Midwives are concerned about the current risk-focussed system of maternity care for women with a high BMI.

Current literature around high body mass index (BMI) in pregnancy in Aotearoa New Zealand is predominantly medicalised, risk-focussed and negative. Jade Wratten, Principal Lecturer in Midwifery, set out in her Master of Midwifery research to understand the perspectives of midwives supporting women with high BMI in pregnancy.

Jade undertook a qualitative study, which included focus groups and interviews with 17 New Zealand midwives. Thematic analysis identified four main themes:

  1. A flawed approach: BMI has become a single indicator of risk and dictates a medicalised pathway of care. Midwives would like to see a more holistic focus to risk assessments for pregnant women with a high BMI.
  2. Experience of women: Midwives recounted that surveillance tools such as scans are often inaccurate when applied to women with increased BMI. Midwives see these women becoming fearful and disempowered in a medicalised pathway.
  3. Being stuck: Midwives were frustrated that the risks of increased BMI were frequently communicated to women, but not the risks of medicalisation and intervention. Midwives felt vulnerable working within a system that was dominated by the belief that women with an increased BMI could not birth normally.
  4. Sticking together: Midwives reported that they gained positivity from environments where women and women's choices were respected and normal birth was promoted.

April 2022

Image credit: Marcos de Madariaga, used under Creative Commons Attribution Non-Commercial No-Derivatives licence CC BY-NC-ND 2.0