Lauren Kearney

Objective : To co-create nationally agreed Best Practice Principles for Weight‑inclusive Maternity Care in Australia. Design : A multi‑stage consensus study using a modified Delphi process and Nominal Group Technique. Candidate principles were generated from prior qualitative research with women with lived experience of weight stigma, interviews with maternity care providers, and relevant literature. These principles were ranked and shortlisted through two national surveys, followed by a face‑to‑face national consensus workshop. Peak interest-holder organisations were subsequently invited to provide feedback and formally endorse the final principles. Setting : Australia. Participants : Women with recent lived experience of weight stigma in maternity care, maternity care providers across disciplines, and representatives of maternity consumer, medical, and midwifery organisations. Consumers and clinicians contributed equally throughout the process. Results : Five Best Practice Principles for Weight‑inclusive Maternity Care were agreed and endorsed by interest-holder organisations. These focus on acknowledging the impact of weight stigma in maternity care; educating the maternity workforce about weight stigma and weight‑inclusive practice; appropriately resourcing services to provide weight-inclusive care; partnering with women with lived experience in the development of policies, guidelines and service directives; and providing respectful, woman‑centred, trauma‑informed, and strengths- and evidence‑based care. Consensus was readily achieved on principles addressing respect, communication and partnership, while more contested issues highlighted the need for individualised assessment and adequate resourcing rather than categorical exclusions based on weight or body mass index. Conclusions : These nationally endorsed Best Practice Principles provide a shared, evidence‑informed, and consumer‑led framework to guide maternity care practice, education, and policy. By explicitly addressing weight stigma and moving beyond weight‑centric approaches, the Principles offer an essential foundation for improving maternity care experiences and supporting respectful, individualised care for women with larger bodies.

Background: Weight stigma is pervasive in maternity care, contributing to negative health outcomes and disengagement among larger‐bodied women. To reduce weight stigma and promote respectful, individualized care, a weight‐inclusive approach prioritizes overall well‐being rather than focusing on weight as a key health indicator. How maternity care providers adopt weight‐inclusive approaches remains underexplored. This study aimed to investigate the perspectives and practices of weight‐inclusive maternity care providers. Methods: Semi‐structured interviews were conducted online with medical, midwifery, and allied health maternity care providers, nominated by consumers or peers for their weight‐inclusive practice. Interviews were audio recorded, transcribed, and analyzed thematically. Results: Twenty‐four professionals were interviewed, with three themes generated to describe their weight‐inclusive approaches: (1) Time and space for reflection —participants described a gradual shift from weight‐centric to weight‐inclusive care, often prompted by personal or professional experiences of weight stigma; (2) Questioning weight science —participants questioned the value of body mass index or weight as indicators of individual health, favoring holistic assessments; and (3) Taking action to make change —participants had made specific changes to their practice, including to clinical environments, communication, and in responding to weight‐centric systems. Discussion: Our findings map how some maternity care providers describe enacting weight‐inclusive maternity care. Despite systemic barriers such as weight‐centric education and clinical guidelines, maternity care providers made meaningful change through deliberate reflection and compassionate practice. Reform in education and clinical guidelines is needed. Extending existing frameworks, our study describes maternity‐specific enactments to address weight stigma and support broader adoption of weight‐inclusive approaches.

Background Weight stigma is a pervasive issue in healthcare, including maternity care, characterised by bias, discrimination, and exclusion. Experiencing weight stigma can negatively impact health outcomes, self-esteem, and engagement with care. While existing literature documents the nature and consequences of weight stigma in maternity care, few studies have explored solutions or involved women with lived experience. This study aimed to investigate larger-bodied women’s experiences of weight-centric and weight-inclusive maternity care across the preconception, antenatal, intrapartum, and postnatal periods, as part of a broader program to co-create Best Practice Principles for Weight-Inclusive Maternity Care. Methods A consumer-led, national online photovoice study was co-designed and co-facilitated by a multidisciplinary team of lived experience experts and academic researchers. Qualitative data—including transcripts, images, and discussions—were analysed using reflexive thematic analysis. Participant demographics were analysed descriptively. Synthesised member checking was used to enhance trustworthiness. Results Sixty-five women from across Australia took part in the photovoice activity, attending virtual workshops and engaging in asynchronous online discussions that yielded 261 shared images and 899 comments. Thematic analysis generated seven themes: (1) BMI dictates care, (2) larger-bodied women feel excluded, (3) weight-centric care creates burdens, (4) stigmatising experiences leave lasting impacts, (5) women have embodied knowledge of their own health and wellbeing, (6) women hope for weight-inclusive care, and (7) individual maternity care providers can make a difference. Participants described weight-centric care as stigmatising, exclusionary, and emotionally burdensome, often undermining their autonomy and birthing confidence and leaving lasting impacts. Encounters with weight-inclusive care providers were described as empowering and healing. Women articulated a clear vision for respectful, individualised, and holistic maternity care. Conclusion Larger-bodied women experience maternity care as weight-centric and stigmatising. Conversely, encounters with weight-inclusive providers contributed to positive care experiences, and shaped women’s vision for more respectful, strengths-based care. Larger-bodied women’s experiences inform the need for respectful, strengths-based care and informed choice. Findings will inform the co-development of national care guidelines to address weight stigma and improve maternity care for women in larger bodies.

Background: Supporting intrapartum research through recruitment and intervention delivery and data collection can be challenging for clinical midwives. While there is a need for high-quality evidence of effective care during labour and birth, there are very few midwifery-led randomised controlled trials conducted during this period. Similarly, there is little research on the motivating factors and challenges for clinicians associated with intrapartum research. Aim: Our aim was to explore the experiences of midwives who participated in a placebo-controlled intrapartum trial. Methods: Midwives who had participated in a trial investigating the use of sterile water injections for managing abdominal labour pain were invited to participate. Semi-structured interviews were conducted via videoconferencing. Data were transcribed and analysed thematically. Results: Interviews were conducted with 11 midwives. Three themes were identified: (i) introducing a novel treatment for labour pain; (ii) the conflict of care and placebo and (iii) participating in a clinical trial. Conclusions: Participants described experiences ranging from the support for an experimental analgesia and expectations of effect, to reservations to participants potentially encountering the placebo treatment. At times the experiences were both positive and negative. Midwives often found the timing of providing trial information and obtaining informed consent challenging. Our findings highlight the challenges encountered by midwives when presenting trial information, establishing equipoise and the timing for these to occur during labour. Trial registration: The trial is registered at the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12621001036808). Registration date 5/08/2021.

Introduction: Medical interventions during labour and childbirth have rarely been designed with end‐users, including frontline clinicians and consumers of maternity care. This has resulted in difficulties in evidence uptake, translation and acceptability by those who it is designed to help. Diverse views of ‘what is best’ in research interventions and approaches exist, yet arguably, if consensus can be reached, more rigorous and acceptable interventions will ensue. One such area of uncertainty is hydration management in induced labour, with an increasing reliance on intravenous therapy, without high‐quality evidence pervasive across maternity settings. Therefore, we aimed to co‐design a labour and childbirth intervention to optimise maternal physiology during labour, through evidence synthesis, consumer survey and a consensus‐generating activity. Methods: A multi‐modal, intervention co‐design study was undertaken. This involved three key stages: evidence‐synthesis, consumer‐survey and then a modified nominal group technique workshop to reach consensus on the intervention design. The whole process took place between April and November, 2023 in South‐East Queensland, Australia. Results: In total, 96 completed responses were returned in the consumer survey, detailing women's preferences for hydration management during induced labour. This informed a Nominal Group Technique Workshop, inclusive of consumers, midwives, obstetricians, lactation consultants, dietitians, clinical trialists, neonatologists and nurses. Following robust discussion and various viewpoints presented, the expert reference group decided to support an approach whereby women would self‐determine their own intake during induced labour and that the routine administration of intravenous fluids as a ‘side‐line’ (current ‘standard practice’) to the synthetic oxytocin (labour hormone) infusion for induction of labour would not be routinely administered. In order to provide information/education to women on how best to optimise their hydration, a co‐designed information brochure was developed. Conclusion: What clinicians and researchers may assume is important as interventions and outcomes in a clinical trial may not always align with the opinions and lived experience of consumers. Incorporating co‐design into trial protocol development has the potential to improve the relevance of research to the target population. This in turn may improve trial feasibility through enhanced recruitment, intervention and treatment adherence, and fidelity. Patient or Public Contribution: People with lived experience (inclusive of both first‐time mothers who had recently experienced a labour induction; and two maternity consumers involved in advocacy and research work to optimise labour and birth care) were involved in several parts of this study. This included study conceptualisation, data collection and analysis, interpretation and authorship of manuscript.