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Understanding the experience of group antenatal care for women with a raised body mass index: a multi-method study

Holmes, Vivian (2023). Understanding the experience of group antenatal care for women with a raised body mass index: a multi-method study. (Unpublished Doctoral thesis, City, University of London)


Background: Women with a BMI>30kg/m2 typically report poor experiences with standard antenatal care. Group antenatal care (GANC) has been shown to improve care experiences. Positive care experiences are associated with safer clinical outcomes. Little is known about how women with a raised BMI experience GANC. Utilising a critical feminist intersectional lens may help us understand whether facets of the GANC model improve these women’s experiences of antenatal care.

Methods: A multi-method qualitative study was undertaken nested within a large trial testing a model of GANC (Pregnancy Circles) within the English NHS. Seven Pregnancy Circle sessions were observed. Twenty-two women with a BMI >30kg/m2 allocated to Pregnancy Circles in the trial were interviewed using a narrative approach. Semi-structured interviews were undertaken with eight midwives who facilitated Pregnancy Circles. Data were analysed thematically with narrative analysis overlaid on the women’s interviews, utilising cultural safety as a theoretical framework.

Findings: Three meta-themes were developed- Pregnancy Circles as a site of tension, the hospital as a site of danger, and good motherhood in a pandemic. Facets of GANC such as peer support and relational continuity support women with a raised BMI to have a positive care experience. These facets normalised pregnancy, which mitigated the impact of increasing medicalisation when complications developed. In principle, midwives support GANC but in practice were deeply enmeshed in a risk-management paradigm and so found it difficult to utilise facets of the GANC model to support a personalised care approach for women with a raised BMI. Absence of GANC facets such as relational continuity and facilitative decision-making processes in the hospital setting contributed to a poor experience of labour and birth for women with a raised BMI. The COVID-19 pandemic aggravated this further. Facets such as peer support alleviated postnatal isolation during the pandemic and supported the transition to motherhood. Women cited various barriers to postpartum weight management but identified peer support as a strong motivator.

Conclusion: This was the first study to explore the experiences of women with a raised BMI receiving GANC qualitatively. Mapping a cultural safety paradigm onto GANC provision allows a radical reimagining of maternity care provision for women with a raised BMI as woman-centred, culturally safe and non-stigmatising. How safety is approached and delivered in maternity services requires reconfiguration.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Holmes thesis 2024.pdf]
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