Navigating weight, risk and lifestyle conversations in maternity care: a qualitative study among pregnant women with obesity.

Autor: Sandsaeter HL; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. heidi.l.sandsater@ntnu.no.; Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway. heidi.l.sandsater@ntnu.no., Eik-Nes TT; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.; Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway., Getz LO; Research Unit for General Practice, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway., Magnussen EB; Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway.; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway., Rich-Edwards JW; Division of Women's Health and Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Horn J; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2024 Aug 23; Vol. 24 (1), pp. 552. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1186/s12884-024-06751-1
Abstrakt: Background: Pregnant women with obesity face heightened focus on weight during pregnancy due to greater risk of medical complications. Closer follow-up in maternety care may contribute to reduce risk and promote health in these women. The aim of this study was to gain a deeper insight in how pregnant women with obesity experience encounters with healthcare providers in maternity care. How is the received maternity care affected by their weight, and how do they describe the way healthcare providers express attitudes towards obesity in pregnancy?
Methods: We conducted in-depth interviews with 14 women in Trøndelag county in Norway with pre-pregnancy BMI of ≥ 30 kg/m 2 , between 3 and 12 months postpartum. The study sample was strategic regarding age, relationship status, education level, obesity class, and parity. Themes were developed using reflexive thematic analysis. The analysis was informed by contextual information from a prior study, describing the same participants' weight history from childhood to motherhood along with their perceptions of childhood quality.
Results: This study comprised of an overarching theme supported by three main themes. The overarching theme, Being pregnant with a high BMI: a vulnerable condition, reflected the challenge of entering maternity care with obesity, especially for women unprepared to be seen as "outside the norm". Women who had grown up with body criticism and childhood bullying were more prepared to have their weight addressed in maternity care. The first theme, Loaded conversations: a balancing act, emphasizes how pregnant women with a history of body criticism or obesity-related otherness proactively protect their integrity against weight bias, stigma and shame. The women also described how some healthcare providers balance or avoid weight and risk conversations for the same reasons. Dehumanization: an unintended drawback of standardized care makes apparent the pitfalls of prioritizing standardization over person-centered care. Finally, the third theme, The ambivalence of discussing weight and lifestyle, represent women's underlying ambivalence towards current weight practices in maternity care.
Conclusions: Our findings indicate that standardized weight and risk monitoring, along with lifestyle guidance in maternity care, can place the pregnant women with obesity in a vulnerable position, contrasting with the emotionally supportive care that women with obesity report needing. Learning from these women's experiences and their urge for an unloaded communication to protect their integrity highlights the importance of focusing on patient-centered practices instead of standardized care to create a safe space for health promotion.
(© 2024. The Author(s).)
Databáze: MEDLINE
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