An interpretive exploration of the experiences of mothers with obesity and midwives who care for the obese mother during childbearing

Obesity, as defined as a BMI ≥ 30 (kg/m2) had been established as a risk factor for increased morbidity and mortality during childbearing. There was a need for empirical research to explore the experiences of obese women and midwives during childbearing to stimulate debate and inform the delivery of care to this client group. This thesis provides a justification for a qualitative interpretivist study using semi-structured interviews with a small group of obese women (N=13) and midwives (N=11). This study found that once an obese mother has been placed on the high-risk medicalised pathway, her choices are reduced and the ability to bring a sense of agency and choice to promote and support her own health is limited. The relationship with the midwife, which could have been focused on promoting the health and wellbeing of mother and baby, instead becomes a relationship of managing risk in a reductionist way. This makes it harder for both mothers and midwives to raise the issue of obesity, resulting in a tendency not to deal with the issue. Subsequently, the opportunities for health promotion offered by the midwife-mother relationship sustained over 7 to 8 months are lost, so that encouraging self-understanding and self-help in managing and reducing obesity cannot be achieved. The findings of this study suggest the need to enhance the health promotion role of the midwife. This thesis suggests reviewing the use of BMI, developing discussions about gestational weight gain and healthy lifestyle choices with women during antenatal care, and listening to mother's lay theories, perceptions and concerns around weight. Midwifery care, which uses positive discourses and forward-facing care approaches and supported by continuity of carer schemes and access to midwifery-led care, could enhance the midwife's health promotion role. This could lessen the risk of post-partum weight retention post-birth and enhance a new mother's physical and emotional well-being.