Thursday, January 13, 2011

About Time: Asking Fat Women About Their Experiences

This is one of those no-duh studies, but I thought it was interesting enough to pass along.  Here's the study abstract.  [emphasis mine]

Nyman VM et al.  Obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth.  Midwifery. 2008 Dec 17.

OBJECTIVE: To describe obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth.

DESIGN: A qualitative study using a phenomenological approach. Data were collected by means of interviews that were tape-recorded.

SETTING: The women's homes or at a hospital in western Sweden.

PARTICIPANTS: 10 women with body mass index greater than 30, three primiparous and seven multiparous, who had given birth at a hospital in western Sweden in the period between October 2006 and September 2007 were interviewed four to six weeks after childbirth.

FINDINGS: The meaning of being both obese and pregnant is living with a constant awareness of the body, and its constant exposure to the close observation and scrutiny of others. It involves negative emotions and experiences of discomfort. Feelings of discomfort increase as a result of humiliating treatment, whilst affirmative encounters alleviate discomfort and provide a sense of well-being.

CONCLUSION AND IMPLICATIONS FOR PRACTICE: Obese pregnant women are a vulnerable group because obesity is highly visible. Caregivers tend to focus on providing care to obese patients somatically, but are additionally in need of knowledge about care from the woman's point of view.

Many obese women have negative experiences of health care that they have to overcome.

It is necessary to individualise care for obese pregnant women, which involves taking time to give the women an opportunity to tell their own story.

Caregivers have to promote health but it has to be done honestly and respectfully.

In order to avoid judgmental attitudes and causing increased suffering for obese pregnant women, midwives and physicians need to be conscious of, reflect upon and verbalise their own attitudes and power

My Comments

I wish more doctors and midwives would reflect thoughtfully upon their attitudes, assumptions, and biases around "obesity," and realize just how much negative impact insensitive and fat-phobic care during pregnancy and birth can have.

AND if they'd only realize that "promoting health" doesn't necessarily have to mean promoting weight loss ─ that health can be promoted without dieting/weight loss being the keystone.

How much could outcomes be improved if they promoted Health At Every Size instead of weight loss as the goal?Sigh.

*Your comments?


Kate said...

I too wish more doctors would think about what it's like to be us and that obesity is so visible that we fear they will see nothing else.

I'm seeing a new gynocologist next Friday and I can't stop thinking about it and stop worrying about how's she's going to treat me. The swirling thoughts are destructive and bad, but I can't get them out of my head.

Anonymous said...

AND if they'd only realize that "promoting health" doesn't necessarily have to mean promoting weight loss ─ that health can be promoted without dieting/weight loss being the keystone.

Unfortunately that just doesn't make sense to so many people...!

Unknown said...

I totally agree!! I'm obese and now after sveral miscarriages, I'm 23 weeks pregnant with a helthy baby boy. Luckily I have a good OB that does not see just my weight but the actual person. Sadly I have an overwieght friends that's been trying to conceive & shes' been through everything I have even IVF and nothing. Everyone she's went to says it's her weight (she's obese too). They have her so convinced no that she' going to do gastric bypass surgery just to try and conceive a year from now. So sad how people can't accept that someone can be obese yet by all the medical books (other than the scale) be healthy.

Fat Grad said...

I'm really glad that someone did a study about this because often that is the only way to get people to realize how destructive policies and behaviors are. I, too, am planning to see a new gyno and I am very nervous about how it will turn out because I am very, very fat. There is no reason that going to the doctor should be a source of such stress and anxiety for anyone because that alone is an important barrier to health. Keep fighting the good fight, because only when HAES becomes standard policy will these issues be removed for fat women.

Unknown said...

I'm quite overweight, as per many BMI indexes and scales, but my doctor has never said anything about it. She's never told me that I HAVE to lose weight to do anything, even for pregnancy. In fact, she has never even mentioned that dropping a few pounds might make things easier. Last appointment I had, which was within the last year, I asked about the best weight I should be at before trying to get pregnant. She named the number, I said "I'd have to lose about a hundred pounds to get down to that". She looked extremely surprised and then said "Well, start with 10 pound, and we'll just aim for as close to that as we can"

I'm incredibly glad that I've had the same doctor since I was 14 (11 years), and that she has never EVER discriminated against me because of my physique. I also had to see an actual gyno and she wasn't discriminatory either. I think I may have lucked out with my doctors.

Back to the topic at hand, more doctors need to be open to the fact that not each one of their patients is going to be a picture of perfect health, so they shouldn't treat them as such.

DeAun said...

I am studying to be a Naturopathic Midwife (A naturopathic physician and a midwife) and in my class this term we are supposed to do research papers on a topic related to pregnancy, childbirth, pediatrics, or women's health. I found your blog while doing research for the HAES group I am starting at my school and I am really interested in doing my paper on obesity in pregnancy. I will likely talk some about health related issues that may be more likely for obese women, but I plan to spend a large portion of the paper on the myths of obesity in pregnancy and the horrible damage we are doing mentally and emotionally to too many women!

I have seen you link some good research articles and I was wondering if there was a place where they are being gathered (aside from your amazing blog), or are you finding them as you go. I certainly am going do to my own searches, but if I don't have to reinvent the entire wheel, that would be nice too. :)

This blog has opened my eyes to a specific issue that I had not thought of before, though, as a woman of size, I probably should have.

Thank you so much for writing this.

Anonymous said...

My midwife is awesome about weight. She does not let ME be critical about my weight. She is actually very careful about any judgement words to describe anything good or bad. Instead of a "perfect pregnancy" she likes to say "unremarkable". I like that a lot. It takes a judgement off the table. She tells me to give her the info and how I am feeling and such but does not allow me to worry. Concerns are to come to her and we discuss and move on. It has been bliss. I suspect the fact that she has had 10 kids has helped her perspective.
She is a skinny little thing, but I don't hold it against her. Lol.