When Zena Mason was preparing to conceive her youngest child, the last thing she thought she would need was a “bikini body”.
But the Brisbane mum of two children, aged six and 18 months, said that’s exactly how she felt after a series of demoralising appointments with healthcare professionals.
“I would always be chastised about my weight, even before pregnancy,” Ms Mason said.
“I felt like every time I was going to a midwife appointment that I was going to a Weight Watchers meeting.
“Most of the time, I was like, ‘I’ve got to get a bikini body before I fall pregnant’ … I was waiting for the perfect body to fall pregnant.”
Having previously had a medical termination at 22 weeks and then a miscarriage, Ms Mason was already apprehensive about what she considered her “very final chance”.
She said a preconception appointment was almost the end of her family dreams.
“I felt like [the doctor] blamed me and my body size for the reason I had pregnancy losses,” she said.
The 35-year-old’s BMI (body mass index) placed her in the overweight category, so she was referred to a dietician.
The impact of stigma
Ms Mason’s experience is one of 10 cases from across Australia as part of a pilot study.
In the next phase, up to 100 women will be involved in the research to develop best practice guidelines for weight-inclusive maternity care.
Bec Jenkinson from the University of Queensland’s School of Public Health said it was a vital piece missing from current policies.
“We’ve heard about how often women with larger bodies experience stigmatising interactions with healthcare professionals,” Dr Jenkinson said.
“It’s not because they set out to shame or blame the women — it’s more about the systems and policies that are in place.
“But when a woman is in a larger body, they [healthcare professionals] don’t have the tools or confidence to engage in that conversation in an affirming and encouraging way without provoking stigma.”
Alka Kothari from the Australian Medical Association Queensland (AMAQ) agreed things needed to change, but she said the situation was complicated.
“We know that women in larger bodies, there’s lots of factors that contribute to this — childhood experiences, mental problems and financial hardship,” Dr Kothari said.
“Then there’s feelings of guilt and shame associated with living in a larger body and [the women] don’t feel empowered enough to seek health care, they don’t feel confident going to hospital to have a discussion about their choices in delivery.
“And that can affect their quality of care.”
Data from the Australian Institute of Health and Welfare shows 51 per cent of pregnant women in Australia in 2021 were above the “normal” weight range.
Dr Kothari said it increased the risk of maternal and neonatal complications.
“Gestational diabetes, pre-eclampsia, pre-term delivery, organs not forming properly,” she said.
“Unfortunately, these women tend to have a difficult pregnancy and birth.”
A focus on weight, not patients
As the lead researcher, Dr Jenkinson said the current focus on weight in maternity care was causing immense distress to expectant parents.
“Some women have been encouraged to lose weight during pregnancy and that steals their joy,” she said.
“Rather than pregnancy being an opportunity to marvel at what your body can do, it became a time when they felt blamed and that they failed as a mum before their baby was even born.”
Zena Mason said that was exactly how she felt.
“I’ve been devalued as a person because of my size … I was made to feel like I was basically inadequate, that I couldn’t do anything with my own body,” she said.
“We need to recognise the unintended harm of weight-centric care.”
Dr Jenkinson said the qualitative research would include negative and positive experiences, as well as focus on regional areas, where some women were forced to leave home to give birth in the city because of their size.
“A person’s health isn’t defined by what the scales are saying… this is a turning point about maternity care for larger bodied women,” she said.
Developing non-discriminatory care
Dr Jenkinson said while poor outcomes were widely known, there needed to be a better understanding of them.
“What if we come at this from a weight stigma point of view… what is the contribution of weight stigma to those poor outcomes?” she said.
“If we can improve that, do their outcomes improve as well?”
Both Dr Jenkinson and Dr Kothari agreed language around weight needed to change.
“Our maternity care practice must be non-discriminatory and patient-centric,” Dr Kothari said.
“We need to support and train health care professionals to develop communication skills that enable positive and non-judgemental discussions about weight.”
Dr Jenkinson said she hoped the guidelines would be completed within two years and would be co-designed by women with lived experiences, doctors, midwives and policy makers.