University of Huddersfield Repository Iyekekpolor, Maria E. The Antenatal Care Experiences of Overweight Pregnant Women in the UK Original Citation Iyekekpolor, Maria E. (2016) The Antenatal Care Experiences of Overweight Pregnant Women in the UK. Doctoral thesis, University of Huddersfield. This version is available at http://eprints.hud.ac.uk/id/eprint/34176/ The University Repository is a digital collection of the research output of the University, available on Open Access. Copyright and Moral Rights for the items on this site are retained by the individual author and/or other copyright owners. Users may access full items free of charge; copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational or not-for-profit purposes without prior permission or charge, provided: • The authors, title and full bibliographic details is credited in any copy; • A hyperlink and/or URL is included for the original metadata page; and • The content is not changed in any way. For more information, including our policy and submission procedure, please contact the Repository Team at: [email protected]. http://eprints.hud.ac.uk/ THE ANTENATAL CARE EXPERIENCES OF OVERWEIGHT PREGNANT WOMEN IN THE UK MARIA E. IYEKEKPOLOR A thesis submitted to the University of Huddersfield in partial fulfilment of the requirements for the degree of Doctor of Philosophy The University of Huddersfield November 2016 Copyright statement i. 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Such Intellectual Property Rights and Reproductions cannot and must not be made available for use without the prior written permission of the owner(s) of the relevant Intellectual Property Rights and/or Reproductions 2 Abstract The current position of the World Health Organisation (WHO, 2014) is that there is a threat of a global “obesity epidemic” (Boero, 2007, p.1); and existing studies in the UK report that a 5th of pregnant women are overweight. This has created increased scrutiny of fatness and weight, especially in pregnant women. The concern about obesity and pregnancy outcomes also contributes to the National Institute for Health Care Excellence (NICE, 2010), recommending that the antenatal care delivered to overweight pregnant women should be within the guidelines of a high-risk pathway of antenatal care. This has increased the medicalisation of the care for overweight pregnant women. The aim of this study is to explore the experiences of overweight pregnant women in relation to their heightened medicalised antenatal care. Using a social constructionist approach and a Foucauldian interpretive lens, semi-structured face-to-face interviews were used to collect data from 12 women who were between 16 and 30 weeks pregnant, 6 midwives who provide antenatal care for them, and 3 obstetricians to whom women are referred. The data were analysed using thematic analysis. The findings show that pregnant women do not identify with being ‘obese’ and perceive themselves as being overweight but healthy. Key themes that emerged from the data describing women’s perception of heightened antenatal care are: their understanding of risk and risk perception, the power of science and how it constructs their maternal health and the power of obstetricians justifying medical interventions in pregnancy and childbirth. This study creates and contributes to the awareness of how overweight pregnant women who are healthy experience antenatal care. It explores the need of overweight pregnant women, and identifies changes that need to be made to positively enhance how these women experience pregnancy and childbirth. These findings need to be considered by policy makers, individuals in practice and those with a role in educating health care practitioners so that overweight pregnant women are provided the appropriate antenatal care. 3 Table of Contents Abstract .............................................................................................. 3 Table of Contents................................................................................. 4 Dedications ........................................................................................ 10 Acknowledgements ............................................................................. 11 List of abbreviations ............................................................................ 13 Chapter 1 .......................................................................................... 14 Background to the research ............................................................... 14 Introduction .................................................................................. 14 Rationale ...................................................................................... 25 Gaps in existing literature ............................................................... 25 Aims and objectives ....................................................................... 26 Aims ............................................................................................. 26 Objectives ..................................................................................... 26 Research Approach ......................................................................... 27 Terminologies ................................................................................ 29 Thesis structure ............................................................................. 30 Chapter 2 .......................................................................................... 33 Biomedical constructions of maternal fatness ....................................... 33 Antenatal care offered to pregnant women with high ‘BMI’ in the UK .... 34 A critical understanding of Body Mass Index (BMI) ............................. 37 Risk construction within healthcare/practices ..................................... 43 Perceptions of risk within antenatal care ........................................... 46 Media constructions of fatness ......................................................... 56 Accounts of maternal responsibilities ................................................ 62 Risk discourse: the birthing of large babies ....................................... 64 Overweight Pregnant women – a “Burden on the NHS?” ...................... 66 Communicating risks in antenatal care .............................................. 67 Governance and the medicalisation of pregnancy and childbirth ........... 70 Choice and birthplace in antenatal care ............................................. 74 Conclusion .................................................................................... 81 Chapter 3 .......................................................................................... 83 4 Body size and antenatal care: Power, Knowledge and Surveillance ......... 83 Introduction .................................................................................. 83 Understanding the political context ................................................... 83 Constructions of power in a clinical healthcare setting. ........................ 86 Power and Knowledge ..................................................................... 86 Surveillance................................................................................... 88 Bio-Power ..................................................................................... 89 The clinical gaze ............................................................................ 90 Maternity system culture ................................................................. 93 Stigma .......................................................................................... 98 Maternity Care Policies .................................................................... 99 Culture Perceptions of Fatness (obesity) ......................................... 104 Constructions of maternal Responsibility ......................................... 106 Conclusion .................................................................................. 107 Chapter 4 ........................................................................................ 109 Methodology .................................................................................. 109 Introduction ................................................................................ 109 Research Approach ....................................................................... 110 Philosophical underpinnings ........................................................... 112 Research Process ......................................................................... 116 Gaining