Navigating weight stigma: An integrative review of midwives' knowledge, attitudes and beliefs about caring for larger-bodied women

Abstract

Problem: Women are vulnerable to weight bias during their reproductive years. However, little is known about midwives’ knowledge, attitudes and beliefs about caring for larger bodied women. Background: Women have reported experiencing weight stigma during interactions with healthcare providers, including midwives. Weight stigma is associated with reduced quality of health and primary healthcare avoidance. In Australia over half of pregnant women are of a higher weight during their reproductive years. Aim: To describe what is currently known about midwives' knowledge, attitudes and beliefs relating to caring for larger bodied women across the peripartum period. Methods: An integrative review was undertaken, involving a systematic literature search, quality appraisal, and synthesis of findings within the socioecological framework. Findings: Sixteen articles were included. Across the socioecological levels: individual level themes related to midwives’ attitudes and beliefs and midwives’ own body size; interpersonal themes related to communication and relationships; community themes related to the influence of cultural norms; organisation/institutional level themes related to BMI and weight checks, the need for training and education, and the role of healthcare practices and guidelines emerged; finally, at the policy level, system level factors and a weight inclusive approach were identified. Discussion: This review highlighted that some midwives and student midwives hold negative, stigmatising views towards larger bodied women. Midwives are impacted by their own attitudes and beliefs as well as interpersonal, societal, organisational and system level factors. Conclusion: Efforts to reduce weight stigma require a multi-level socio-ecological approach, including educational strategies aimed at shifting current and future midwives’ stigmatising attitudes and beliefs towards larger bodied women.