A group of maternity consumers and advocates from across Australia have released a paper calling for equitable and non-stigmatising care for pregnant women and potential parents who live in larger bodies.

It voices concern that “the current weight-centric approach to maternity care is creating unintended harm for pregnant, birthing and postnatal women.”

The paper, titled “Listening to larger bodied women: Time for a new approach to maternity care,” was written by a group of authors, including members of CRE HiPP’s Body Positive Birth Alliance. 

“As a group we have lived experience of hospital birth and homebirth, continuity of care and fragmented care models, waterbirth, induction of labour, caesarean birth, pregnancy loss and stillbirth.

“We share the common, unwelcome experience of weight stigma in our maternity care, which remains one of the few unchallenged sources of bias and discrimination, both in society generally and healthcare more specifically.”

The paper paints a difficult picture of these women’s experiences of pregnancy care. Rather than being able to enjoy and celebrate the remarkable ability of their bodies to grow and birth a baby, they have found that the stigma and over-emphasis on risk has largely robbed them of the joy of this time.

Their experiences have included maternity care which focuses on body weight at the exclusion of other health considerations, being given limited options and choices in care and birthing, and derogatory remarks about their bodies. Some have even been turned away from preconception care until they achieved a ‘healthy’ Body Mass Index (BMI). 

As one author wrote, “I loved pregnancy and felt so incredible that I was growing my baby. It’s really disappointing that care providers make women feel so ashamed of their weight…. Like I was endangering my baby.

“There was no compassion or conversation, just blame.

“The sense that our bodies endanger our babies creates the impression that we are failing as mothers even before birth.”

Given that over 50% of Australian women of childbearing age live in larger bodies, the impacts of this stigmatising care are widely felt.

One common aspect of maternity care discussed in the paper is the use of high BMI as an indicator to predict adverse pregnancy outcomes. Despite its ubiquitous use, there is a growing body of evidence to show that BMI is a problematic indicator in some ways. 

The narrow focus on BMI, as well as other forms of weight stigma in pregnancy care, can have damaging and dehumanising impacts on pregnant and birthing people. They can trigger problematic outcomes such as obsessive weight monitoring, body image issues and stress, all of which are known to have negative impacts on pregnant mothers and their children. 

Furthermore, recent research challenges the conventional paradigm and demonstrates that there is little evidence that excess gestational weight gain causes adverse pregnancy outcomes. The paper highlights that, despite the over-emphasis on risk, “a healthy pregnancy remains the most common occurrence for larger bodied women.”

On the positive side, some of the authors have experienced weight inclusive maternity care, such as supportive and respectful clinicians who discuss all aspects of health, and who uphold a commitment to autonomy and informed decision making.

“Even just one maternity care provider who believed in our ability to birth, on our own terms, (and) believed that our larger bodies were capable, made all the difference.”

The paper includes a call to action, asking maternity care providers to recognise and address the unintended harms of weight-centric and stigmatising systems and practices. Studies have shown that additional training and resources which focus on these issues can help in transitioning to weight inclusive care.

There is also a need for further research in this area. Even though there is a growing body of work addressing weight stigma in maternity care, there is a lack of studies investigating its impacts on perinatal outcomes.

The Australian Pregnancy Care guidelines are currently under review, and an opportunity exists to include strategies to address weight stigma.

CRE HiPP’s Body Positive Birth Alliance, established in 2023, is also working towards challenging weight-centric maternity care. It brings together consumers, clinicians, researchers, advocates and professional groups to directly address weight stigma and discrimination, and to define weight-inclusive care.

Overall, the main aim of those working in this space is to “increase health access, autonomy, agency and social justice for all individuals across the entire body size spectrum.”

To find out more about the Body Positive Birth Alliance, please visit our website at: https://hipp.org.au/networks/body-positive-birth-alliance/.

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