Large women's accounts of health and weight management in postpartum: a longitudinal qualitative study
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Date
02/07/2016Author
Connolly, Suzanne Gertrude
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Abstract
Postpartum weight retention is commonly considered an important precursor to long-term
weight gain, with existing research suggesting that failure to lose weight in
postpartum has significant future health implications. While postpartum has been
identified as a possible ‘window of opportunity’ for women to make health
behaviour change and manage their weight, it remains unclear how mothers, and in
particular ‘large’ (BMI ≥ 40 kg/m2) mothers, experience health and engage with
health-related behaviours at this particular point in the life course. Existing research
has done little to enhance our understandings of the lived, embodied and practical
realities of caring for an infant and, crucially, how this impacts health and weight
management during the postpartum period. In addition, qualitative research focusing
on postpartum has largely ignored the temporal dimensions of this period and,
instead, has tended to focus attentions on a single ‘snapshot’ in time.
To address these gaps in the literature, this study employed longitudinal qualitative
methodology to explore 15 ‘large’ (BMI ≥ 40 kg/m2) women’s lived experience of
health and weight management over the first six months following childbirth.
Participants were recruited from a specialist antenatal metabolic clinic based in
Edinburgh, Scotland. When possible, three in-depth semi-structured interviews were
carried out with each participant: the first at six weeks postpartum, the second at
three months and, the third at six months postpartum. Both six weeks and six months
have consistently been identified in the literature as important markers for
postpartum women. Hence, it was hoped that by interviewing at these and an
intervening time point (i.e. three months) it would be possible to capture and
understand processes of change with regards to weight management in the
postpartum period.
The analysis revealed that accounts of health and weight were far from
straightforward and seemed to be heavily influenced by the wider social context,
which routinely pathologises, demonises and stigmatises ‘fatness’. Challenging
contemporary discourses of the ‘obesity epidemic’ which frame the large body as a
direct consequence of individual lifestyle, participants principally drew upon lay
notions of inheritance and implicated a genetic predisposition to resist individual
responsibility for weight and body size. The analysis suggests that concerns for
health were largely predicated on subjective experiences and, in the absence of
tangible and embodied experiences of ill-health, participants expressed little if any
impetus to engage in weight management for the purpose of improving their health.
In short, the idea that their weight was an indicator of poor health, or future health
risk, was not a view shared by participants. Instead, they expressed more complex
understandings of their weight, and their responsibilities to engage in health
changing behaviour.
Despite articulating often strong desires to engage in weight management ‘for the
baby’, the longitudinal focus revealed a disjuncture between these intentions and the
reality of those engagements. Influential in this discordance was the transition from
an intensely medicalised and closely monitored pregnancy, to a period of minimal or
no follow up in postpartum. The lack of ‘surveillance’ appeared to have a notable
impact on participants’ engagements with health-related behaviours once at home
and going about the day-to-day tasks of caring for their infant. Dominant discourses
around ‘good’ mothering also made it difficult for participants to prioritise their own
needs (such as weight management) ahead of those of their children and other family
members. When participants reflected on their experiences of mothering they
frequently drew upon understandings of themselves as relational beings and, at times,
positioned themselves as phenomenologically inseparable from their baby. This
relationality was often experienced as a diminishing of individual autonomy, as the
body of the mother and the baby became inter-embodied and bounded.
Consequently, my analysis serves to problematise the individualised expectation
surrounding a mother’s ability to act autonomously and engage in health-related
behaviours in postpartum. These findings also call for a stronger appreciation to be
developed of the complexities surrounding engagements with health-related
behaviours at this particular point in the life course. In particular this research
demonstrates the importance and utility of adopting a more embodied approach,
which in turn has some notable implications for public health policy and practice.