Antenatal classes-specifically for obese women...any ideas/suggestions?

[hermione2001ie]

Hi everyone,

I'm a student antenatal teacher. I'm currently in the process of doing an assignment on 'meeting different needs' and I have chosen 'obesity' as the theme. This is partly because I live in the North East where obesity in pregnancy is a significant 'issue' and also because it is an area I am interested in specialising in once I have qualified.

I appreciate that it is a very emotive subject area and I absolutely do not intend to offend any one in any way, so please forgive me if I inadvertently do so.

From what I have researched thus far, findings from studies/surveys indicate that pregnant obese women generally feel unsupported by medical professionals (that's not to say that there isn't good support out there), that they're not given sufficient information or that the information they are given is inappropriate i.e. judgemental and making sweeping generalisations that all obese women are somehow the same. Studies show that some obese (sorry to keep using the term over and over!) women are more likely to be reluctant to seek antenatal care/classes for fear of being judged about their size. There is also evidence that some womens' birth experiences are negatively affected by others' reactions to their size e.g. a midwife who says 'you can't use the birth pool because of your size' rather than focussing on other things that maybe the woman CAN do, or perhaps assessing suitability for using the birth pool on a case-by-case basis, rather than a blanket ban? So where a woman hears negativity like that in the birthing room, her hormones can stop doing the good work, her adrenaline kicks in, labour slows or stops and she finds herself having far more intervention than she had hoped for. Anyway, you get the picture.

So...with all of this in mind, I'm thinking of the content of an antenatal class, which may or may not be part of a multidisciplinary approach (I do not work for the NHS btw!) Most of which wouldn't deviate from what I would teach any other group, why would it? Thus far I have considered placing more emphasis on the role of hormones in labour, how if a woman is feeling relaxed then the oxytocin's a'flowin' and she stands a good chance of having a 'normal' birth. Body image - I would let the group define what they would like to discuss on this rather than me imposing what I think their body image issues are. The benefits of having a doula (evidence that there are better birth outcomes and less intervention when a trained female doula is present), helping women find 'normality' amongst all the medical/dietary/health info they are being presented with, perhaps writing birth plans which reflect this-using informed decision making etc. Possibly just allowing more time for women to express their concernd.

These are obviously just outline ideas. I would be very interested and grateful to hear your thoughts either on here or by IM.

Thanks, Jo

I think a large (no pun intended) part of the benefit of a class would be women meeting women who have similar body issues as themselves and not feeling like the odd one out, 'the fat one' as it were.

As for the class content, yes most of it should be the same. Obviously eating sensibly (not eating for two) and keeping fit/flexible during pregnancy so that they can be mobile in labour is a particularly important. It's the tone of this that's important. It can't be "I need to tell you this stuff because you are obviously lazy and eat like pigs because you are fat". It has to be more about finding exercises/dietry advice that obese women genuinely feel is helpful to them.

It's important to realise that obese women will be a very diverse group not just in terms of 'how' obese they are, but also in terms of health and attitude. You will have some people with lots of confidence and those who are really self-concious. Those who desperately want to lose weight, those who are happy with where they are. There'll be people who have put weight on very slowly over the years by eating a very small amount more than they needed to, those who are still putting on weight rapidly, and those in the process of losing weight.

It is also vital that these women are recognised for more than their weight. They have just the same variety of hopes and fears as any pregnant woment (e.g. those wanting a birth with minimal intervention, those wanting as much pain relief and assistance as they can get).

Personally, as I've said on another thread today, I don't like the idea of medical professionals judging me as unhealthy and ignorant just because of my BMI (currently 39). I started last year with a BMI of 53. I have been eating a lot better than I used to be (though there is always room for creme eggs improvement). I lost weight to get pregnant after struggling to concieve, and imagined I'd be down at my target weight (BMI 22-25) before I got pregnant. I was surprised to find myself pregnant before then (though delighted) and am a little disappointed that I am still seen as a risky, overweight pregnancy when I'm doing my damndest to be healthy. But you don't lose 12 stone overnight. It took me 9-12 months to lose 6 stone. I'm trying to keep my weight down sensibly - am 18 weeks and still weight a bit less than at booking in - I don't expect I'll manage to keep this up into the third trimester, but hopefully if I exercise and eat properly then I'll only gain genuine pregnancy weight and lose it afterwards.

I'd encourage any self concious members of the group who want to increase their exercise to keep in contact and do it together. It can feel awkward going into a swimming pool/gym/walking group/yoga class alone and feeling like you will be the only 'big' person there. A group of friends to chat to/giggle with/cheer/moan with each other on is priceless.

Hope this helps.

A group of friends to chat to/giggle with/cheer/moan with each other on is priceless.

A group of friends to chat to/giggle with/cheer each other on/moan with is priceless. :)

Hmm. Would I want to go to a class specifically for fat people? Erm, no.

However, you raise some valid points some of the NHS literature is a bit patronising for overweight people and yes, I have heard that some of the medical care suggested seems rather intervention heavy because of the weight which does imply a need for some specialist advice for some people.

So, with that in mind I'd expect something like an online support group to ask questions or a helpline might be better? I think you would struggle to fill a such a specific class in a local area because there might not be enough obese prenant women in the locality and it would mean publicly acknowledging their fatness. Which may be hard.

Or even a support group in person because you could attend at any stage of the pregnancy.

I'm not fat myself so I could be wrong about all this.

I think having an antenatal class specifically for obese people would just draw attention to the fact you are obese. In my antenatal classes there were women of varying sizes and weight was not an issue as we were all there for the common purpose of having a baby.

As for there not being support for obese women, I think that if you are labelled as a low risk pregnancy you virtually get no support during pregnancy and obviously this depends on the area you live in as well. Am currently on my second pregnancy and receiving even less support than first as I am deemed to know what I am doing this time round!

Hi everyone, thank you for taking the time to reply to this thread. What you have said has given me quite a bit to think about. I still don't know which way to go with it at all. Women are saying there isn't enough support but don't want to attend the support that is there (I know it's complex, I understand that) so I'm thinking that there isnt' a single 'best' way of reaching these women. As with a lot of public health interventions, more often than not you're only going to be reaching those who want to be reached. I'll keep working away on it-if nothing else, then I hope that I do meet ALL womens' needs adequately who attend my classes, regardless of their size.

Thanks again. x

I'm another one that would not be happy about being sent to the "just for chubbers" group in place of regular antenatal classes. If this is an optional extra though then some people might choose to go.

Hi, I understand your viewpoint completely. I think it's a case of those who want to would and those who wouldn't, won't! :-)

Also, where would you draw the line? If there is to be a special class for obese women, what about an extra class for underweight women, women with eating disorders or mental health problems, women who suffer abuse, different races and religion etc etc. This would totally segregate different types of people and the good thing I found with my antenatal was that it was a great way of bringing together a variety of people with one common interest.

a lot of obese people won't admit they have a problem.... or take offence to health professionals saying they are obese....

but it is a real problem isn't it.

pointless post there! sorry!

No, not pointless iloveberries...there is an issue with the assumption (by health professionals) that all 'fat' pregnant women are the same. For example, someone I know who has a high BMI has had her 3 children at home in a birth pool, because she fought for it. If she'd gone the 'traditional' hospital route she would have been categorised as high risk and written off if you see what I mean? As it happens her 3 births were straightforward...

I see what you're saying TimothyClaypoleLover (corr that's a mouthful to type!), but there are specific health interventions for women who are obese and pregnant, in the same way that women with other health issues do. I think health issues are very different to things like ethnicity, gender, sexuality. Health issues can (to some extent, depending on what they are) be either treated or managed whereas if you set out to 'manage' or 'treat' race or whatever you'd be lynched! Women who have been abused should also be entitled to proper support. It's not about segregation, it's about appropriate support for those who want it. Whilst it's a nice idea that antenatal classes are a melting pot of experiences and backgrounds, perhaps it isn't always appropriate?

Here's the research I was looking for. Look at the stats-suggests that larger (obese, whatever terminology you prefer women) do want more support www.rcm.org.uk/college/about/media-centre/press-releases/a-uk-wide-survey-of-6226-mothers-experiences-of-maternal-obesity-issues-by-netmums-and-the-rcm-15-11-2010/

www.rcm.org.uk/college/about/media-centre/press-releases/a-uk-wide-survey-of-6226-mothers-experiences-of-maternal-obesity-issues-by-netmums-and-the-rcm-15-11-2010/

I am 17 weeks into my first pregnancy and classed as medically obese. I don't think I'd go to an antenatal class purely for obese women, but some form of help/support would be nice. The thing that I have found most irritating - and this hasn't just been in pregnancy - is that so many medical professionals assume that everyone who is obese lives on junk food and does no exercise. I don't claim to be a saint in either of these respects , but there are often other factors in play - in my case, PCOS and several years of depression. I have skinny friends who eat worse and exercise less than I do - they're just luckier with their metabolisms!

Hi again, the irony is aliphil, all the stuff I'm reading talks about how midwives/other health professionals should not treat all 'obese' women the same, that it's not a disease, that there are many factors that influence weight gain, that they mustn't stigmatise or segregate...yet it still happens. sigh I don't think I would run classes soley for obese women...I've looked into it enough and I just don't think it would work, on many levels. I think it's just a matter of me being genned up, having an open mind and making sure that I offer support as and when someone requires it-but mainly my focus would be on what is 'normal' within any woman's experience rather than the 'abnormal.' If that makese sense? I hope you're able to get some more useful support aliphil. Have a look at the well-rounded mama blog on blogspot-she's awesome! (imho!) Best wishes x

Thanks. First appointment with the specialist midwife today, so fingers crossed she's nice!

How did your appointment go aliphil?