Weight Stigma in Pregnancy

The current ANS featured article is titled “Weight Stigma Related to
Pregnancy: A Concept Analysis” by Rachel Dieterich, MSN, RN; Jill Demirci, PhD, RN, IBCLC and Cynthia Danford, PhD, RN, PNP-BC, CPNP-PC. While this is featured, we invite you to download it at no cost, and share your comments here. Here is a message that Ms. Dietrich has shared for our readers:

As a first year nursing PhD student at the University of Pittsburgh, I found myself knee-deep in the literature, investigating any and everything I could related to maternal body weight and breastfeeding outcomes, and how these two were related. I learned about the physiological relationship, such as the association between excess maternal adipose tissue and delayed lactogenesis II. As I delved more into this topic, I discovered that women with pre-pregnancy overweight or obesity have very poor breastfeeding outcomes compared to women without overweight or obesity. I had a feeling that these breastfeeding disparities may be attributed to more than just hormones and physiology.

Through my time sifting through the literature, I found numerous qualitative research studies detailing a wide range of psychosocial breastfeeding barriers experienced by women with higher body weight, including feeling uncomfortable and embarrassed breastfeeding around others or in public. I was in a rabbit hole – as they say. I then found several other qualitative studies interviewing obese women about their experiences interacting with their obstetric providers. The consensus was this: women with pre-pregnancy overweight or obesity often feel stigmatized, vulnerable, and judged when interacting with their obstetric healthcare professionals based her weight. In fact, one study found that midwives admitted to making negative judgments about a pregnant patient’s character or intelligence if she was obese. I was on to something. Has anyone examined this concept of weight stigma in relation to pregnancy before?

In my second semester of my PhD program, I took a course that challenged us to develop a concept analysis paper for our phenomenon of interest, the topic we would most likely conduct our dissertation research about. For me, the choice was easy. I chose to write a concept analysis on weight stigma related to pregnancy. I found that there was no definition or investigation into this concept and I felt the need to fill this gap to bring awareness to this ugly and unfortunate reality that some pregnant women are currently facing. It is my hope that through this article, nurses and other healthcare professionals will become more aware of the existence and consequences of weight stigma in the obstetric setting.

Currently, I am conducting my dissertation study, “The Relationship between Perinatal Weight Stigma and Breastfeeding Outcomes.” The development and publication of this concept analysis manuscript has been pivotal in the operationalization and development of my dissertation study data collection measures. In my future work, I aim to investigate how maternal race and ethnicity may influence the relationship between weight stigma and breastfeeding outcomes.