Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers?

Objectives  Obese women have lower breastfeeding initiation and maintenance rates than healthy weight women. Research generally focuses on biomedical explanations for this. Psychosocial factors including body image and well-being after childbirth are less well understood as predictors of breastfeeding. In obese and healthy weight women, we investigated changes in body image between 72 hrs post-delivery and 6–8 weeks post-natal, studying how women's body image related to breastfeeding initiation and maintenance. We also investigated how psychological distress was related to body image.  Design  Longitudinal semi-structured questionnaire survey.  Methods  Body image and psychological distress were assessed within 72 hrs of birth and by postal questionnaire at 6–8 weeks, for 70 obese and 70 healthy weight women initiating exclusive (breastmilk only) breastfeeding or mixed feeding (with formula milk) in hospital. Breastfeeding was re-assessed at 6–8 weeks.  Results  Obese women were less likely to exclusively breastfeed in hospital and maintain breastfeeding to 6–8 weeks. Better body image was related to maintaining breastfeeding and to lower post-natal psychological distress for all women, but education level was the most significant predictor of maintenance in multivariate regression including body image and weight status. Body image mediated, but did not moderate the relationship between weight and breastfeeding maintenance. Body image was lower overall in obese women, but all women had low body image satisfaction around childbirth, reducing further at 6–8 weeks.  Conclusions  Health professionals should consider women's body image when discussing breastfeeding. A focus on breast function over form may support breastfeeding for all women

A qualitative exploration of the experiences of clinically very severely obese women during pregnancy and the postnatal period

Very severe maternal obesity (BMI >40kg/m2) increases significantly the risks of poor pregnancy outcomes for both mothers and babies. In light of the limited success of behavioural interventions to date in improving outcomes in very severely obese women, this study sought to gain an understanding of women’s beliefs and experiences regarding weight, health and pregnancy, within the context of their everyday lives.Qualitative serial interviews were conducted with eleven very severely obese women during pregnancy and the postnatal period. Seven partners of the women took part in one semi-structured interview during the woman’s pregnancy. Analysis took place in several stages using a thematic approach. Themes were identified within and between individual women’s accounts, as well as within and between the accounts of members of couples. Participants’ narratives demonstrated the ways in which they navigated the experience of high-risk pregnancy, and stigma emerged as a key theme.This research contributes new knowledge about the complex ways in which women experience ‘very severe obese’ pregnant embodiment, relating to both formal and informal discourses around weight and health in pregnancy. Most undertook ‘moral accounting’ in response to stigma, and several accounts resonated with Monaghan’s (2006) categorisations of excuses, justifications, contrition and repudiation, in both accounting for their weight and in demonstrating their ‘fitness’ for pregnancy and motherhood. Following birth, high levels of motivation to enact behaviour change were expressed, in some cases alongside repudiatory accounting regarding the associated risks and the medicalisation of very severe obesity. Participants experienced a lack of formal healthcare support in the postnatal period. Future approaches to policy and practice should consider ways in which to engage women and partners during pregnancy, exploring ways which in which stigma can be acknowledged and neutralised, in order to provide support and advice during and after pregnancy and birth, and into parenthood

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

“If she wants to eat…and eat and eat…fine! It's gonna feed the baby”: Pregnant women and partners' perceptions and experiences of pregnancy with a BMI >40kg/m2

Introduction: women with a raised BMI are more likely to gain excessive weight in pregnancy compared towomen with a BMI in the normal range. Recent behaviour change interventions have had moderate to noinfluence on GWG, and no effect on other perinatal outcomes. Evidence is required regarding the social andcultural contexts of weight and pregnancy. No studies to date have included the views of partners.Aims: to explore the experiences, attitudes and health-related behaviours of pregnant women with a BMI >40 kg/m2; and to identify the factors and considerations which shape their beliefs, experiences and behaviours,and how these may change during and after pregnancy. 2. To determine the impact, if any, of the beliefs andattitudes of significant members of the women's families and social networks upon the women's experiences,attitudes and health-related behaviours in relation to weight and pregnancyMethods: this was a prospective serial interview study. Semi-structured interviews were conducted with 11pregnant women with a BMI > 40 kg/m2, during pregnancy and after birth, and once with 7 partners (all male)of women. Interview questions were designed to be appropriately but flexibly framed, in order to explore andgather data on participants' everyday life, lifestyles, views, experiences, relationships and behaviours, focussingmore specifically on beliefs about health, pregnancy, weight and diet. Thematic content analysis was used toformally analyse and unearth patterns in the data.Findings: the findings can be grouped into six interrelated themes: the complexities of weight histories andrelationships with food; resisting risk together; resisting stigma together; pregnancy as a 'pause';receivingdietary advice; postnatal intentions. These themes are interrelated due to the 'spoiled identity' (Goffman, 1963)that the large body represents in western culture and related stigma.Conclusion and implications: this study provides evidence that there exist deeply ingrained social and culturalbeliefs among women and in particular their partners, regarding pregnancy diet and weight gain. Further, thisstudy provides evidence that male partners may resist stigmatised risk on behalf of a pregnant partner. Allwomen (and several men) expressed an intention to adopt healthy behaviours and lose weight once their babywas born. Further evidence is required regarding the means by which women who experience stigmatised riskduring pregnancy, and their partners, might be engaged and receptive to health advice. Models which draw onideals of relationship-centred care, and selfefficacy via open discussion with women and families, engagingwomen and partners by providing them with an opportunity to talk about their beliefs and concerns, could beexplored to inform future research and practice

“We Should Be Working Together, and It Felt like They Disrupted That”: Pregnant Women and Partners’ Experiences of Maternity Care in the First UK COVID-19 Pandemic Lockdown

Pregnant women were identified as being at elevated risk from COVID-19 early in the pandemic. Certain restrictions were placed upon birth partners accompanying their pregnant partner to in-person maternity consultations and for in-patient maternity care. In the absence of a central directive in England, the nature of restrictions varied across maternity services. Eleven participants (seven pregnant women and four partners), who were expectant parents during the first UK COVID-19 pandemic lockdown, took part in serial interviews in pregnancy and the postnatal period. Data were subject to a reflexive thematic analysis. Four main themes were identified, with sub-themes: uncertainty and anxiety (uncertainty and anxiety about COVID-19, uncertainty and anxiety about maternity services); disruption of partnering and parenting role; complexity around entering hospital spaces (hospitals offering protection while posing threat, individual health professionals in inflexible systems); and attempting to feel in control. Separating couples may result in disruption to their anticipated roles and significant distress to both partners, with potential impacts for mental health and future family relationships. Trauma-informed perspectives are relevant for understanding parents’ experiences of maternity care in the pandemic and identifying ways to improve care to promote and protect the mental health of all parents

“We Should Be Working Together, and It Felt like They Disrupted That”: Pregnant Women and Partners’ Experiences of Maternity Care in the First UK COVID-19 Pandemic Lockdown

Pregnant women were identified as being at elevated risk from COVID-19 early in the pandemic. Certain restrictions were placed upon birth partners accompanying their pregnant partner to in-person maternity consultations and for in-patient maternity care. In the absence of a central directive in England, the nature of restrictions varied across maternity services. Eleven participants (seven pregnant women and four partners), who were expectant parents during the first UK COVID-19 pandemic lockdown, took part in serial interviews in pregnancy and the postnatal period. Data were subject to a reflexive thematic analysis. Four main themes were identified, with sub-themes: uncertainty and anxiety (uncertainty and anxiety about COVID-19, uncertainty and anxiety about maternity services); disruption of partnering and parenting role; complexity around entering hospital spaces (hospitals offering protection while posing threat, individual health professionals in inflexible systems); and attempting to feel in control. Separating couples may result in disruption to their anticipated roles and significant distress to both partners, with potential impacts for mental health and future family relationships. Trauma-informed perspectives are relevant for understanding parents’ experiences of maternity care in the pandemic and identifying ways to improve care to promote and protect the mental health of all parents