Specialist services provided for obese pregnant women, particularly during the antenatal period were discussed, and the women described their experiences of them. Both of the NHS hospitals where the research was conducted had a specialist midwife for the care of women with raised BMI and both hospitals ran a specialist antenatal clinic for women with raised BMI, although the clinical templates differed. Contrary to the negative experiences described about the relationship with and the care provided by the community midwife, the women were very pleased with their experience of care from the specialist midwife and described feeling well-looked after.
“You do feel like you’re getting well looked-after which I think is a good thing.” (2)
Also, contrary to the experiences described about the relationship with community midwives, some women described a very positive relationship with the midwife they met at the specialist antenatal clinic. They felt they received the majority of information from the specialist midwife and looked forward to the appointments they had.
“The specialist midwife was the only one that actually sat down with me and spoke to me about stuff ... she was the only one that sat and spoke to me.” (6)
“I looked forward to my session of going to see the specialist midwife and dietician because I felt as if they were the only people that listened and the only people that tried to help.” (7)
Conversely, one woman’s experience of the specialist clinic was contrary to this and she describes feeling like she was being singled out for being obese and the clinic was viewed as a negative aspect of her care.
“There’s special clinics and you think to yourself, that eight stone girl sitting there with the designer bump, who’s smoking and ten years younger than you, having kids at
16 and 17, and you think to yourself ‘why isn’t there a special class for them?’ but it’s for the likes of me and I try to look after myself, why isn’t there for the likes of them?” (2)
“I understand what you are saying because some people would think ‘well, why are we being segregated from someone else?” (1)
Interestingly one woman was unaware that she was attending a specialist clinic for obese women, but had noticed that the majority of women there were of a similar BMI.
“Not a specific clinic for size, no, although there may have been and they just didn’t tell you because a lot of the people I noticed that were there at the same time were slightly bigger, so it’s possible.” (5)
Input from health professionals from other disciplines was common, including dieticians and anaesthetists and the support was highly valued.
“Because I was overweight when I was pregnant I asked to be referred to the dietician, so I was referred to her.” (4)
“That helped me a lot, being under the dietician and having the support of the specialist midwife, as well as my own midwife.” (6)
6.5.3.3 Antenatal education
Antenatal education was discussed in detail by all the participants, in particular the notion of antenatal education sessions specifically tailored for obese women. The majority of women viewed this positively and felt they would be open to them and would be keen to participate.
“I think if it was an option to have specific classes then I think you’d find that more people would use it than you think.” (1)
“I’d like to be told, there’s one for higher BMIs.” (8)
Some women said they would feel more comfortable and confident going to a class specifically tailored for obese women where they are the same as everybody else.
“I would rather go knowing I was the same as everybody else than go and have everybody looking at you. I’d feel more confident going to that class.” (7)
“I think if there was a class and it was all bigger people that was there, I think I’d be more likely to attend. I would rather go knowing that I was the same as everybody else than go than have everybody looking at you.” (7)
With the ability to share experiences was found to be one of the benefits of a class specifically for obese women.
“If people want to pigeonhole me and put me in a class with other big people, I’m quite happy with that, we’re all in the same boat together and we’re all pigeon-holed together, we’re all put there and we can all share our experiences.” (4)
However, not all of the women viewed tailored classes positively. One participant felt that these classes could leave some women feeling a bit constrained and less inclined to attend.
“If they had specific classes for specific types, you might feel less sort of wanting to go, you may feel a bit like, you can only go to this class or can only go to that class.” (3)
Interestingly, some felt classes for obese women would mean they were being ‘segregated’ and may feel they are being singled out as different from other women.
“I think for me personally if there was like an antenatal class for overweight women, you’d be thinking ‘well, aren’t I good enough to go with other people?’ I think you would feel a bit segregated. But other people might prefer that, they might feel more comfortable. That’s just personal choice.” (3)
“Do you want to be segregated just because you’re overweight?” (8)
The majority of women, however, felt that antenatal classes specifically tailored for and targeted at obese women should be down to individual personal choice. The availability of classes specifically tailored for obese women would allow them to make a choice as to which to attend, based on which they would feel most comfortable attending and which they would gain the most benefit from.
“I think you can’t win no matter what you do and that’s honestly my opinion….I think if the classes are there, I think it’s what suits people.” (2)
6.5.3.4 Caesarean section
Five of the eight women who participated in this work gave birth by caesarean section. All women reported being informed of the risks of obesity and despite the increased risk of caesarean section amongst obese women, which as presented earlier, is three-times higher when compared to non-obese women, some of these women did not anticipate that they would themselves, require a caesarean section.
“I was expecting to have a normal delivery ... because I wasn’t expecting to have a c- section, everything about it afterwards felt a bit strange.” (1)
“It didn’t really cross my mind because I didn’t think I would end up having one [caesarean].” (5)