0:01

Hello , my name's Florence . Welcome

0:03

to the OBSPod . I'm an

0:05

NHS obstetrician hoping

0:07

to share some thoughts and experiences about

0:09

my working life . Perhaps

0:12

you enjoy Call the Midwife . Maybe

0:14

birth fascinates you or you're simply

0:16

curious about what exactly an obstetrician

0:18

is . You might be pregnant

0:21

and preparing for birth . Perhaps

0:23

you work in maternity and want to know

0:25

what makes your obstetric colleagues tick , or

0:27

you want some fresh ideas and inspiration

0:30

. Whichever of these is the case and

0:33

, for that matter , anyone else that's interested

0:35

, the OBS pod is for you . Episode

0:54

170 , weight Stigma in

0:56

Pregnancy . Today I have two very special

0:58

guests . I have Jenny

1:01

Cunningham , who's a midwife , and

1:04

I have Catriona Forbes

1:06

, part of a research

1:09

collective , and

1:22

we are going to be talking all things weight stigma in pregnancy , which kind

1:24

of builds on the episode I did recently episode 163

1:26

, I saw on social media that Jenny was looking

1:28

for people who'd experienced

1:31

pregnancy , who were

1:33

overweight or had

1:35

a bigger BMI and

1:38

we'll talk about whether BMI is a good thing or

1:40

not and I

1:42

was interested because she's doing research

1:44

in this area and

1:46

that's kind of how we connected and

1:49

we've got lots to talk about today

1:51

. But I don't know if you want to start

1:54

Jenny with perhaps how

1:56

you got interested in this as a topic

1:58

.

2:00

Hi Florence , thank you very much and thank you for the invite

2:02

. Very pleased to be here .

2:12

It was some years ago when I was working clinically as a community midwife and

2:14

we were suddenly given a kind of sheet , a checklist sheet , a brand new sheet

2:16

which came in the booking pack so the packs

2:18

we use when we first meet women who are pregnant

2:20

to talk about their pregnancy

2:22

and kind of go through various

2:24

kind of conversations and

2:27

blood pressure and that kind of thing . And this new checklist

2:29

was for women with a raised body mass index

2:31

of 30 or more and

2:34

at the time we hadn't

2:36

been alerted to this coming . So it literally landed

2:38

on the desk and I found it very

2:40

negative . It was talking about risks , really

2:43

fairly negative kind of of . You know , tick , have you talked

2:45

about shoulder dystocia ? Tick , have you talked

2:48

about this ? And that it felt

2:50

quite a difficult

2:52

conversation to have with women right at

2:54

the outset and my

2:56

kind of colleagues we kind of talked

2:58

about this and we just found it quite difficult and

3:00

we were quite surprised by it Because

3:03

of course a lot of the things we talk about affect all

3:05

women in pregnancy potentially . That's

3:08

where my interest came started at

3:10

. So I did a small study

3:12

, interview study

3:14

a couple of years later in my hospital trust

3:16

, asking women about their

3:19

feelings , about the conversations we had

3:21

. So that that was the kernel of the idea

3:23

and I've just kept that with me . I

3:25

kind of follow lots of weight neutral

3:28

kind of people and activists and it

3:30

just raised my interest and I had an opportunity to

3:32

do a PhD and I chose

3:34

this topic and that's why we are here

3:37

today .

3:39

Fantastic . So I

3:41

agree , I remember the kind

3:43

of start of the idea that

3:45

one should have a guideline

3:47

and of

3:49

different rules

3:52

in inverted commas

3:54

applying to depending

4:09

on what the body mass index was what

4:11

one should or shouldn't talk to people about

4:13

, and

4:15

I think it

4:17

came from a

4:21

place of good intention

4:23

in terms of

4:25

analysis , in

4:28

perhaps things like embrace the maternal

4:30

morbidity and mortality that

4:33

we were seeing , perhaps

4:35

a disproportionate number of women that

4:38

that fitted into those categories

4:40

represented in those reports

4:42

. But I agree

4:44

, I remember having many conversations with

4:46

women in my clinic where they were kind of saying

4:49

, well , I'm pregnant

4:51

already and

4:53

you telling me now , when

4:55

there's nothing I can do about it , but I

4:57

have the risk of this and the risk

5:00

of that and of

5:10

that , and making me absolutely petrified of my pregnancy is really unhelpful . Yeah

5:13

, catriona , I'm sure you might like to

5:15

chip in here and tell us

5:17

a bit about yourself and why

5:20

you're involved in the research

5:22

collective . Uh , sure , florence .

5:24

I got involved in the Research Collective Sure Florence . I got

5:26

involved in the Research Collective after

5:29

a call was put out on a group

5:31

on social media that I follow , and

5:33

it was Jenny's call

5:36

for participants to contribute

5:38

to her Research Collective as part of her PhD

5:40

study into weight stigma in pregnancy

5:42

. I had

5:44

already had my child

5:46

by that point , so I have a almost

5:49

three and a half year old and my I mean

5:51

my pregnancy was an interesting one in that it took

5:53

place entirely in 2020 . So that

5:55

in itself had its own flavour

5:57

, unique to that period . But , yeah

6:00

, there were multiple points , I think , through

6:02

my experience experience of pregnancy that

6:05

had me asking a lot of questions

6:07

about how

6:10

I like my experiences

6:12

, I guess . So I , from

6:15

that first conversation that Jenny references

6:17

as the one that you know you have as you're booking an appointment

6:19

with your midwife which , checking back

6:21

on my own notes of it from four years ago , was a 51

6:24

minute telephone call for me in

6:26

COVID times , and

6:29

from that 51 minute call

6:31

of questions that then decided

6:34

a pathway , which was obviously

6:36

that my pregnancy would follow , I think

6:38

a weight management pathway . I

6:40

don't know what it's called higher weight pregnancy . I have

6:43

no idea what the actual official name for it is , but

6:45

essentially it meant I was consultant-led

6:47

care Maybe that's the actual name of it . So

6:50

I was immediately kind of under that pathway

6:52

, based on that initial conversation

6:55

which , to be fair , my midwife

6:58

just was very much like it

7:00

was just a very master of fact thing . You've ticked a certain

7:02

number of boxes . Anyone who ticks

7:04

a certain number of boxes can end up on

7:06

this pathway . These are the boxes

7:09

that have obviously kind of made you eligible for it . But

7:11

it just did set a tone , I

7:13

think , for then what felt like how

7:16

my pregnancy was then going to be perceived

7:18

and experienced , I think

7:20

.

7:22

That's really interesting that

7:24

it was just was just kind of automatic

7:27

default , is that right ? So you didn't have

7:29

any kind of say in it ?

7:31

Well , I mean I maybe did have a say . I guess

7:33

I didn't question having a say . It

7:35

was I'd gone over a threshold

7:37

that meant I was under consultant-led

7:39

care and I didn't question

7:42

that . I just went to the appointments that I received the

7:44

letters telling me to go to . So

7:46

, um , I didn't , I didn't question

7:48

why I , why that was entirely necessary

7:50

, or , or , yeah , I guess

7:52

part of the kind

7:54

of go to the appointments that you're given is because

7:57

you know you expect you're given them

7:59

for a reason and you're pregnant

8:01

and are effectively now responsible

8:04

both for yourself and someone that's

8:06

growing inside you .

8:07

So , uh , you , you do

8:09

as you think you're supposed to be doing and

8:13

did that feel

8:16

like I'm

8:19

being well looked after

8:21

because I've ticked these boxes and

8:23

therefore I'm going to have this pathway

8:25

, or did that make you

8:27

feel apprehensive or worried about

8:29

your pregnancy ?

8:31

I mean I was apprehensive before becoming pregnant

8:33

about my

8:35

body size . In healthcare in general

8:37

, I very much fit the

8:39

classic that's

8:42

now been studied extensively about

8:44

people who will avoid seeking medical

8:46

advice or conversations

8:48

based on the encounters

8:50

of how your body starts

8:52

to become or your weight starts to become , part

8:54

of the discussion around anything that

8:57

you might actually be seeking health

8:59

care for . So I think pregnancy

9:01

wasn't something that I was fairly apprehensive

9:04

about anyway , and then

9:06

became pregnant and so then it just felt

9:08

like , well , definitely do all the things you're

9:10

told to do for fear of

9:12

something going

9:14

wrong , and most pregnant people , I think , feel that way

9:16

. I don't think that's specific to people of a higher weight

9:18

. I think it's very much . You

9:21

don't necessarily question much

9:23

, especially perhaps the first time around , and

9:25

just go with it . I guess I had some

9:27

experiences through it that

9:29

I did have a particular negative

9:33

reaction to

9:35

, and then so when I saw Jenny's call

9:38

and the work that she was doing , I was just

9:40

really interested , I guess , in the fact that you

9:42

know Jenny is a midwife and

9:44

has worked firsthand in delivering

9:47

babies and working with pregnant people

9:49

, and so I always

9:51

think it's great if clinicians are actually

9:53

looking to speak to the people that are impacted

9:55

by the decisions that are , you know , kind

9:58

of taken at whatever level .

10:01

Definitely that

10:03

sort of has really nicely

10:05

led us into this idea of

10:08

stigma and

10:10

and weight stigma . And

10:14

, jenny , you sent me a great blog which

10:16

I will put in the show notes for

10:18

people to read . But do you

10:20

want to talk a bit about what we mean

10:23

by stigma or weight stigma

10:25

?

10:26

Sure , I've got

10:28

a really , I think , a really nice definition of

10:30

weight stigma , which I'll read out . Is that OK ?

10:32

Yes .

10:33

And this one which was published

10:35

just two years ago . So weight

10:37

stigma can be defined as prejudice and

10:40

discrimination due to weight or body

10:42

size . It includes experiences

10:44

of being stigmatized by others , internalized

10:47

weight or self-stigma , and

10:50

anticipated or expectation

10:52

of stigma , all of which have

10:54

been linked to negative health outcomes and

10:57

potentially life-limiting disparities

10:59

of evidence . So that's not

11:01

particularly about pregnancy , but that's just about weight

11:03

stigma as a whole , and I think

11:05

that to me is a really kind

11:08

of holistic definition . It talks about

11:10

self stigma , which not all weight stigma talks

11:12

about , because we internalize as human

11:14

beings in society what others feel about

11:16

us . And it also talks

11:18

about expectation of stigma , that anticipation

11:21

that you're going to walk into that room be

11:23

kind of humiliated or judged

11:25

in some way . So I kind of really like this

11:27

definition . And also the

11:30

other thing it doesn't use the

11:32

words I'm going to use it now . I don't like it

11:34

obesity . It doesn't use the

11:36

word body mass . It will determine body mass index

11:38

either , and I

11:42

think when clinicians speak

11:45

to I'm going to just

11:47

talk about kind of in the maternity field to

11:49

women and birthing people , they will

11:51

rarely say obesity to their faces , but

11:53

it will be in all the written documents and of course

11:56

it's always in the press around . You

11:58

know the original words on TV etc . And

12:01

obesity is known to be a stigmatising

12:03

word . So I really try not to use it

12:05

. And you mentioned earlier Florence

12:08

body mass index and we we know

12:10

it's a contested term . It doesn't accurately

12:12

say anything about someone's

12:14

health . It just tells us about

12:16

people's weight

12:18

. So I try , so I'm using higher weights

12:21

or higher weight bodies , and I

12:23

talk to the research collective about what

12:25

language I should use , which is kind of why I really

12:27

wanted to have a group of women

12:29

and birthing people to support this work . And

12:33

I think , Catriona , we felt higher

12:35

weight seemed satisfactory , it seemed OK

12:37

, it didn't seem particularly

12:40

good or bad , it was fairly

12:42

neutral enough , I think . Was that how you'd agree

12:44

?

12:44

Yeah , I would agree with that . What was

12:46

interesting , though , is that in the discussions with the

12:48

collectives , when we did meet to have that

12:50

kind of conversation the first meeting to

12:52

talk about some terminology and how Jenny

12:54

might want to approach things there there

12:57

wasn't a universal response or

12:59

agreement in . You know , we didn't

13:01

all think the same way about what words

13:03

were or weren't okay , and

13:06

that , I think , relates to kind of the different

13:08

relationships or points that we all were

13:10

at with our own bodies at that time

13:12

and and how we'd experience things . So

13:15

, you know , there is kind of movement

13:18

around removing the stigmatization

13:20

of the word fat and to use fat as a descriptor

13:23

and fat is just a description it's

13:25

in the context that you use a word that gives

13:27

it its meaning . However , there's

13:29

a lot of other people that would

13:32

have responded really poorly or negatively

13:34

to to the use of the word fat , and I think

13:36

, certainly , if you'd put that in a research call

13:38

to say I'm interested in talking to fat

13:41

people who are pregnant , I don't

13:43

I don't think you'd have necessarily had a a

13:46

positive response . So

13:48

, yeah , even in the research collective

13:51

, it what it's been an interesting experience , because we've

13:53

been hearing each other's stories

13:55

and experiences and even

13:57

how we relate to the

13:59

language around , uh , how bodies are

14:02

spoken about . But yeah , higher weight , I

14:04

think the one we all just kind of agreed was most

14:06

neutral fundamentally . It didn't

14:08

instill really any negative

14:10

responses from anyone , so it just felt

14:13

like the most neutral and kind of safest

14:15

approach . And then , obviously , for research

14:17

purposes , jenny was then able

14:19

to kind of put a little asterisk with a definition

14:22

of what that would mean , you know , in BMI terms , because ultimately I guess there just has to be kind of put a little asterisk

14:25

with a definition of what that would mean , you know , in BMI terms , because ultimately I guess there

14:27

just has to be kind of a clinical outlook

14:29

on it from a research perspective

14:31

. So there was an

14:33

ability to expand on that without it centering

14:35

on BMI as kind of the measure

14:38

.

14:39

Thank you , catriona , that's a really helpful

14:41

expansion of what I started to say

14:43

. So thank you . And I did have to choose , you're quite right , bmi of 30

14:45

or more , because that's a really helpful expansion of what I started to say . So , thank you . And I did have to choose , you're quite right

14:47

, bmi of 30 or more because that's when interventions start

14:50

happening to pregnant women and people . So

14:52

under that , as you know , people

14:54

are treated the same generally

14:57

, unless there's a particular medical condition . But 30

14:59

or more is when those conversations start happening . So I had

15:01

to define it otherwise because

15:03

I wanted to particularly look at people who have those conversations

15:05

as additional interventions potentially

15:08

. And just to perhaps just add

15:10

on here about the collective

15:12

, which is more commonly

15:14

talked about as an advisory group

15:16

. So I'm using the word research collective

15:19

, I'm using an approach called critical participatory

15:21

action research . So what I'm

15:23

trying to do within this approach is kind of flatten

15:25

the hierarchy a bit between researcher and

15:28

topic and people , and by using

15:30

a collective rather than advisor group , I'm trying

15:33

very much to not just be advised

15:35

by them but to actually do

15:37

what is suggested . You know , it's perhaps

15:39

a more direct um use

15:42

of advice and there's nine

15:44

people , nine in the research collective , some

15:47

I've had one to one meetings with , because not everyone can make a

15:49

meeting . I think the biggest meeting we've had is six , six

15:51

or seven at one time and it's been immensely

15:53

valuable to me that really

15:56

fits in with a lot

15:58

of the work I do in terms

16:00

of co-production .

16:02

That idea that from the get-go , you're

16:04

working alongside people with no

16:06

hierarchy that's the other

16:09

thing that , when I looked at what you were doing , made

16:11

me think this is really

16:13

good stuff , because this is from the get-go

16:16

. You've got the people , the right people

16:18

, with you to really

16:21

understand the questions . I'm

16:24

interested in what you just said about

16:26

avoiding

16:28

interactions with health professionals in

16:30

general , or not seeking medical

16:32

advice . And now you've

16:35

said that to me . I can see

16:37

that's obvious . But I'm

16:39

thinking oh

16:41

, I hadn't really thought about that . So

16:43

consciously consciously , even before

16:45

you've got pregnant , you're thinking oh

16:48

crikey , I'm gonna have to go and

16:50

deal with health professionals . Glug

16:53

, is that kind of what

16:55

you're saying yeah , absolutely

16:57

so .

16:58

One of the things and it was something

17:01

that came up in one of the collective meetings

17:03

as we were talking about how

17:06

a few of us knew that

17:08

if you're a higher weight in

17:10

early pregnancy , you'll be prescribed a higher

17:12

level of folic acid , but it is

17:14

available as prescription only and

17:18

before getting pregnant . If you're attempting

17:20

to get pregnant , you are advised to be taking

17:22

folic acid to prepare for pregnancy

17:24

, but I personally

17:26

certainly did not have any conversation

17:29

with my general practitioner about whether

17:31

I was attempting to get pregnant to then ask

17:33

if I could therefore have the prescription

17:35

for the higher level folic acid that would be recommended

17:38

, even though I knew that that's

17:40

a thing , and so I

17:42

did not seek out that prescription

17:45

in advance of trying to get pregnant , because I wasn't

17:47

interested in the conversation about whether

17:49

getting pregnant

17:51

at my size was something that they

17:54

perhaps should be doing or is

17:56

recommended , because we don't want

18:07

to have that conversation about decisions

18:10

that we're taking about starting a family or

18:13

expanding our family for those that already had children

18:16

, and so , yeah , it's a key

18:18

example of the way that we before

18:20

pregnancy , even if you are aware of that being

18:22

something , and the best

18:25

recommendation would be that perhaps we should go and

18:27

get that prescription as part of the

18:29

preparing for pregnancy journey , and

18:31

we don't um , or you know those

18:33

of us who are discussing it , haven't ?

18:34

perhaps some do so we've

18:37

got two kind of barriers there

18:39

, I'm thinking , because you've

18:41

got the barrier of it's

18:43

prescription only , whereas

18:45

anyone else can go and buy what they need

18:48

over the counter , yeah , and

18:53

then the barrier of you don't actually want to go and talk to the person that's able to do the prescription

18:55

. Yeah , it's like a bit of a double whammy

18:57

.

18:58

Well , I certainly purchased what you can purchase

19:00

over the counter and use that , but

19:03

I was aware that it may not

19:05

really be what I

19:07

needed .

19:08

you know , at my at my weight that

19:11

was an eye-opener for me in that meeting because I

19:14

had read research around people

19:16

not wanting to go to their doctor , their family

19:18

doctor , because , as Katrin

19:20

has described really well , you

19:23

know you go in with whatever pain or

19:25

problem and weight can be

19:27

the kind of the first conversation or maybe

19:29

all that appointments around

19:31

weight or losing weight . I

19:33

should say that's what it's about , isn't it ? So

19:36

it's kind of known that people of a

19:38

higher weight will often not go to appointments

19:40

with delay , so diagnosis gets delayed

19:42

, they may get iller because of

19:44

this , etc . Etc . So there's a really poor

19:47

outcome , potentially poor outcome . But

19:49

and I was wondering whether it was different in

19:51

maternity and then the the research

19:53

I'd read up until you know , hearing

19:55

that conversation was around

19:58

people may again anticipate

20:00

stigma , but they will turn up because they're pregnant

20:02

and this is what katherine

20:04

said earlier . You turn up , you go down the pathway because

20:06

you're pregnant and you're not there just for yourself , you're there for your

20:08

baby . So weight stigma plays

20:10

a different role but of course , preconceptually

20:13

it really plays into

20:15

that kind of people not wanting

20:17

to see a healthcare professional , and that's really important

20:20

information to know .

20:24

So , talking about weight

20:27

, stigma and shame

20:29

, you have

20:32

given some good examples

20:34

in the work you've done about

20:37

various moments

20:39

in that pathway that

20:42

you

20:44

might encounter that sort

20:47

of stigmatizing moment

20:49

or shame . So

20:52

you mentioned actually

20:54

being weighed , but also

20:56

things about ultrasound scan

20:58

and stuff like that . So I don't know if you want to

21:00

talk a bit about that , of

21:03

course , thank you , yeah so I

21:06

have completed a type of

21:08

systematic review .

21:09

It's called a meta-ethnography it's

21:11

enough to put anyone off reading about research

21:14

these terms . But basically I've

21:16

systematically reviewed the evidence

21:18

and all the studies which included

21:20

a finding of weight stigma or

21:23

with a weight stigma focus around

21:25

maternity kind of pregnant women , people

21:27

. So I was looking at studies where

21:29

people were interviewed or part of focus groups , so

21:31

it was kind of the written word . In

21:34

the end I found 38 studies and

21:36

one of the key findings of

21:38

these 38 studies from around the world

21:40

was

21:43

shame . So I conceptualised the

21:45

findings into the first person so I

21:47

experienced shame during maternity care

21:49

was across all but I think one

21:51

of the studies . So

21:53

shame is a factor . During

21:55

the ultrasound scan it can be realized

21:58

as like mother blaming , mother blame where

22:01

, uh , in this case it's the woman's size

22:03

. Maybe the sonographer says I can't

22:05

see your baby very well , or

22:07

maybe maybe all the measurements are taken satisfactorily

22:09

as far as the woman knows . But when she gets her notes

22:11

back , there's a little comment in the notes saying

22:14

visibility restricted

22:16

due to maternal habitats . I

22:18

think it's a common one and

22:21

it appears that even when the sonographer at

22:23

the time has said yes , everything's

22:25

fine and appears to be ticking everything

22:27

off . Even in those situations

22:30

can this little sentence be written

22:32

in the notes ? And of course the woman might not

22:34

see it till she's home , and then

22:36

that's a really can

22:38

be potentially quite humiliating thing

22:40

to read , because that wasn't addressed

22:42

in person at the time . So

22:45

that was found in

22:48

quite a few studies and

22:51

that's also popped up in my own study too , when this scan seems particular

22:53

area , particular time , and

22:55

I don't know why because I haven't talked to sonographers

22:57

about this . But I will do .

22:59

But it is a real issue and it's obviously

23:01

partly to the technology maybe not being good enough

23:03

or may not be the right type of technology

23:05

you're correct , it

23:08

is partly related to the technology

23:10

and its ability

23:12

to go

23:15

through different layers and

23:17

different depth of layers , because

23:19

it's ultrasound that is bouncing back

23:22

and forth between the probe and the baby

23:24

. I feel that

23:26

maternal body habitus thing

23:28

is a little bit like when

23:32

you buy something

23:35

and it's like a little guarantee don't

23:37

sue us if we've done it wrong . So

23:39

when they go , all this and the other can't

23:41

be excluded because of you

23:44

were nodding along there . Cat

23:46

Catriona , would you like to

23:48

share anything about your experience

23:51

of scanning or what was making you nod ?

23:54

Well , I had a fairly straightforward

23:56

experience of scanning . I was quite open

23:58

in going into the appointment and asking

24:01

if it would help if I held my tummy in a

24:03

particular way . That would allow

24:05

them to obviously get to wherever they need

24:07

to be . That

24:10

would allow them to obviously get to wherever they need to be . So I was just

24:12

fairly open about the fact that , you know , I may in fact have

24:14

body fat that gets in the way and you know it's perhaps helpful to just

24:16

move it back or whatever that might be to

24:18

hold it in place . So I was quite open about

24:20

that in the scans . But I definitely

24:22

had the experience that Jenny describes

24:25

, where a scan

24:27

took place , all the measurements

24:29

were taking place . There was , you know , a

24:31

discussion about whether all the measurements

24:33

, whether they captured everything they needed In one scan

24:35

my 20 , my first attempt at a 20 week scan

24:38

. We couldn't , but it was entirely

24:40

about the baby's position and that's what they'd

24:42

said and I'd had to do

24:44

. You know I'd done everything . I'd had to go for a walk , I'd

24:46

had to try drinking very cold water

24:48

to shock the baby into moving , bit and go

24:50

and empty my bladder , wait a while again and

24:52

see . So I'd done various things in this

24:54

appointment to attempt to move baby and

24:56

then baby was not up for moving

24:59

. I don't think I've ever done such bizarre movements

25:01

on a kind of hospital table

25:03

thing to try and get a baby to move . It

25:05

didn't work so I had to go back for

25:07

a repeat scan . Then we went up for a repeat scan

25:09

, baby was in the right place and they got all the measurements

25:12

, but then , yeah , I went home

25:14

and that note was added . So then

25:16

I think the experience is you then

25:18

question well , hold on , did you get

25:20

all the measurements you need ? Like I

25:22

thought we did get everything we needed , but

25:25

now this note's there . So did you get

25:27

everything you needed ? And then , obviously it's , it

25:29

turns out on all the notes . So then you kind of have the question

25:32

of wait , have we ever had the measurements we

25:34

need ? And so it just kind of puts that uncertainty

25:36

in place of particularly

25:39

, I think , because scans started to become part

25:41

of the discussion about

25:43

, obviously the size of my

25:45

baby and then what that might mean for

25:48

delivery of my baby and it

25:50

, I think , because there's that note and

25:52

then there's not really been a conversation

25:54

about what that actually means . You

25:57

then start to question well , how can you be basing

25:59

so much on something that you've added a note that

26:01

may be inaccurate yourself ? How am I supposed

26:03

to take this as an accurate

26:05

assessment for something else , when you

26:08

yourself have said it's possibly not an accurate

26:10

assessment ? So there's this kind of weird

26:13

conflict of what

26:15

advice am I supposed to take here ? Because , on the one

26:18

hand , this is the most accurate

26:20

evidence that you have to make clinical

26:22

decisions , but on the other hand , you've acknowledged

26:24

that it may , in fact , not at all be accurate because

26:27

of my body . So it

26:29

does kind of presents quite a juxtaposition

26:31

of how to even like

26:34

participate in the conversations

26:36

about plans going ahead based on scans

26:39

.

26:41

That's a really good point , because

26:44

I'm assuming you're then thinking about

26:46

at the end of pregnancy , if someone tells you

26:48

your baby's big

26:50

and is starting to talk

26:53

about decisions to do with that , because

26:56

higher weight women there seems

26:58

to be a correlation with a higher

27:01

weight baby , although I

27:04

don't know if that's actually true , but that's certainly what

27:06

we've written in our guidance , that

27:08

we should be doing a 36-week scan

27:11

to decide . But then you're right , how

27:13

accurate are those measurements and

27:15

then influencing all sorts of

27:17

choices rippling out from

27:20

there . Just

27:22

I wanted to pick up on what you

27:24

said about being

27:27

very open in appointments and

27:29

that your body fat . You might need

27:31

to hold it out the way . I

27:34

always find it really difficult to

27:36

know the right

27:38

way to approach a conversation

27:41

, particularly if a woman has perhaps

27:44

been , like

27:46

you said , put on the pathway to see me

27:49

because she's ticked a certain

27:51

box . Then

27:54

to say , well , you're

27:56

here because you're

27:58

a heavier weight , and

28:01

yet that

28:03

just seems very rude

28:06

. But then you can't not mention

28:09

it because that's why the woman's potentially

28:12

been asked to come to the

28:14

clinic . So do you have some

28:16

? And

28:18

I guess I usually open

28:20

up the conversation by asking the woman why

28:23

are you here ? What can I do for you today and that

28:25

sort of open question . But

28:28

do you think

28:30

there's a good way to

28:32

approach that ?

28:34

it's a good question . What is the good way

28:36

to approach that ? I mean , I guess the challenge is there is no

28:38

one good way to approach it . Everybody

28:41

is their own . You know , I , I

28:44

guess , approached it the way I did in scans because

28:47

I guess I was a bit more

28:49

matter of fact . I , you know , there was

28:51

that mention at the start where I'm

28:54

already pregnant . How helpful is it to be talking

28:56

about my body size at this point ? You

28:58

know , this is the body that is going

29:00

to be , you know , if all goes well

29:03

, birthing a child later . So we

29:05

might as well all just wrap our heads around that now

29:07

this is the body that will be

29:09

doing that . So you

29:11

know I guess that was kind of a part

29:14

of my mindset was well , this is the body

29:16

I have , so this is the body we're working with . There's

29:19

nothing really to discuss or expand on

29:21

there um , I

29:24

don't really remember how my first

29:26

discussion went with my consultant because

29:28

it was over the telephone and

29:30

I really don't remember what

29:33

the opener of it was , but

29:35

I do remember I do hypermobile

29:38

EDS and so I

29:40

did have questions relating to that

29:43

Because that for me was actually

29:45

like a large concern for

29:47

me . I remember trying to ask questions about it and

29:49

it was just dismissed as kind of that

29:52

was not something that was of any concern to

29:54

my consultant and

29:56

in a way , initially that seemed like a positive

29:58

thing . It's like , oh , it's not a worry for them , they're actually

30:00

fine with this . And I think

30:03

as things went on and because I started

30:05

to have more questions about that , I actually started

30:08

to feel really frustrated that that wasn't

30:10

a concern actually

30:12

because we were talking

30:15

about things . That obviously was the

30:17

concern . That had been the reason that I was flagged

30:19

to the pathway , but then there

30:21

wasn't room for me to talk about the concerns

30:24

I had , it felt like . So I

30:26

don't remember my opener conversation , but

30:28

I also feel like there's just something powerful in

30:30

someone saying the reason that you've

30:33

been referred to this is because of these risk

30:35

markers that have been checked off . I

30:37

do have a tale of a really

30:39

positive experience , which is one of my best friends who

30:42

also ended up on a consultant-led pathway

30:44

of BMI kind of being the driving

30:46

factor who in

30:49

the first appointment with her consultant

30:51

basically the consultant

30:53

had obviously looked at records and then looked

30:55

up and was kind of like , okay , and

30:57

I think he had actually said , well

31:00

, you know , your referral is based on your BMI

31:02

because you've ticked this thing , but

31:05

having looked through your records , um , this

31:07

is going to be an incredibly boring pregnancy

31:09

for me . And you know it was very

31:11

much like unless

31:14

something actually happened

31:16

, you know , unless her BMI

31:19

suddenly shot up or unless you , you know

31:21

, developed gestational diabetes or unless she any

31:23

other number of conditions that

31:25

can occur in pregnancy happened . It

31:28

was otherwise just going to be a

31:30

meeting someone with a perfectly normal

31:32

pregnancy that

31:35

just happened to be on his book because her BMI

31:37

was too high , and so I think that

31:39

kind of brought like just , you know , it

31:41

was an opener . This is why you're coming to me

31:43

. There's really nothing interesting for me

31:45

to talk about yet . Hopefully

31:48

that will remain and

31:50

that was just kind of a nice way to open

31:52

it with , like you're here because of this , but

31:55

looking at these papers , you're quite boring at this point

31:57

, um , and hopefully you'll stay that way , um

32:00

. So you know , I think there's

32:02

something powerful in just acknowledging , you

32:04

know , it's actually quite boring , I

32:06

would imagine , to just have to . You

32:08

know , even for medical practitioners , you just like , this

32:10

is just a process we're also going through

32:12

, that there's certain thresholds that are met

32:14

and that need to be ticked , and that we have to follow

32:16

the protocol . But fundamentally

32:18

, x number

32:20

of people will never even become interesting

32:23

in this kind of medical context

32:25

. So you know , she had a really positive experience

32:27

in that respect because and she did remain boring

32:30

, uh , right through to the end- I

32:32

like that story .

32:33

That's really great . Can

32:36

I just come in here ?

32:37

yes , do me again

32:40

going back to my kind of not my

32:42

, but this this theme around shame and how people

32:44

are shamed , um , with higher

32:46

weight and pregnancy . It's those

32:48

assumptions and the kind of preconceptions

32:50

people have . You know , midwives and doctors , when

32:53

that woman walks in the door who all

32:55

we see is someone of a higher weight . And

32:58

inevitably obviously I'm paraphrasing

33:00

what people might think but inevitably this person

33:02

is going to end up with X

33:04

and Y . But the example

33:06

Catriona just gave of her friend was there

33:09

was none of that kind of preconception of those judgments

33:11

given to that woman , which is kind of what you want

33:13

. So it is completely reducing

33:15

, minimizing any kind

33:17

of feelings she may have about her

33:19

size , because this doctor is just

33:21

saying well , it

33:23

might not be the right system , but you're here . But

33:25

you know I'm not anticipating anything bad's going to happen

33:27

and I think people in

33:30

the review I did women are tend

33:32

to be being told that you're going to

33:34

have a cesarean section , you're going to be induced , you know you

33:37

can't go to the midwife led unit . So

33:39

right at the beginning , throughout , they're

33:41

being restricted , they're being told bad

33:44

things will probably happen . But

33:46

of course we don't know they're going to happen , do we , and

33:48

maybe by saying this bad , you

33:50

know these kind of giving those expectations

33:53

, maybe we as healthcare professionals

33:55

is what these things are more likely

33:57

to happen and I haven't done the research to say that

33:59

but who's to say that isn't the case as well

34:01

?

34:01

yeah , I worry about that . I

34:05

was thinking about what Catriona said about

34:07

actually I was interested in my hypermobility

34:10

and you know Stannis

34:12

syndrome and the consultant

34:14

wasn't at all interested in that . They were focused

34:16

on the weight and that's a kind of classic

34:19

really not listening

34:21

to and thinking about what matters to

34:23

the person in front of you . I

34:25

agree , I worry . One

34:28

of the things I see quite

34:31

a lot is the

34:33

idea of oh , it

34:36

might be difficult to put in an epidural

34:38

, so we're going to make you

34:40

be on the obstetric

34:43

unit because you're in inverted

34:45

commas , high risk , and you can't go to

34:47

the birth centre and you can't use the birthing pool

34:49

, all sorts of restrictions we're going to place on you

34:52

. And then we're going

34:54

to tell you you ought to have an epidural

34:56

because it might be difficult to put it in

34:58

and therefore we should put one in just

35:00

in case , and

35:03

then we

35:05

can even . I've even had people

35:07

be told well

35:10

, I know you don't want an epidural , but we'll put

35:12

one in in case , but we don't necessarily

35:14

need to put any medication down

35:16

it , but it's just there when

35:19

and if we need it or

35:22

you need an induction . But

35:25

that increases your chance of emergency cesarean

35:28

and a planned cesarean would be safer than

35:30

an emergency cesarean . So maybe we should just

35:32

do a planned cesarean rather than having an

35:34

induction . We start to kind

35:36

of perpetuate more

35:40

complications , more interventions

35:42

, because we're so worried about the possibility

35:44

they might happen , we actually

35:47

make them happen . So worried about

35:49

the possibility they might happen , we actually make them happen . Catriona

35:51

, I'm interested in what

35:53

conversations you may

35:56

have had or choices you felt

35:58

you did or didn't have when you were thinking

36:00

about giving birth well

36:05

, yeah , so at 35

36:08

weeks I developed a hypertension .

36:10

So pregnancy induced hypertension kicked in

36:12

at 35 weeks for me and that was exactly

36:15

the point . I was about to be having birth conversations

36:17

and then a lot of things went

36:19

out of the window . Anyway , I

36:21

never had any intention of having a home

36:23

birth . That was never a discussion . I was actually

36:26

very comfortable with the idea of hospital

36:29

birth . Anyway , I was intending

36:31

or planning to have hospital birth

36:33

, ideally a water birth , but

36:35

that would unlikely

36:37

have been granted , even if not for the hypertension

36:40

, because of policies around

36:42

water births and weight . But I

36:44

did have a birth preferences conversation

36:47

I had . I was in and out of hospital stays

36:49

to try and get

36:51

the medication at the right level to manage

36:53

it . My midwife still

36:55

had a birth preferences conversation with me

36:57

. So I checked out of hospital

36:59

one day and came home

37:01

and think I had the conversation later that day with

37:04

my midwife , came to my house

37:06

but we could talk through what the options were at

37:08

that point . Obviously , induction had been spoken

37:10

about , uh , quite extensively

37:13

on when I was on the hospital

37:15

ward and I was very against

37:17

induction . So I was very

37:19

much of the mindset that if my baby

37:22

wasn't choosing to come out and

37:24

there was a medical reason why my baby

37:26

needed to be delivered with any sense of immediacy

37:28

, then that would be the cesarean , because

37:31

to my mind I don't see how an induction

37:34

really is about dealing with

37:36

an emergency delivery situation

37:38

, given that they can take so long . So

37:40

for me those were kind of my thresholds was

37:43

that unless I went into labour naturally

37:45

and my baby was obviously ready to come , then

37:48

cesarean was the only route that I was willing

37:50

to discuss as

37:52

the alternative delivery , I guess

37:54

. So I did have hard lines around

37:57

what I did and didn't

37:59

want , and when I had the same

38:01

discussion , I guess , with my midwife , we obviously spoke

38:04

about the pain options

38:06

and what I might or might not

38:08

want to consider , and I'd done an NCT

38:11

class , albeit entirely online also

38:13

, with another group of expectant parents

38:15

, so kind of . I had enough

38:18

knowledge about all of those processes

38:20

and the kind of delivery things anyway and

38:22

all the different pain medications and the different

38:24

phases of labor and things like that . But

38:26

yeah , I guess I had quite a hard line on

38:28

it's a , it's a natural kind

38:31

of own accord or if

38:33

it's that emergency , then a cesarean

38:35

is the way we'll need to go .

38:36

Then I guess , and it we

38:38

did end up with a cesarean , the

38:41

timing of which , yeah

38:44

, for the days leading up to my cesarean they'd

38:46

everything had remained pretty stable , but there was a fear

38:48

about allowing me to go over the weekend , and

38:51

then they're not being more senior staff , so

38:54

friday delivery it was by

38:56

cesarean yeah

38:59

, I'm interested in that

39:02

and whether you felt that choice

39:04

was respected , because we

39:06

can often think about restrictions in

39:08

terms of being allowed

39:11

in inverted commas to use

39:14

birth centre or have midwifery

39:16

led birth or home birth , but

39:19

in the kind of modern

39:22

era where we

39:24

accept maternal

39:27

request or maternal wishes

39:29

as being a valid reason for

39:31

a cesarean birth . I

39:35

do remember the first time a

39:37

higher weight woman came

39:40

and asked me for a cesarean

39:42

because that's what she

39:44

wanted . And

39:46

I mean , just

39:49

to be clear , she she had the cesarean

39:51

she wanted . Yes , it did

39:53

give me pause for

39:55

a moment , suddenly thinking

39:57

well , some of

39:59

the complications are potentially

40:01

higher for this woman . Yeah

40:04

, such as wound infection , maybe

40:06

, or deep vein thrombosis . Yeah

40:13

, such as wound infection , maybe , or deep vein thrombosis . And I did

40:15

have to kind of sense , check in my head that this was still a valid choice

40:17

for her , just otherwise

40:19

I would be discriminating against

40:22

her on account of her being

40:24

higher weight . Yeah , you know , and

40:26

I think that's something I had to consciously

40:28

wrap my head around . I mean , it's quite a few

40:30

years ago now , I'm pleased

40:32

to tell you , but I can't

40:34

imagine that I'm the only obstetrician

40:38

that has perhaps suddenly thought

40:40

oh , actually

40:42

, that needs to be

40:44

a valid choice , just in the same way as if a woman of

40:46

higher weight asks me for a home birth . That has to be a valid choice . Just in the same way as if

40:48

a woman of higher weight asked me for a home birth . That has

40:50

to be a valid choice .

40:52

Yeah yeah

40:54

, I mean , you know , I guess it is an

40:56

interesting conundrum . I guess

40:58

for me my choice

41:00

wasn't cesarean , my choice

41:02

was that I wanted a natural birth

41:05

. My choice would have been a

41:07

water birth . But that choice probably

41:09

would not have been available to me even if I

41:11

had gone down the perfectly straightforward

41:13

, boring pregnancy route . So

41:17

I think that the challenger

41:20

sticking point came , that I was comfortable

41:23

, I guess , in continuing with

41:26

pregnancy as it was , but my

41:28

medical team weren't comfortable

41:30

, and so this sticking

41:33

point then came around induction versus

41:35

cesarean . And I

41:38

know that there's a higher incidence

41:40

of cesarean from induction

41:43

. I just turned 37

41:45

weeks pregnant at the point at which

41:47

I had my cesarean . I

41:49

was very clear about it , but I would say that

41:52

a number of different staff did

41:54

keep seem to taking it in turns to

41:56

just double check about my response

41:58

to the induction question

42:01

. So I did face a

42:03

number of different people coming in to

42:05

have the discussion around . We

42:08

need to talk about induction yeah

42:10

my response being well , we don't

42:12

, because I'm not going to have one yeah and

42:14

and that kind of being a bit of a hard

42:16

line , uh sticking point

42:18

of I'm happy

42:21

for my baby to stay where it is . So

42:23

if you're not happy for my baby to stay where it

42:25

is , then it seems like we're gonna have to talk about

42:27

a cesarean yeah and so that was kind of

42:29

the sticking point I guess for me , like I'm happy

42:31

my baby is where it is . I'd I've

42:33

been having the extra doppler scans and blood

42:35

flow was fine . You know , as I say , my um

42:39

blood pressure in the days the

42:41

I guess four or five days , which

42:43

had been the longest period it had stabilized . In the two-week

42:46

period that this had kicked off , um had

42:48

in effect stabilized , but there was

42:50

just that fear of if it became unstable

42:52

, I guess . So for

42:54

me I was like I'm happy for my baby to stay where

42:56

my baby is and they weren't

42:58

. So that was kind of the but

43:01

yeah , I definitely had numerous

43:03

conversations about

43:06

induction , but that was very

43:08

much my red line of no , we

43:10

don't need to talk about that , I won't be having one

43:13

.

43:13

Yeah , I definitely recognize that

43:15

. Just checking , repeatedly , just checking

43:17

thing , yeah , I'm

43:19

sorry to say that that does that

43:22

absolutely is something

43:24

that I think we do . Yeah

43:28

, it's . It's difficult , isn't it , to get the

43:30

right balance between making sure

43:32

it's a really well informed decision

43:34

and then constantly challenging

43:37

someone's decision .

43:38

Yeah , so for me I had raised concerns

43:41

around , you know

43:43

, for induction I had concerns

43:45

about epidural and the

43:48

positions that my legs may have to be held

43:50

in and what that could mean , because

43:52

I wouldn't be able to feel pain or if my

43:54

joints were being pushed too far or if I was

43:56

in a position for an extended period that I couldn't

43:58

recognize that my body was actually in

44:01

pain because of my hypermobility as well . I guess

44:03

I'm more aware of that and

44:05

so those things were my concerns

44:07

and I did raise those as the concerns

44:09

of these are the reasons why I have these

44:11

concerns . It's

44:14

interesting because I'd had the birth preferences

44:17

conversation with my midwife and

44:19

she was really supportive of , like

44:21

, the reasonings that I was giving and that

44:23

I had reasons . And

44:26

you know I'd thought about why I

44:28

had these concern . You know , I guess

44:30

it was difficult because there'd been points where

44:32

I had raised questions or concerns around

44:35

, you know , being hypermobile up until that

44:37

point anyway and they'd always been dismissed

44:39

and even in trying to have the

44:41

discussion at that point there wasn't much

44:44

in the way of attempting to provide reassurance around

44:46

that specific concern

44:48

or issue . But I definitely

44:50

had the conversation as well where I

44:52

was made aware of the higher risk of infection

44:54

with my wound and

44:57

you know anesthesiologists discussions

44:59

as well about the ease of that and things as well

45:01

, and so all of the

45:03

risks associated with cesarean were

45:05

also obviously raised and discussed as well

45:08

. But on balance I had kind

45:10

of other concerns around

45:12

induction and

45:14

also just wasn't convinced that they don't end up in cesarean

45:16

anyway . So all of the things to attempt to put me

45:19

off a cesarean that would ultimately

45:21

be forgotten about if a cesarean was determined

45:23

and needed we're

45:26

just a bit like . Well , there's

45:28

scenarios in which you'll completely ignore all

45:30

of these concerns too , so I don't know

45:32

why I'm going to put them at the forefront of my mind excellent

45:36

.

45:37

Yeah , I

45:39

would like to know a

45:41

bit . So , jenny , in terms

45:43

of you , you've kind of talked

45:45

about some protective things , some

45:47

things , that good things that

45:49

we could do as as health professionals

45:52

. Um , so we've talked about quite a lot

45:54

of negative things . Now , what

45:57

are some good things that people could

45:59

think about or that

46:01

you've discovered ?

46:03

yeah . So I don't think you'll be surprised

46:05

to hear . But what people really value

46:08

are individualised care

46:10

. There's this expression

46:12

I read a couple of times women feeling

46:15

invisible behind the very visibility

46:17

of their bodies . So we just see this kind

46:20

of person who's a higher weight , not

46:22

actually their aspirations and

46:24

who they are , so being seen as a person , a human

46:26

being , connecting with them , individualizing

46:29

their care . Um , the

46:31

evidence also showed a few women spoke

46:33

about kind of didn't necessarily call it continuity

46:35

, but seeing the same midwife or

46:37

even the same doctor , it was more commonly the midwife

46:40

they found really helpful because

46:42

they didn't have to start that conversation

46:44

, as with any issue or whatever you know it

46:46

was , it was there , it was understood and

46:48

it would have been spoken about and

46:52

a kind of protective factor that a couple

46:54

of the studies talked about . About midwives , this is

46:56

more around the birth , but they're kind of like a birthing bubble

46:58

, kind of supporting them . For

47:01

these examples they were , um vaginal

47:04

births they weren't well , I think they're in a midwife led

47:06

unit , but being really supportive

47:08

and kind of supporting what their bodies

47:10

could naturally do in those situations

47:13

to birth their baby . And the women themselves

47:15

felt really empowered at the end of that and really

47:17

kind of proud of themselves

47:19

but also really recognized that support those

47:21

health care professionals had given . So

47:24

I think , yeah , individualized care , not having

47:26

we talked before about those kind of preconceptions

47:29

and judgments people might bring about what

47:32

we might expect someone of a high weight

47:34

to have in terms of their pregnancy or their birth , but kind

47:36

of leaving that to one side , I suppose , addressing your

47:38

implicit beliefs , which we all

47:40

hold , don't we ? And leave them at the

47:42

door , so to speak , and kind of talk to the person

47:44

one to one and being open to

47:46

as Catrina's friends

47:48

heard , and they're open to it being really boring

47:51

. And as a midwife I used to like saying this

47:53

is gonna be , hopefully again , really boring , really mundane

47:56

, not mundane , but you know nothing's going to happen

47:58

because it's all just going to kind of go along smoothly

48:01

, as we hope , and not kind of , yeah , not

48:03

sowing seeds of doubt . But

48:06

of course you know we have to talk about

48:08

certain aspects of what

48:11

pregnancy might bring . You know what someone might

48:13

bring to their pregnancy . So it's not , it's not to

48:15

shy away from

48:17

conversations . Again being direct and honest

48:19

and open and , florence , when you were

48:21

asking earlier to catch her , and what should

48:24

you say ? Or what should one say to

48:26

a woman who comes to a clinic because

48:28

she is a higher weight ? And I think being really

48:30

honest about you know you being

48:32

really honest and transparent with that individual , that

48:34

woman , you know you've come here

48:36

because because the

48:38

evidence I've read women don't always know

48:40

why they appear at consultants

48:43

rooms or even there's studies

48:45

around weight management services another expression

48:47

I don't like but I don't even know why they've

48:49

they've attended this clinic because

48:51

it's all been hidden , because everyone's a bit embarrassed

48:54

about it . So it's being

48:56

open and honest and being more

48:58

nuanced around the around the evidence . I think

49:00

if we just say your risk is higher or

49:04

you know your risk is double , that says nothing

49:06

. So I think definitely being honest

49:08

about we don't actually know this . There

49:10

is some evidence that says it

49:12

goes from a 0.5% risk to a 1%

49:15

risk , but that's still you know it's not

49:17

scaring people with statistics and

49:20

being informed as a professional yourself

49:22

, so you're not just repeating not

49:24

very well explained risks which

49:28

I think we're all guilty of at times . You know becoming

49:31

the expert so you can

49:33

give good guidance and good

49:36

advice .

49:37

That makes sense . Catriona , you were

49:39

nodding away there . Do you want to add

49:41

to that ?

49:42

Yeah , there is something interesting , I think , in

49:45

what Jenny said about being invisible whilst

49:47

also being so visible based on

49:49

your size , yeah , is

49:52

that it's not a secret

49:54

to a higher weight person that

49:56

they are a higher weight . They

49:59

know they have mirrors in their home

50:01

, they buy the clothes that they wear , so

50:03

they know their size . So

50:05

it is a challenging thing , I think , to

50:08

you know , I don't think there

50:10

is that sense of let's just

50:12

pretend that's not a thing . But I think

50:14

being open about the reason

50:16

that you're here , there's probably more than

50:18

one tick that went into the boxes

50:20

to justify it and to then just

50:22

create space to say these are the things and

50:25

these are why you're here . Everything else

50:27

if that for that person , everything else

50:29

is falls entirely within the normal

50:32

spectrum , it's very much a so

50:34

, unless anything special happens

50:36

, we'll just have a

50:38

nice chat every time you come in . So I

50:40

think just that openness of why someone

50:42

is there , I don't think anyone

50:44

should shy away from it in the sense

50:46

of these are the reasons

50:49

and you know , yes , there may

50:51

be some people that will get really combative

50:53

. You know who've done their research and might

50:55

know that it's like well , what are these based on and what studies are these ? You know

50:57

who've done their research and might know that it's like , well , what are these based on and what studies are these about ? You know , I'm sure there are patients

50:59

that might try that Maybe

51:01

I read some stuff . But

51:03

you know , there's just that sense of you

51:06

know some people will want to rail

51:09

against the pathway or the

51:11

reason that they've been referred as well

51:13

. So I think if that's

51:15

kind of the opener as well , you'll be able to kind of

51:17

have that discussion up front too , because

51:19

the person who is sceptical

51:21

of it all can then share their

51:23

scepticism , and you as a

51:26

professional may also

51:28

have some scepticism of your own . You don't necessarily

51:30

just say , oh yeah , I know these are just guidelines

51:33

and we're just having to follow them . We're all in the process . You

51:39

know , it's not that there's an expectation of that . It's just that sense of saying , yeah , I

51:41

can understand that these are based on studies and particularly in your first pregnancy , you definitely

51:44

couldn't have been part of them . So it's not about

51:46

you , it's actually just about numbers

51:49

. But you're a person and

51:51

, okay , let's work with you through

51:54

your pregnancy . Um , so yeah , I

51:56

think that openness , probably at the beginning

51:59

, would be a more , a more

52:01

positive opener in my , in my

52:03

opinion , but I don't know , maybe there would still

52:05

be people that found it incredibly confronting to be told

52:07

that that's the reason that they've got

52:09

this referral .

52:10

But I suppose that's something that

52:12

can then at least be gauged or understood

52:15

from that starting point , if that's how it opens and

52:18

I think , also remembering people can decline

52:20

, decline appointments , decline to

52:22

be weighed , decline a glucose tolerance test

52:24

, and not again , not shame

52:26

them into making an informed choice about

52:28

what they want to do their pregnancy . When you

52:31

work for you know the nhs you're so kind

52:33

of used to these conversations , aren't

52:35

you ? And what ? We know what the expectation

52:37

is . Sometimes we're a bit flawed if someone

52:39

says no . And again

52:41

, you know , catriona's , the kind

52:43

of point you're making really nicely about how

52:45

you kept having healthcare . You know doctors or midwives

52:47

, whoever it was , coming through your door saying are

52:49

you sure ? Are you sure ? And it's kind

52:51

of you shouldn't have had that

52:53

. I don't think they could have been documented in your

52:56

notes . Catriona is sure ? Or

52:58

maybe whoever spoke to you first would say

53:00

someone will ask you one more time and

53:03

you can have that discussion . But

53:05

we should allow people to decide and

53:07

not infantilise them by thinking

53:10

we know best . So allow people not

53:12

to be weighed , not to have a test , that's fine

53:14

, as long as they understand asja

53:16

only said the the rationale behind

53:18

it . As much as we know , from

53:20

as much evidence as we know , we people

53:22

can make their own choices and sometimes

53:24

we forget that .

53:25

I think yes

53:27

, I agree with you

53:30

. I think sometimes we tiptoe

53:33

around a bit and I

53:35

find it a big relief when a

53:37

woman will say to me well , I'm here

53:40

, you know , because of this , or I

53:42

know my body's this , that and the other , or I

53:44

know I might look like this , but actually I

53:47

run , or you know , whatever they challenge

53:49

my assumptions , and it makes it

53:51

much easier to have a conversation than if

53:53

we're all kind of ignoring

53:56

or tiptoeing around it . So

53:58

I think the advice you've given

54:00

there , catriona is , is

54:02

really helpful , even

54:04

though it sounds so basic . We

54:07

need it , I think . Jenny

54:11

, in terms of research

54:13

, are you still looking for people to

54:16

contribute and , if so

54:18

, how do they do that or how do they get in touch

54:20

?

54:21

Yeah , I'd love to kind of speak to a couple

54:23

more women . I particularly would be

54:25

interested to speak to someone of South

54:27

Asian heritage , because I've not spoken

54:30

to anyone from that background

54:32

. So that would be great if anyone could get in

54:34

touch . The university email

54:36

address I'm also on twitter called

54:39

x , and instagram as

54:41

jenny midwife or phd jenny

54:43

midwife , so you can find me there . I've

54:46

, having done this kind of review as I spoke about

54:48

before , I'm now interviewing people hopefully

54:51

three times twice in pregnancy and once physically

54:53

to find out about their experiences

54:55

. And I've interviewed 10

54:58

people so far , which is great . Someone

55:00

more than once and everyone

55:02

has a very different experience , as you can imagine . But I

55:04

think common throughout is it's anticipated

55:07

fear

55:09

is perhaps too strong word , but that expectation

55:11

they're going to be kind of told off or have

55:14

weight discussed or be embarrassed , so

55:16

that's that's common throughout . All that kind of told off or have weight discussed or be embarrassed , so that's that's common throughout . All

55:18

that kind of planning the next appointment

55:20

or planning the first appointment comes up a lot

55:22

. The scan I've already mentioned that

55:24

. That comes up quite a bit . Checklists

55:27

of risks that

55:29

seems to be quite a common theme too . So maybe

55:31

not a great discussion but kind of ticking off

55:33

a list of things we . The risk we've talked about

55:35

and actually

55:38

interesting , certainly haven't but we've touched on

55:40

is a lack of discussion about

55:42

where to have the baby . It

55:44

seems to me and I don't know if this just

55:46

generally happens , you know , because

55:49

time's so tight at

55:51

the moment in the NHS with appointment

55:53

times but

55:55

I'm being told that women have

55:57

themselves have to initiate where I might

55:59

have my baby . Again , whether it's to do with

56:01

someone's high weight and the midwife

56:04

isn't sure , the doctor isn't sure , and

56:06

I spoke to someone the other day . She was actually in active

56:08

labour before she was

56:10

told definitely she could birth in the midwife

56:13

led unit . She kind of asked and asked and

56:15

so she actually was in hospital

56:17

in active labor and then got there . So there's

56:19

something about putting off those discussions

56:22

which kind of interests me . So we'll see if that continues

56:24

.

56:25

So yeah , I'd love to talk to two

56:27

or three more people if they're interested that's

56:30

fine , and I can put all those links

56:33

and things in the in the show notes

56:35

. So I think

56:37

I've probably taken up enough

56:39

of your time . So we're kind of coming

56:41

to the end and I normally end with

56:43

a zesty bit , a bit the kind

56:45

of real essence key bit that

56:48

we want people to remember from our conversation

56:51

. And my audience is

56:53

mixed , so we have midwives

56:55

, student midwives , obstetricians listening

56:57

, but also women and birthing

56:59

people themselves . So it

57:02

may be the same for both of them or it may

57:04

be that there's a different one for

57:06

each group . I

57:08

think what I'm going to take away is

57:11

higher weight as a phrase

57:14

. That's really very

57:16

simple , but something that immediately

57:18

I think I can use in opening

57:21

up the conversation in my clinic by

57:23

saying one of the reasons

57:25

you've been sent to see me is because you're

57:27

of higher weight . Let's

57:29

talk about that . What do you know about that ? You

57:32

know , but also , what

57:34

do you want to talk to me about today

57:36

? You know that's one of the things I need

57:38

to talk to you about . But what do you want to

57:40

talk to me about ? Because I'm really taking

57:43

on board what Catriona has said about

57:46

. Actually that wasn't what she wanted to talk

57:48

about . So so

57:50

have either of you got , or you

57:52

can have your own zesty bit or

57:54

a joint zesty bit , depends what

57:57

. What do you think you really want people to remember

57:59

? Perhaps if we start with katriana

58:01

?

58:02

I guess the takeaway or the wraparound

58:04

for everything is that maybe

58:07

let's not approach everything

58:09

as if there's a problem before

58:11

there's a problem . That's nice

58:13

so yeah , let's

58:15

go into things . Until

58:18

there's a problem , there is no problem and

58:21

, and maybe that's the the easiest approach

58:23

to take things with and to to

58:26

be able to have those safe and neutral

58:28

discussions that allow people

58:32

to listen and also to

58:34

be heard , I guess .

58:35

I think that's a really good point . Taking

58:38

out of it being

58:40

higher weight in itself is

58:43

not a problem .

58:45

Yeah , until a problem happens

58:48

, yeah , which may or may not be related

58:50

, might be something completely different exactly

58:53

, and I think it's that that point

58:55

as well , about let's not

58:57

treat something as a problem until it's actually a problem is also

58:59

um , I guess that's also

59:02

the advice I should have given to myself in

59:04

going into those appointments , as well as these kind

59:07

of anticipations and assumptions of

59:09

how it was going to be . I

59:11

was having that before it had happened . So

59:14

it's it's not just about practitioners

59:16

approaching it as a until there's

59:18

a problem , let's not think there's a

59:20

problem .

59:21

I think that's how most women learned . You

59:24

know , when they first had their midwife , they'd have had appointments

59:26

, negative appointments

59:29

, probably throughout their lives yeah

59:31

, I think it's just that challenge .

59:32

Isn't it to yourself that it's like ? If you expect

59:34

a healthcare professional

59:37

to treat you as an individual , perhaps

59:40

we also need to treat them as individuals

59:42

and not assume that they're coming in with

59:44

the same baggage and opinions

59:47

and load as another health practitioner

59:49

has brought into the room when you've seen

59:51

them , so it's . I know that obviously

59:54

there's a system that everyone exists within

59:56

, but right now I'm speaking to an obstetrician

59:58

and a midwife that both don't necessarily

1:00:01

subscribe to that system . So you

1:00:03

know , it's also a lesson to think about from

1:00:06

a user's perspective . If

1:00:09

I want to be treated as an individual , maybe I'll just

1:00:11

approach appointments as I don't know this

1:00:13

person . I've not met this person yet . I don't know what their

1:00:15

opinion or approach with me is . So

1:00:17

until there's a problem , there is no problem

1:00:19

.

1:00:21

I like that .

1:00:22

I like that too .

1:00:23

Thank you that , I'll write that

1:00:26

do you

1:00:28

want to add anything to that , jenny , or

1:00:30

is that the last word , do you think ?

1:00:33

I mean I was , I would have said in a different way , but I liked

1:00:35

Catriona's way far better . It's , yeah

1:00:37

, seeing the person

1:00:39

be , you know , human to human connection

1:00:42

, seeing the person for who they are and their

1:00:44

hopes , and don't prejudge . Catriona

1:00:46

says it much better than I do . She

1:00:51

always does excellent

1:00:54

.

1:00:54

Well , thank you both very , very

1:00:56

much . I think that's been

1:00:59

a really interesting conversation which

1:01:01

will hopefully give people lots to think

1:01:03

about and hopefully

1:01:05

have some better conversations

1:01:07

and more holistic

1:01:10

conversations with less assumptions

1:01:13

.

1:01:13

So thank you both very , very much

1:01:15

thank you , it's been

1:01:17

really great to talk to you .

1:01:20

I very much hope you found this episode

1:01:22

of the OBS pod interesting . If

1:01:25

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1:01:27

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1:01:30

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1:01:32

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1:01:34

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1:01:36

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1:01:38

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1:01:41

. There's also tons of

1:01:43

episodes to explore in my back

1:01:45

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1:01:47

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1:01:50

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1:01:52

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1:01:55

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1:01:57

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1:01:59

very seriously and

1:02:02

take great care not to use any

1:02:04

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1:02:07

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1:02:09

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1:02:11

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1:02:14

rare occasion when it's been absolutely

1:02:16

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1:02:19

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1:02:21

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1:02:24

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1:02:26

, don't forget to take a

1:02:28

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1:02:31

I've attached some links . If

1:02:33

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1:02:35

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1:02:38

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