Download Overweight and obesity during childbearing

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
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 men
NB
1980 – around 8% of women were obese and 6% of
men
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 2008.
• Interviews complete end of October 2008
Characteristics of 19 women
interviewed
• BMI ranged from 34.6 – 54
• Age from 20 - 44 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 CS
►Elective CS
►Ventouse birth
►Normal birth with
Complications
►Normal birth and no
Complications
4
4
2
3
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