Presentation on theme: "An exploration of the psychosocial experiences of obese women during childbearing Dr Christine Furber School of Nursing Midwifery & Social Work."— Presentation transcript:
An exploration of the psychosocial experiences of obese women during childbearing Dr Christine Furber School of Nursing Midwifery & Social Work
Latest estimates: England has one of highest prevalence rates of obesity in adults around the world Estimates indicate that 24% of > 16 year olds are obese in England Around 25% of women in England are obese Overweight prevalence seems static but obesity is increasing 2.9% of women are morbidly obese Source: NHS Health Profiles 2007, National Statistics 2008
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 men NB 1980 – around 8% of women were obese and 6% of men Overall trends:
Maternal 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
An 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.
Semi 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
Postnatal interviews explored 4-6 weeks after the birth Birth 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.
Recruitment 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.
Recruitment 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 Interviews complete end of October 2008
Characteristics of 19 women interviewed BMI ranged from 34.6 – 54 Age from years Physical complications reported include: Gestational diabetes (3), Hypertension (3), Reduced mobility (7), severe nausea / vomiting (5), preterm birth at 29 weeks (1)
Mode of birth ►Emergency CS4 ►Elective CS4 ►Ventouse birth2 ►Normal birth with Complications 3 ►Normal birth and no Complications 6
Five stages of data analysis 1.Familiarisation 2.Identifying a thematic framework 3.Indexing 4.Charting 5.Mapping and interpretation
Weight profile of participants Women interviewed rarely weigh themselves (or weighed by health professionals) but perceive that they put on little weight during pregnancy PN – majority not weighed but thought they were at pre-pregnancy weight at time of interview Most had changed eating habits somewhat during the pregnancy PN – some maintained ‘healthy eating’ but others reverted back to habits from pre-pregnancy Activity levels limited in pregnancy due to back / joint pain PN – many had increased walking
Reasons for their BMI being high Stopping smoking Previous pregnancies Good living / lifestyle Feeling comfortable now have a partner Serial dieters – tried lots of diets in the past. Grazing all day because of a tendency not to eat three main meals each day
Perceptions of health professional care Mixed reports – supportive to feeling victimised Dietary advice related to safety of food, not related to healthy eating now pregnant Care focussed on medical screening rather than supportive and being helpful about eating / exercise AN – focus on epidural which was not forthcoming in labour Feeling stressed by the amount of attendances at the hospital – GTT, see anaesthetist, scans for fetal size
Attitudes 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
Psychological issues reported Body image – disappointment if not recognised as being pregnant Anxiety – about developing diabetes, giving birth to a large baby Feeling isolated – stigmatised by being overweight
Some 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 blamed Improved information about weight gain and healthy eating / exercise during pregnancy from health professionals
Implications for clinical practice continued … Be aware of communication especially during antenatal care when assessing fetal growth and size ►Midwives ►Ultrasongaphers
Thank you for listening! Thanks to the School of Nursing Midwifery & Social Work for funding this study Thanks also to Dr Linda McGowan and Professor Karina Lovell for their continued support