Adelson BM Dwarfs: The changing lives of archetypal ‘curiosities’—and echoes of the past. Disability Studies Quarterly. 2005; 25:(3)

Arden MA, Duxbury AMS, Soltani H Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums. BMC Pregnancy Childbirth. 2014; 14:(1)

Berg M Choose sensitive, accurate terms. Healthy Weight Journal. 1998; 12:(1)

Boskin J, Dorinson J Ethnic humor: subversion and survival. American Quarterly. 1985; 37:(1)81-97

Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry VLondon: The Stationery Office; 2007

Cowan J The essential features for a successful academic game. SAGSET Journal. 1974; 4:(2)17-22

Deery R, Wray S ‘The hardest leap’: acceptance of diverse body size in midwifery. Pract Midwife. 2009; 12:(10)14-16

DeJoy SB, Bittner K, Mandel D A qualitative study of the maternity care experiences of women with obesity: “More than just a number on the scale”. J Midwifery Womens Health. 2016; 61:(2)217-23

Leeds: NHS Commissioning Board; 2012

Dumas A, Robitaille J, Jette SL Lifestyle as a choice of necessity: Young women, health and obesity. Social Theory & Health. 2014; 12:(2)138-58

Fillingham A, Peters S, Chisholm A, Hart J Early training in tackling patient obesity: a systematic review of nurse education. Nurse Educ Today. 2014; 34:(3)396-404

Furber CM, McGowan L A qualitative study of the experiences of women who are obese and pregnant in the UK. Midwifery. 2011; 27:(4)437-44

Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery. 2011; 27:(5)e170-7

Heslehurst N, Russell S, Brandon H, Johnston C, Summerbell C, Rankin J Women's perspectives are required to inform the development of maternal obesity services: a qualitative study of obese pregnant women's experiences. Health Expect. 2015; 18:(5)969-81

Keyworth C, Peters S, Chisholm A, Hart J Nursing students' perceptions of obesity and behaviour change: implications for undergraduate nurse education. Nurse Educ Today. 2013; 33:(5)481-5

Lavender T, Smith DM Seeing it through their eyes: a qualitative study of the pregnancy experiences of women with a body mass index of 30 or more. Health Expect. 2016; 19:(2)222-33

Mezirow J Transformative learning: theory to practice. New Directions for Adult and Continuing Education. 1997; 74:5-12

Olander EK, Atkinson L, Edmunds JK, French DP The views of pre- and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sex Reprod Healthc. 2011; 2:(1)43-8

Olander EK, Berg M, McCourt C, Carlström E, Dencker A Person-centred care in interventions to limit weight gain in pregnant women with obesity – a systematic review. BMC Pregnancy Childbirth. 2015; 15

Olander EK, Scamell M Teaching students about maternal obesity without creating obesity stigma. Nurse Educ Today. 2016; 42:59-61

Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015; 16:(4)319-26

Whose shoes? A catalyst for change in health and social care. 2015. (accessed 8 June 2016)

London: RCM; 2013

Schmied VA, Duff M, Dahlen HG, Mills AE, Kolt GS ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women. Midwifery. 2011; 27:(4)424-30

Teaching about obesity: Caring, compassion, communication and courage in midwifery education

02 July 2016
Volume 24 · Issue 7


Teaching innovation can be used to promote the 6Cs in one of the most purportedly stigmatising areas of maternity care: obesity. As rates of maternal obesity continue to rise, getting this area of care right becomes more urgent. Although a great deal has been published about the unsatisfactory and stigmatising impact that staff attitudes can have on those with obesity, there is relatively little on how this problematic area of care should be taught to the next generation of midwives. This article presents a case study of learning about obesity management at the pre-registration, undergraduate level. The case study described is an effort to move away from what is currently largely an academic debate, towards a set of tangible practice recommendations.

Higher education institutions (HEIs) are tasked with equipping newly qualified midwives with the skills, knowledge and understanding they need to care for pregnant women. This includes being able to demonstrate all of the 6Cs in their practice: caring, compassion, competence, communication, courage and commitment (Department of Health, 2012).

Using obesity (defined as having a body mass index (BMI) ≥ 30 kg/m2) as a case study, this article presents a series of teaching techniques aimed at enhancing the teaching of the 6Cs in pre-registration midwifery education. In particular, we will use four of the 6Cs—caring, compassion, communication and courage—to frame this article, on the basis that evidence suggests that improvements in these key areas could have a significant impact on improving women's experience of maternity services (Deery and Wray, 2009; Phelan et al, 2015). The case study of obesity was selected to demonstrate the value of teaching innovations in the 6Cs for two reasons. Firstly, because obesity has been identified as one of the most significant current issues facing midwifery (Royal College of Midwives, 2013); despite this, obesity training for health professionals has been found to be inadequate (Fillingham et al, 2014). Secondly, because there is a growing body of concerning evidence to suggest that health-care students and professionals (including midwives) may hold negative, even discriminatory attitudes towards obesity, seeing the condition as a sign of lack of self-control (Schmied et al, 2011; Keyworth et al, 2013). Not surprisingly, research suggests that the lived experience of receiving maternity care when obese is far from positive (Deery and Wray, 2009; Furber and McGowan, 2011). Phelan et al (2015), in their review on obesity stigma, outline how individuals are affected by negative attitudes towards weight. This includes individuals feeling devalued and stereotyped which, in turn, threatens their sense of identity and self-worth. It is the apparent lack of professional principles—including caring, compassion, communication and courage—which makes these findings of particular concern.

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