Nugent, Rachael, de Costa, Caroline, Callaway, Leonie, and Kearney, Lauren (2025) Maternity care experiences of women with a BMI> 35 kg/m2: An interpretive phenomenological analysis. Women and Birth, 38 (3). 101900.

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Abstract

Problem: Maternity care of women with a Body Mass Index > 35 kg/m² is driven by a biomedical approach, with limited inclusion of women's views or experiences. Background: Body Mass Index > 35 kg/m² in pregnancy is common. Women with a higher Body Mass Index are more likely to access medical care during their pregnancy owing to increased rates of obstetric complexity. Aim: To understand experiences of care for women with a Body Mass Index > 35 kg/m² accessing maternity care. Methods: We conducted in-depth, semi-structured interviews with ten women with a Body Mass Index > 35 kg/m² accessing maternity care in Australia. Data were analysed using Interpretive Phenomenological Analysis. Findings: Women's experiential data were analysed and three superordinate themes were constructed: Women's knowledge and agency; Healthcare that harms; and Healthcare that heals. Participants recounted their own role in invoking knowledge and enacting agency, describing birth as a significant life event. Participants acknowledged that past life and pregnancy experiences informed present experience, including intuitive knowledge of their own bodies. Harm was experienced when care was discriminatory or stigmatising, in response to inadequate or inconsistent information or inadequate consent. Healing care was experienced when care was relationship-based, knowledgeable, kind and listening, and when adequate preparation was facilitated. Irrespective of the specifics of their maternity care experience, participants in this study rejected Body Mass Index as a measure of health and expected more nuanced and detailed individual health assessment from their maternity carers. Discussion: Women described variable experiences of maternity care. A woman's knowledge and agency are central to her pregnancy care experience. Delivery of healthcare that heals minimises harmful care experiences. Harms such as stigma, discrimination, inadequate consent, and difficulty gathering and sharing information can be avoided with maternity care that was relationship-based, kind and knowledgeable, and affords adequate preparation. Conclusions: Previous experience informs personal agency. Body Mass Index was rejected as a marker of health. Women want personalised care.

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