title: The attitudes of pregnant women and midwives towards raised BMI in a maternity setting: A discussion of two repertory grid studies.
abstract: OBJECTIVE
  Weight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18-30kg/m2. This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs.
  
  
  METHODS
  Ten pregnant women with a BMI≥30kg/m2and 11 midwives and from an inner city maternity service were recruited.
  
  
  METHODS
  Participants provided information that allowed for the creation of a repertory grid; generating psychological constructs (perceptions or attitudes) identifying similarities and differences between pregnant women and midwives across a BMI range.
  
  
  RESULTS
  Midwives were extremely conscious of being perceived as judgemental. They construed all pregnant women as anxious and vulnerable, but attributed characteristics such as "less health-conscious" and "complacent" to those with a raised BMI. The ideal pregnant woman and ideal midwife were typically construed as more likely to have a BMI of 18-30kg/m2. Pregnant women with a BMI≤18kg/m2were construed as lacking warmth. While midwives differentiated between the elements based on role, the pregnant women construed the elements according to their BMI. Similarly, they construed those with a BMI≤18kg/m2as having an undesirable personality, and acknowledged weight-related stereotypes for those with a raised BMI.
  
  
  CONCLUSIONS
  It is possible these constructs impact on the way midwives care for and interact with women. Midwives may be supported through reflective clinical supervision and communication skills training to reduce the perceptions of stigma experienced by women with a raised BMI. It may be beneficial to involve pregnant women with a raised BMI in service development to ensure services meet their needs.
authors.affiliation: Clinical Psychology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Hodgkinson
authors.affiliation: School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, United Kingdom.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: South Wales DCLinPsy Programme, Cardiff University, United Kingdom.
authors.forename: Dougal J
authors.initials: DJ
authors.lastname: Hare
authors.affiliation: South Wales DCLinPsy Programme, Cardiff University, United Kingdom; Manchester Mental Health and Social Care Trust, Manchester, United Kingdom. Electronic address: anja.wittkowski@manchester.ac.uk.
authors.forename: Anja
authors.initials: A
authors.lastname: Wittkowski
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology*; D010465:Perception; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Body mass index; Midwives: Pregnant women; Obesity; Repertory grid