Danielle J Hurst1, Nicholas B Schmuhl2, Corrine I Voils3,4, Kathleen M Antony5,6. 1. University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53726, USA. 2. Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 1010 Mound Street, Madison, WI, 53715, USA. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health K6/100 Clinical Science Center, 600 Highland Avenue, WI, 53792, Madison, USA. 4. William S Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA. 5. Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 1010 Mound Street, Madison, WI, 53715, USA. kantony@wisc.edu. 6. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 1010 Mound Street, 4th Floor, Madison, WI, 53715, USA. kantony@wisc.edu.
Abstract
BACKGROUND: Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women's interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology. METHODS: We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States. RESULTS: All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated "weight" and "BMI" as the most desirable terms for describing weight, while "large size" and "obesity" were rated least desirable. CONCLUSIONS: Many pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term "high BMI" will be used in place of the term "obesity" to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.
BACKGROUND: Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women's interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology. METHODS: We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States. RESULTS: All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated "weight" and "BMI" as the most desirable terms for describing weight, while "large size" and "obesity" were rated least desirable. CONCLUSIONS: Many pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term "high BMI" will be used in place of the term "obesity" to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.
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Authors: Darine El-Chaar; Sara A Finkelstein; Xiaowen Tu; Deshayne B Fell; Laura Gaudet; Jacques Sylvain; George Tawagi; Shi Wu Wen; Mark Walker Journal: J Obstet Gynaecol Can Date: 2013-03