Health Policy and Its Unintended Consequences for Midwife-woman Partnerships: Is Normal Pregnancy at Risk When the BMI Measure Is Used?

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aut.relation.endpage37
aut.relation.journalNew Zealand College of Midwives Journalen_NZ
aut.relation.startpage30
aut.relation.volume54en_NZ
aut.researcherGilkison, Andrea
dc.contributor.authorKnox, Sen_NZ
dc.contributor.authorCrowther, Sen_NZ
dc.contributor.authorMcAra-Couper, Jen_NZ
dc.contributor.authorGilkison, Aen_NZ
dc.date.accessioned2020-08-04T23:59:26Z
dc.date.available2020-08-04T23:59:26Z
dc.date.copyright2018-12-01en_NZ
dc.date.issued2018-12-01en_NZ
dc.description.abstractBackground: Little attention has been paid to understanding the unintended consequences of health policy for midwife-woman partnerships. The measure of Body Mass Index (BMI) is one such policy example which has become established in contemporary midwifery practice as a tool for assessing pregnancy risk. The universal acceptance of BMI creates an unsettling paradox for midwives concerned with promoting woman-centred practice. The increasing focus on BMI is challenging for midwives as they navigate ethical tensions when directed to undertake practices which have potential unwonted consequences for the midwife-woman partnership. Aim: The aim of the study was to explore the use of an indicator, using BMI as an example, to provide an international perspective on obesity prevention policy and maternity care provision. Method: A comparative case study approach was taken, using descriptive cross-national comparative analysis of obesity prevention policy, weight management guidelines and midwifery models of care in New Zealand and Scotland. Discussion: Despite promoting healthy weight gain in pregnancy, New Zealand and Scottish health policies may be missing health promotion opportunities. Focusing on BMI in maternity, per se, should not prohibit other assessment of lifestyle issues or delivery of services based on individual needs, capacities, histories and sociological characteristics. Relying solely on pre-pregnancy BMI as a marker of health in all women has remained relatively unchallenged and, as such, constitutes a policy problem because it occludes the factoring in of other lifestyle issues that may significantly alter individual risk status. Further, such an assessment of risk status is ideally arrived at within a partnership model of maternity care, rather than reliance on an a priori medical test. Conclusion: Decontextualised policies are challenging for midwives where medical and midwifery values are in conflict. Policy which fails to consider the multiple and complex contexts of women’s lives is confronting for midwives as they attempt to re-articulate the meaning of woman-centred practice. Furthermore, BMI as a tool may be ineffectual. The current focus on BMI in policy and practice requires re-consideration.
dc.identifier.citationNew Zealand College of Midwives Journal, 54, 30-37. https://doi.org/10.12784/nzcomjnl54.2018.4.30-37
dc.identifier.doi10.12784/nzcomjnl54.2018.4.30-37en_NZ
dc.identifier.issn0114-7870en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/13576
dc.publisherNew Zealand College of Midwivesen_NZ
dc.relation.urihttps://www.midwife.org.nz/wp-content/uploads/2018/08/Jnl-54-article-4-BMI.pdf
dc.rightsThe Journal is double-blind peer reviewed and uses electronic, article-based publishing to provide open access to all papers as they are published.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectMidwifery partnership; Health policy; Weight management guidelines; BMI; New Zealand; Scotland
dc.titleHealth Policy and Its Unintended Consequences for Midwife-woman Partnerships: Is Normal Pregnancy at Risk When the BMI Measure Is Used?en_NZ
dc.typeJournal Article
pubs.elements-id383806
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Clinical Sciences
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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