Weight Stigma in Maternity Care: Women’s Experiences and Care Providers’ Attitudes

Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims\u27 psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses

Practicing food anxiety: Making Australian mothers responsible for their families’ dietary decisions

Concerns about the relationship between diet, weight, and health find widespread expression in the media and are accompanied by significant individual anxiety and responsibilization. However, these pertain especially to mothers, who undertake the bulk of domestic labor involved in managing their families’ health and wellbeing. This article employs the concept of anxiety as social practice to explore the process whereby mothers are made accountable for their families’ dietary decisions. Drawing on data from an Australian study that explored the impact of discourses of childhood obesity prevention on mothers, the article argues that mothers’ engagements with this value-laden discourse are complex and ambiguous, involving varying degrees of self-ascribed responsibility and blame for children's weight and diets. We conclude by drawing attention to the value of viewing food anxiety as social practice, in highlighting issues that are largely invisible in both official discourses and scholarly accounts of childhood obesity prevention

Symptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials

Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. Methods We did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. Findings In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. Funding UK Medical Research Council, British Sjogren's Syndrome Association, French Ministry of Health, Arthritis Research UK, Foundation for Research in Rheumatology

From distress to flourishing: towards a strengths-based approach for young mothers

Objective: The current study aims to better understand the predictors of flourishing, as well as the predictors of distress, among first-time Australian mothers in their teens and early 20s in the first year postpartum. Background: Past research has linked early motherhood with poor outcomes for mother and baby. However, other research has demonstrated that disadvantage often precedes early motherhood, rather than results from it, and there has been a consistent body of qualitative research highlighting positive outcomes for young mothers. In this paper, we investigate who is doing well amongst a sample of young mothers. Methods: Through quantitative analysis of survey data of 86 women aged 16–24 years who had transitioned to motherhood in the past 12 months, we investigate the predictors of flourishing, along with postnatal distress. Results: Our findings suggest that this sample of women was doing well, with relatively high scores on flourishing and low scores on distress. As expected, the two constructs were negatively correlated. Conclusion: Whilst self-esteem was a consistent predictor of both distress and flourishing, and acted as a mediating factor, this research also showed that there are unique and independent predictors for distress and flourishing, which can be used to inform tailored programs for young mothers

Qualitative accounts of teenage and emerging adult women adjusting to motherhood

Objective: The aim of this study was to better understand how young women in their early 20s transition and adjust to motherhood in the first year postpartum, compared to teenage mothers. Background: A body of research suggests that teen mothers have unique challenges and experiences adjusting to motherhood. However, less research has focussed on mothers in their early 20s, who have increasingly become a minority in Western countries, and are supposedly adjusting to motherhood in a new developmental period characterised by self-focussed identity exploration and individual freedom. Method: Using a semi-structured interview format, 12 Australian women (mean age 20.5 years; mean baby age 6.5 months) were interviewed, and verbatim transcriptions analysed with thematic analysis. Results: Two broad themes identified were Change within the self and Involvement of others. Some of the early 20s women reported more difficulties with identity adjustment compared to that of teen women, and this appeared primarily related to women’s background and circumstance. Social support was important for all women, while experiences of stigma were common and negatively impacted on women’s adjustment to motherhood. Conclusions: The extent to which first-time mothers in their early 20s experience conflict between responsibilities of motherhood and self-focussed identity exploration appeared to be largely dependent on background and prior circumstances, suggesting that emerging adulthood norms do not consistently apply to these women

Australian women’s experiences of admission to hospital in labour: The implications of strict admission policies that keep patients in the dark.

Background: Admitting pregnant women to hospital while still in early stage labour is associated with higher rates of diagnosis of slow labour progress, obstetric intervention, and resource utilisation. This evidence has prompted policies and guidelines internationally that discourage hospital admission during early stage labour, but such documents typically offer providers little guidance on how to ensure women are informed of the rationale for the practice, feel engaged in individual admission decisions, and feel supported to manage early labour at home. The implications for women's maternity care experiences are poorly understood. Aims: Our objective was to examine women's experiences of spontaneous labour onset and hospital admission in Queensland, Australia. We were particularly interested in better understanding the impact of policies and practices pertaining to timing of hospital admission. Method: We identified and thematically analysed comments pertaining to labour onset and hospital admission that were spontaneously provided by women in a free text box at the end of the Having a Baby in Queensland Survey, which was completed by 7,193 women in 2010. Results: While several themes were identified in women's comments, two were particularly relevant to the impact of admission timing policies and practices. "Unwelcome" described many women's feelings of being turned away from their planned place of birth when seeking care and support in labour. Typically, women's comments suggested little awareness of the reasons underlying such practices. "Non-individualised care" reflected women's frequent comments about providers' disregard of their own knowledge, thoughts and beliefs about their labour, their lack of voice in admission decisions, and receipt of care untailored to their unique needs and preferences. Implications: Strict admission policies that do not provide guidance in ensuring birthing women are informed, involved, and supported may negatively affect their care experiences and their psychosocial well-being, offsetting potential benefits of such policies