Big Birthas — the effect of being labelled ‘high-BMI' on women's pregnancy and birth autonomy
- Greenfield, Mari
- Marshall, Amber
Dr Mari Greenfield is a postdoctoral researcher at King's College, London, researching birth trauma, LGBTQ+ birth, fatphobia in perinatal services, and the impact of COVID-19 on perinatal mental health. Email: [email protected].
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Amber Marshall created BigBirthas.co.uk to provide information and support for people experiencing pregnancy with a BMI 30+. Having had two healthy, unremarkable pregnancies and births with a BMI 40+, she is a firm believer that having a high BMI is not necessarily a barrier to a great pregnancy, or a healthy one! Twitter: @ BigBirthas. Facebook:https://www.facebook.com/groups/bigbirthaspsg.
Background and objective:
Increasingly, pregnant women are labelled ‘high-BMI'. They are often advised to follow a specialised pathway, due to perceived greater risks. This research, which comes from a novel user-led citizen science collaboration between Big Birthas and Parenting Science Gang (PSG), aimed to explore the effect of a ‘high-BMI' label on experiences of pregnancy and birth autonomy.
Methods:
Citizen scientists recruited 20 women with two+ full-term UK births, the most recent within the last three years, and whose recorded booking body mass index (BMI) was >29, through social media, parenting websites and informal networks. A qualitative survey was emailed to those who screened positive for inclusion.
Results:
Eight themes emerged. First-time mothers expected involvement in decision making but frequently experienced a simplistic approach to the label ‘high-BMI'. Women reported care revolved around BMI-related risks excluding other factors, particularly mental health. Statistics were presented in misleading relative terms and conversations enforced compliance with a medicalised labour and birth.
The most commonly reported risk discussion was manual handling, irrespective of women's actual weight. Women reported disrespectful and shaming language from health care professionals.
Women reported negative sequalae including stress and panic that they/their baby would die because of their BMI. The conflict experienced when asserting decisions in first pregnancies led some to decline wanted care in subsequent pregnancies, to avoid conflict or denial of choice.
Conclusion:
Being labelled ‘high-BMI' affects women's experiences of pregnancy/birth autonomy, regardless of medical need. Some women experience iatrogenic harm to their mental health as a result of interactions with health care professionals, while other women decline wanted care to protect themselves.