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Should midwives consider associated psychological factors when caring for women who are obese?

02 October 2016
Volume 24 · Issue 10



In the UK, 15.6% of the maternal population are obese (body mass index ≥ 30 kg/m2), posing serious health consequences to the woman and fetus. Current maternal weight management interventions, focusing on healthy diet and exercise, fail to adequately address this problem, which may be attributable to a bidirectional association between maternal obesity and psychological factors not being addressed.


The aim of this reflective literature review is to determine whether there is sufficient evidence to suggest that midwives should consider psychological factors when caring for women who are obese.


A literature review was undertaken of papers from academic journals, dissertations, theses and professional magazines, published between 2005 and 2015. A total of 529 articles were returned, of which 10 were selected for review.


Critical analysis of 10 relevant studies confirms an association between maternal obesity and women's psychological wellbeing. Many midwives are aware of this relationship, but feel they lack the knowledge and interpersonal competence to address such issues.


Midwives require greater understanding of psychological complexities surrounding pregnancy weight management, and training in person-centred counselling techniques, in order to optimise health outcomes for women and neonates.

According to the Centre for Maternal and Child Enquiries (CMACE, 2010: xiii), ‘obesity is arguably the biggest challenge facing maternity services today’. Obesity is defined as having a body mass index (BMI) of ≥ 30 kg/m², and 13% of the global adult population falls into this category (World Health Organization (WHO), 2014). In the UK, 1/1000 childbearing women are classed as super morbidly obese, with a BMI ≥ 50 kg/m² or weighing over 140 kg (Knight et al, 2009). UK prevalence of maternal obesity has risen from 7.6% to 15.6% since 1989, presenting major issues for maternity services owing to associated serious health consequences for mother and infant (Heslehurst et al, 2010). These include direct and indirect causes of maternal death and the risk of congenital abnormality, miscarriage, stillbirth and neonatal death (Knight et al, 2014). Both maternal and neonatal risk of serious complications positively correlate with rising maternal BMI, predisposing offspring to non-communicable diseases (Liat et al, 2015). Consequently, the Clinical Negligence Scheme for Trusts categorises maternal obesity as a high-risk condition (NHS Litigation Authority, 2013).

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