Presentation on theme: "Dr Christine Furber School of Nursing Midwifery & Social Work"— Presentation transcript:
1Dr Christine Furber School of Nursing Midwifery & Social Work An exploration of the psychosocial experiences of obese women during childbearingDr Christine FurberSchool of Nursing Midwifery & Social Work
2Latest estimates:England has one of highest prevalence rates of obesity in adults around the worldEstimates indicate that 24% of > 16 year olds are obese in EnglandAround 25% of women in England are obeseOverweight prevalence seems static but obesity is increasing2.9% of women are morbidly obeseSource: NHS Health Profiles 2007, National Statistics 2008
31980 – around 8% of women were obese and 6% of men Overall trends:Forecasts from ‘Foresight Modelling future trends in obesity and the impact on health 2007’(McPherson et al 2007):Estimated that by 2050, 50% of women will be obese along with 60% of menNB1980 – around 8% of women were obese and 6% of men
4Maternal risks of obesity : Latest CEMACH report (Dec 2007):Of the 231 women who died who had their BMI recorded, 45 were obese and a further 19 were morbidly obese.‘Obesity trajectory’ – women find it hard to lose weight after giving birth and so weight gain continues slowly until middle age – risks of heart disease and diabetes
5An exploration of the psychosocial experiences of obese women (those with a body mass index greater than 35) during the childbearing process.A qualitative study design using a framework analysis method for data analysis.Women were interviewed in the third trimester of pregnancy and again, 4 – 6 weeks after the birth.
6Semi structured interviews that explored …. In the third trimester of pregnancy:Feelings about weight, experiences thus far, reactions from health professionals, family etc, expectations of weight gain now that they are pregnant and exploration of any plans to lose weight in the future
7Postnatal interviews explored 4-6 weeks after the birthBirth experience, feelings about weight now, any worries about weight, eating and exercise patterns after the birth, plans to lose weight, desires to help lose weight, improvements to services for obese women, experiences with health professionals and advice and support given about losing weight.
8Recruitment to the study: At the study site, obese women with a BMI greater than 35 were offered a glucose tolerance test at 28 weeks of pregnancy.Women attending the clinic were invited to take part in the study by the health professional in attendance .
9Recruitment process:57 information packs about the study were taken away by women.26 women responded and were happy for the researcher (CF) to contact them.19 women subsequently agreed to take part in the study.18 women were interviewed during pregnancy and 18 women were interviewed after the birth(Two women were interviewed once – one during pregnancy only and one after the birth only)Recruitment took place between beginning of November 2007 and end of July 2008.Interviews complete end of October 2008
10Characteristics of 19 women interviewed BMI ranged from 34.6 – 54Age from yearsPhysical complications reported include:Gestational diabetes (3), Hypertension (3),Reduced mobility (7), severe nausea / vomiting (5), preterm birth at 29 weeks (1)
11Mode of birth ►Emergency CS 4 ►Elective CS 4 ►Ventouse birth 2 ►Normal birth withComplications 3►Normal birth and noComplications 6
12Five stages of data analysis FamiliarisationIdentifying a thematic frameworkIndexingChartingMapping and interpretation
13Weight profile of participants Women interviewed rarely weigh themselves (or weighed by health professionals) but perceive that they put on little weight during pregnancyPN – majority not weighed but thought they were at pre-pregnancy weight at time of interviewMost had changed eating habits somewhat during the pregnancyPN – some maintained ‘healthy eating’ but others reverted back to habits from pre-pregnancyActivity levels limited in pregnancy due to back / joint painPN – many had increased walking
14Reasons for their BMI being high Stopping smokingPrevious pregnanciesGood living / lifestyleFeeling comfortable now have a partnerSerial dieters – tried lots of diets in the past.Grazing all day because of a tendency not to eat three main meals each day
15Perceptions of health professional care Mixed reports – supportive to feeling victimisedDietary advice related to safety of food, not related to healthy eating now pregnantCare focussed on medical screening rather than supportive and being helpful about eating / exerciseAN – focus on epidural which was not forthcoming in labourFeeling stressed by the amount of attendances at the hospital – GTT, see anaesthetist, scans for fetal size
16Attitudes towards losing weight in the postnatal period ►Strong desire to lose weight and change lifestyle(Several had already started)►Some conflicts with diet and breastfeeding
17Psychological issues reported Body image – disappointment if not recognised as being pregnantAnxiety – about developing diabetes, giving birth to a large babyFeeling isolated – stigmatised by being overweight
18Some implications for clinical practice More recognition of the psychosocial aspects of being obese and pregnant – women know they need to lose weight but want appropriate support, not to be blamedImproved information about weight gain and healthy eating / exercise during pregnancy from health professionals
19Implications for clinical practice continued … Be aware of communication especially during antenatal care when assessing fetal growth and size►Midwives►Ultrasongaphers
20Thank you for listening! Thanks to the School of Nursing Midwifery & Social Work for funding this studyThanks also to Dr Linda McGowan and Professor Karina Lovell for their continued support