Embracing Parenthood
Last year approximately 134 million babies were born worldwide, including around 591,072 in England and Wales1,2. Most women (64%) have 2 or more children2. Despite a global decline in birth rates in recent years, driven by economic, social and personal factors, parenthood remains a joyful and celebrated milestone across any culture. Discussions around the negative impacts of pregnancy and childbirth on mothers’ health and well-being often remain sensitive and controversial, especially in collectivistic societies where traditional norms may overshadow individual needs. To create the best start in life for mother and baby, these impacts on maternal health need to be acknowledged, discussed and prioritized at different levels so a healthier and happier life can be fostered for the whole family. This blog explores this topic combining insights from research and lived experiences.
Maternal health and wellbeing
Research shows that many women, even those with a healthy weight before pregnancy, often struggle with weight retention after having a baby. This is particularly common after multiple pregnancies3,4. Weight gain after baby is born can increase the risk of health issues like diabetes, heart diseases and pregnancy-related complications such as pre-eclampsia or the need for a c-section. It can also lead to mental health challenges such as feeling depressed or anxious. All together this can have a negative impact on future pregnancies and babies’ health. To reduce these risks, experts often recommend returning to pre-pregnancy weight within 6 to 12 months after giving birth. But with weight often being stigmatized and mothers’ healthcare needs misunderstood this can have a huge impact on the journey into motherhood. While weight and lifestyle are frequently monitored during pregnancy—especially for women with overweight or obesity—mental health often does not get the same level of attention. This is true for all women, regardless of their weight, and highlights the need for a more holistic approach to support mothers throughout their journey.
Kelly describes her struggles in prioritizing herself:
“I was 20 years old when I was pregnant of my first child. I was overweight and not living a particular healthy lifestyle. I worked full time in healthcare and was working day and night shifts. Like most colleagues, my diet was very restricted to convenience food, which was often eaten on the go. This habit which was very difficult to change once I found out I was pregnant. On top of this I was suffering from awful morning sickness so I just ate whatever I could tolerate which was not always the healthiest option. During my first pregnancy my weight was mentioned a few times but only with regards to what was healthy for the baby, how to fuel my body and prepare myself for childbirth. As my weight increased I remember hearing the word “high risk pregnancy” a lot but no one really explained to me how me and my baby were considered high risk because of my weight. During my second and third pregnancy I was even heavier and even after moving to a different healthcare team, the only thing they seemed to talk about were the risks involved and being a burden for the healthcare system. I recall being given a lot of literature and advice throughout my pregnancy on the best ways to feed a baby, how to bath a baby and what and where they should sleep. One thing that was really lacking was information on how to look after myself, what should I be eating, how would I be able to lose this ‘baby weight’ after pregnancy. There was no support, no extra advise or signposting other than a lot of weight stigma and negative comments about my weight. Only after my fourth pregnancy, when I was referred to a Maternal Obesity Management Service (MOMS), help seemed to be available on how to lose weight, be healthy and information was given on the benefits of eating healthy both during and after pregnancy”.
Ensure parents are well-supported
Pregnant women do not only hand over the care of their unborn child to medical practitioners, but women also rely on them to prioritise their own health. Any woman can feel overwhelmed, vulnerable and scared when transitioning into parenthood as the focus entirely shifts to the baby’s care, development, and milestones.
Kelly explains:
“My midwives and health visitors would often comment on how well I was doing, how the baby was gaining weight and reaching milestones on time but no one asked that simple question ‘how are you doing’ and there was never any support offered about post-partum weight management or regaining my fitness levels”.
A lack of support was also described by 12 mothers as part of Patient and Public member Involvement and Engagement (PPIE) activities in context of Dr Bul’s research in which Kelly participated. These PPIE activities explored factors that make it easier as well as more difficult to maintain a healthy weight after baby is born and examined attitudes towards the potential use of a digital platform to support women in this journey.
Kelly indicates how the specialised support she received during her 4th pregnancy was a total mismatch with what she needed and how she felt really torn down by it:
“I remember I was very nervous attending MOMS as my weight was the highest it had ever been. In a group setting with 7 other women, we spent an hour listening to a midwife (who was morbidly obese himself) how to eat healthy, exercise more throughout pregnancy and how we were all expected to lose weight moving forward. It was an awful experience and most of us left in tears. I refused to attend any more sessions and wanted to stay away from anyone who was commenting on my weight. In my opinion this could have been an ideal opportunity to offer tailored information, education, and support to a vulnerable group of women thereby taking into consideration their needs and listening to their voices. However, this experience had such a negative impact on my mental health and it certainly contributed negatively to the ongoing eating disorder I already struggled with”.
Research highlights the importance of adequate support, showing that women who return to the weight they were before being pregnant, within 6 months of giving birth, are less likely to experience physical and mental health challenges5. Therefore, supporting women in both a healthy lifestyle as well as making them feel good about themselves is important to prevent long-term health problems and provide the best start for the entire family.
What should support look like? A Call for Change
According to Kelly healthcare should focus on preventative approaches and implement interventions at specific time points during and after pregnancy. Sustainability of healthy lifestyle habits need to be formed to ensure long-term behaviour change. As she stresses, pregnancy is an ideal opportunity to offer support to women regarding nutrition, how weight gain is linked to poor mental health and what support is available through signposting. Care during and after pregnancy should be more focussed on women’s health alongside babies’ health.
To prevent a mismatch in support and women’s needs, support should be co-produced with mothers and offered during pregnancy as mothers seem to be more receptive for healthcare messages especially given they can positively influence outcomes of their unborn baby. As previously suggested by the PPIE members, content needs to be fine-tuned to their needs (e.g., e.g., postpartum exercises, exchange of easy and healthy recipes, coping with low mood) and engagement strategies (e.g., icon-based, rewards, new regular content) should be implemented on a digital platform. Future research can then look into how effective this type of support would be in improving mother’s health and wellbeing.
References
ferences
- Ritchie, H., Mathieu, E., & Roser, M. (2024). How many people die and how many are born each year?. Our world in Data.
- Office for National Statistics (2020, 2021). Dataset births in England and Wales and childbearing for women born in different years [cited 2022 Sep 2]. Available from: shorturl.at/ajF23 and shorturl.at/eNQX9
- Gore, S. A., Brown, D. M., & West, D. S. (2003). The role of postpartum weight retention in obesity among women: A review of the evidence. Ann Behav Med, 26, 149-159.
- Ziauddeen, N., Huang, J. Y., Taylor, E., Roderick, P. J., Godfrey, K.M. et al. (2022). Interpregnancy weight gain and childhood obesity: Analysis of a UK population-based cohort. Int J Obes, 46, 211-219.
- McKinley, M. C., Allen-Walker, V., McGirr, C., Rooney, C., & Woodside, J. V. (2018). Weight loss after pregnancy: challenges and opportunities. Nutr Res Rev, 31, 225-238.
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