“Labelled High-Risk”: Exploring perception of risk during childbirth in women with a BMI>35kg/m²

Abstract

This thesis reports on a qualitative exploration of the lived experience of seven pregnant women, medically classified as severely obese, and subsequently labelled as a high-risk pregnancy.

Aims:
 To explore perception of risk during childbirth in women with an increased BMI> 35kg/m2.
 To explore how their childbirth experience and birth outcome impacts on risk perception over the pregnancy continuum.

Background: The concept of “maternal obesity” and “risk” is particularly pertinent to midwifery care today. It has been well documented that maternal obesity represents an increased risk of mortality and morbidity to both mother and baby, and as a result is classified as a “high–risk” pregnancy. This thesis draws on the influence of the French philosopher Foucault’s work on governmentality, which encourages health care systems to introduce guidelines and interventions to regulate the obese pregnant body. Adjacent to this is an expectation that the “good mother” will conform to such guidelines, which recommend monitoring, regulation and disciplining of the body. In relation to this, the thesis focuses on the joint guideline: CMACE/RCOG (2010) Management of Women with Obesity in Pregnancy, and the high-risk pregnancy journey of seven pregnant obese women.

Methods: This is the only existing longitudinal qualitative study, using a hermeneutic phenomenological approach (IPA) has provided an in-depth exploration of the obese pregnant women’s perception of their own risks. Seven pregnant women were recruited using purposive sampling, with data collected using semi-structured interviews conducted at 18 – 22 weeks, 34 – 36 week’s gestation and 10 – 15 days postnatal. Datum was analysed using an Interpretative Phenomenological approach (IPA).

Findings: Analysis was performed, with four superordinate themes emerging from the results of this study. These included 1) Choice, continuity and control, where some of the participants expressed the need to feel in control of their birth experience, but once they started to experience complications they were more ready to relinquish responsibility to health care professionals. 2) Me and my body, where the participants own body image was not congruent with that of the obese body. Consequently, they rejected the obesity label. 3) No risky talk, which uncovered that despite being categorized as a “high-risk” pregnancy, the women were very aware that health professionals avoided any risk communication. 4) Risk or no risk, with this final theme concluding that in light of their own experience and what participants had observed in friends and family, that they were no more at risk of complications than women with a normal BMI. This thesis proposes a conceptual framework named “my risky self”, which was developed from the four themes identified in this study. Current literature, which included cognitive heuristics, the psychometric model of risk perception and Cooley’s (1902) looking glass theory, were applied as a new way of understanding risk perception in obese pregnant women.

Conclusion: The findings highlight the need for specific training for health professionals, and midwives in particular, which focuses upon developing knowledge around obesity related risks, support services available and weight management during pregnancy. Midwives also require more training in communication skills to support them to approach this sensitive subject more effectively and affectively.