefer recommendations based on evidence! All too often we’re told we should do something while pregnant because it’s ‘policy’, yet when you start unpicking the advice, it turns out to be based on nothing more than a hunch – e.g.taking an an increased dose of Folic Acid.

And then there’s the problem with finding the evidence that applies to our circumstances when it does exist. Many Big Birthas out there, myself included, have found that it’s best not to assume that your healthcare professionals are experts in whatever course of action they’re proposing, and often have no idea of the evidence base (or lack of it) to support their advice, and so we have to do the research ourselves to ensure we’re making fully informed decisions!

Well, I can announce some exciting news.

Parenting Science Gang is a user-led citizen science project funded by Wellcome, and one of the new groups for 2018 is a Big Birthas Parenting Science Gang! This is an amazing opportunity to get involved in looking at issues faced by mothers and mothers-to-be with a high BMI.

You don’t need to be a scientist – I’m not! You just need to want more information and help us find it! We will look for evidence-based answers to the questions that us bigger mums want to know, and where we find gaps, we’ll design and run our own research studies to discover and publish our own scientific results and add to the body of knowledge available.

We’ll get advice from professional scientists along the way – but the group will be in charge of the experiments.

We’ll also have regular online Q&A sessions with experts. They will help us in designing our experiments, and maybe even point us in the direction of equipment and resources.

So far we’ve already talked about weight management in pregnancy, gestational diabetes, use of blood thinners in pregnancy, fat vaginas and more! And we’ve had Q&A sessions with yours truly and Clare Murphy of the British Pregnancy Advisory Service (BPAS).

Come along and find out more, ask your questions, and maybe even help us to find the answers! You can give as little or as much time as you choose. It’s a closed Facebook group (https://www.facebook.com/groups/1955647771354577/)  and there are also some meet-ups being organised across the country for people in the different Parenting Science Gangs to get together and discuss the issues in March and April.

We’d love to have you on board!