The experiences of midwives when caring for obese women in labour, a qualitative study.

BACKGROUND: maternal obesity is a significant public health challenge for maternity services, especially those in developed countries. Obesity presents an increased risk of mortality and morbidity during the childbearing continuum. Caring for the obese woman in labour is challenging for midwives and there is a dearth of qualitative research which examines their experiences.
OBJECTIVES: to explore the experiences of midwives caring for obese women in labour.
DESIGN: a qualitative, phenomenological approach was used to enable in-depth exploration of midwives' experiences.
SETTING: one maternity centre in the North of England. PARTICIPANTS: a purposive sampling approach was used. Eleven midwives who had experience of caring for obese women in labour were interviewed using in depth, digitally recorded semi-structured interviews for data collection.
METHODS: interpretative Phenomenological Analysis was performed, and underlying themes emerged from the data resulting in an exhaustive description of midwives' experiences of caring for obese women in labour.
FINDINGS: the heart sinking phenomena when caring for obese women in labour emerged from the data from these midwives. Midwives were faced with a constant challenge to promote normality during childbearing in a medicalised environment. Mobilisation of the obese woman was a significant factor for midwives who were striving for normality for the woman. A sense of loss of control and helplessness underlying their care provision was apparent. Perceptions of obesity differed, with confusion between embarrassment and empathy emerging. Difficulties of how and when is the best opportunity to address obesity with the women arose. Different provisions of care amongst midwives were discussed. KEY
CONCLUSIONS: the findings suggest that midwives have different levels of understanding of the complexities associated with the condition. There was a sense of frustration at the 'loss' of normality for this group of women. Different provisions of care emerged with the need for more explicit guidelines to guide and support midwives. Communication and education were identified as key concepts when addressing the increasing prevalence of obesity. IMPLICATIONS FOR PRACTICE: it is evident that the maternal obesity phenomenon is growing rapidly and that midwives feel that they are ill equipped to address it. Support must be provided for the practitioners striving for normality for the women. Continuity of care must be encouraged to enable practitioners to build up a rapport with these vulnerable women through the childbirth continuum. Midwives involvement in developing multidisciplinary guidelines should be encouraged to determine the roles and responsibilities of practioners. Antenatal education is key if women are to be made aware of the problems associated with obesity and interdisciplinary learning must be encouraged to ensure support is consistent, appropriate and available to all women.