Obese women's experiences of encounters with midwives and physicians during pregnancy and child birth

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 > 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 wellbeing. 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 judgemental 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. (C) 2008 Elsevier Ltd. All rights reserved.