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.

Reflections on Primary Care and Public Health Conference 2019

Well, that sure was an exhausting but very worthwhile couple of days!

NEC Loading Bay – Hi-vis really sets off my outfit beautifully!

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…

What Women Wanted
Postcard – Words used by women in our research to describe the birth experiences they hoped for

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!

What Women Got
Words used by women in our research to describe their actual birth experiences

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!

I totally need to namecheck our lovely neighbours at https://littlepeopleuk.org/ and https://www.burningnightscrps.org/ with whom we shared laughs (and confectionery when energy was flagging)!

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.

Big Birtha x

Post-show carnage
Post-show carnage

PCPH Conference Here We Come!

Well, this is exciting!

The banners are printed… Collecting the fliers tomorrow… We’re almost ready to unleash ourselves on unsuspecting delegates at the Primary Care and Public Health conference in Birmingham on the 15th and 16th of May!

This is all thanks to Parenting Science Gang, funded by Wellcome.

Representatives from the BigBirthas Facebook group will be staffing the stall, along with representatives from some of the other Parenting Science Gang groups, all eager to talk about our research.

The conference is free to attend, you can find details about it and register here: http://www.primarycareandpublichealth.co.uk/

Come over and say hi!