Table 2 Thematic Framework
Interpretation: Different approaches to obese birth offer opportunities to promote normal birth | |||||
|---|---|---|---|---|---|
Theme 1 | Theme 2 | Theme 3 | |||
Medicalisation of obese birth | The promotion of normal ‘obese’ birth | Complexities and contradictions in staff attitudes and behaviours | |||
Place of birth | Place of birth impacts on mobility | Antenatal education | Importance of information-giving antenatally | Use of fetal scalp electrodes | FSE used to aid mobility |
“We had a woman who wanted to sit on a ball because she was a home delivery, but had to be continuously monitored and they (staff) were unhappy to do it at first” | “I think we should be educating them about mobility and being mobile and trying to get them to the MLU” | “I would preferably, be able to monitor the babe, put the FSE on, to make sure that if she wanted, she could be mobile to help the labour as well”. | FSE viewed as an intervention by some but used to promote mobility by others | ||
Normailty influenced by place of birth | Antenatal education about mobility | ||||
Negative attitudes of staff | Negative attitudes about women’s size | Promotion of normality during labour | Acknowledge risk but promote normality same as anyone else | Risk of caesarean section | Risk of caesarean can influence care |
“And the delivery of those patients, I think it’s probably looked at negatively by the midwifery staff as well to an extent, because they are overweight they see them as ‘oh, this person’s going to be a problem’ | “We should be treating them the same, if not more so promoting normality” | “I think people tend to play safe. I don’t think I personally would agree with that….It’s best to have a normal delivery and if it can be, you know, pushed to that stage, without taking much risk, I will do that. Rather than doing something, like ding a section for example” | Not all obese women have a caesarean | ||
Caring for obese women viewed negatively | Pro-active approach to normality | ||||
Challenges monitoring fetal heart | Technically difficult monitoring fetal heart | Promotion of mobility during labour | Promote mobility regardless of size | BMI influencing clinical management | BMI may influence decision-making for caesarean section |
“I just had to stand there and I was trying to get something and half the time you didn’t know if it was maternal pulse, it was very difficult” | “I think basic care should be managed exactly the same. Like, cos any woman should be mobile in labour, you know, regardless of what they weigh” | “I don’t feel that I do, but I do feel that some people probably make decisions where the lady’s weight influences their decisions” | |||
BMI may influence decision making positively | |||||
Fetal heart monitoring is difficult | |||||
Reluctance to mobilise | Obese women less mobile in labour | Classification as high risk | High risk classification can be detrimental | ||
“I think they’re generally more difficult. They’re more reluctant” | “I think putting somebody in a high risk category actually doesn’t do anybody any favours because then people tread very carefully and they start to think ‘oh God, she’s high risk……I better make sure that nothing wrong happens here’” | ||||
General reluctance to mobilise | Women view themselves as ‘normal’ | ||||
Discouragement of use of water | Water birth contraindicated because of size | ||||
“Because at the moment women are excluded from water birth aren’t they, who have a BMI over 35” | |||||
Water birth not an option | |||||