"There’s a problem with BMI”: An exploration of midwives’ perspectives on the provision of maternity care to women with an increased BMI during pregnancy and childbirth in NZ

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Wratten, Jade
Author ORCID Profiles (clickable)
Master of Midwifery
Otago Polytechnic
Miller, Suzanne
Patterson, Jean
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
New Zealand
pregnant women
Māori pregnant women
maternity services
body mass index
health inequity
maternal obesity
Wratten, J. (2021). "There’s a problem with BMI” : An exploration of midwives’ perspectives on the provision of maternity care to women with an increased BMI during pregnancy and childbirth in NZ. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Midwifery). Otago Polytechnic, New Zealand. https://doi.org/10.34074/thes.5483
The global burden of ‘maternal obesity’1 continues to receive worldwide attention, with the dominating focus being the identification and management of the perceived risks obesity poses to pregnancy. This focus, however, has neglected to seek solutions and perspectives from the individuals themselves and those others that may be best placed to understand the nuanced dynamics and realities. In Aotearoa New Zealand (NZ) over 95% of women2 choose a midwife as their Lead Maternity Carer (LMC) (Ministry of Health [MOH], 2020) yet research exploring midwives’ perspectives on the provision care to women with increased Body Mass Index (BMI) is limited. The aim for this thesis was to explore ‘the perspectives of midwives in NZ regarding the provision of maternity care to women with an increased body mass index (BMI).’ The research question driving this study was “What are midwives’ perspectives on the provision of maternity care to women with an increased BMI in New Zealand?” To answer this question, this qualitative study utilised a feminist standpoint theoretical lens to explore the experiences of seventeen midwives who provide care to such women, in three separate geographical locations in NZ. Data was collected using focus groups and semi-structured interviews and Braun and Clark’s (2013) thematic analysis process was used to identify four themes. Midwives within this study perceived that the use of BMI as a single measure of risk in maternity was flawed. They identified that hype exists around increased BMI which leads to over medicalisation and unnecessary and potentially harmful interventions taking place when women present with an increased BMI. Midwives are aware of and witness both discriminatory behaviour towards, and poor treatment of women with increased BMI within their midwifery work. Midwives desire change, yet often feel obstructed and powerless within the current maternity system which is dominated by these practices. The study themes presented are titled, a flawed approach, concern for women's experience, being stuck, and sticking together. This study suggests that systemic and structural barriers to equitable care exist within the maternity system in NZ regarding the provision of care to women with increased BMI. Viewing this situation from a feminist standpoint perspective has enabled the articulation of a position that despite midwives feeling the system hampers their ability to advocate for women and protect normal birth, their expertise about how to most effectively work with obese women has the potential to transform women’s experience and improve maternity outcomes. Explicit pathways for women who are obese require strengthening within our current system to enable judgment-free informed choice regarding interventionist or non- interventionist care. 1 Maternal obesity is a term used often in literature to refer to women who are obese (≥ 30 kg/m2) in pregnancy. The author acknowledges that this term has the potential to cause offense and is not one that the author condones. 2 The words ‘women/woman/her/she/māmā are used throughout this thesis, yet the author would like to acknowledge trans/nonbinary individuals within our communities and within the maternity space
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