Best Practice Principles for Weight-inclusive Maternity Care: Outcomes of a national consensus process

For many women, the journey through pregnancy is supposed to be a time of profound connection with their developing child and the healthcare team supporting them. Yet, for a significant portion of the population, this experience is shadowed by a different reality: the fear of being judged for their body size. In the medical world, a "weight-centric" approach has long dominated, treating body weight as the primary indicator of health and placing the responsibility for a "healthy" pregnancy squarely on the individual's ability to control their weight. This perspective often overlooks the complex biological and social factors at play. When healthcare providers focus too heavily on the number on a scale, it can lead to "weight stigma," a form of social bias where people are treated with less respect, face stereotypes, or are excluded simply because they do not fit a narrow ideal of thinness. This stigma is not just a matter of feelings; it has tangible consequences. Women who experience it often delay seeking care, lose trust in their doctors, and may even disengage from the health system entirely, which can ultimately harm both the mother and the baby.

A team of researchers in Australia set out to change this dynamic by asking a fundamental question: what would maternity care look like if it stopped judging women by their weight and started focusing on their actual needs? They did not simply ask experts to write a list of rules. Instead, they brought together a diverse group of people to build a new framework from the ground up. This group included women who had recently experienced weight stigma during their own pregnancies, doctors, midwives, and leaders from major health organizations. The goal was to co-create a set of "Best Practice Principles" that would guide how maternity care is delivered, ensuring it is respectful, inclusive, and safe for women of all body sizes.

The process began with a massive collection of ideas. Drawing from previous interviews with women who had faced discrimination, conversations with healthcare providers who were already trying to be more inclusive, and existing research, the team started with seventy-one potential principles. These were not final rules but rather candidate ideas for how care could be improved. To narrow this list down, the researchers sent out two national surveys. The first survey asked hundreds of participants to rank these ideas, deciding which were essential and which were less critical. This process whittled the list down to thirty-seven strong candidates. A second survey then asked participants to select their top ten priorities. This rigorous filtering ensured that the final principles would reflect the true consensus of both the women receiving care and the professionals providing it.

The culmination of this work was a national workshop held in Brisbane, where fifty-four delegates gathered for a day of intense discussion. The room was a mix of lived experience experts, medical doctors, midwives, and allied health professionals. Using a method that encouraged equal input from everyone, the group discussed the top twenty principles that had emerged from the surveys. They worked to group these ideas into broader themes, refining the language until everyone could agree. The result was a set of five core principles that have now been formally endorsed by major consumer, medical, and midwifery organizations across the country.

These five principles form a new roadmap for maternity care. The first principle is to acknowledge the impact of weight stigma, recognizing that bias exists and harms patients. The second is to educate the entire maternity workforce about what weight stigma looks like and how to practice in a way that is inclusive. The third principle focuses on resourcing, ensuring that services have the tools, space, and staff needed to provide care that is truly accessible to everyone. The fourth is about partnership, which means actively involving women with lived experience in the creation of policies and guidelines, rather than making decisions for them. The final principle is to provide care that is respectful, centered on the woman, informed by trauma, and based on evidence rather than assumptions.

Crucially, the researchers found that while there was strong agreement on the need for respect and better communication, some discussions were more complex. When it came to specific clinical situations, such as whether a woman could give birth in a water pool or in a smaller rural hospital, the group did not decide to ban these options based on body size. Instead, they agreed that decisions must be made individually. The principles emphasize that safety should be determined by a woman's specific health history and needs, not by a blanket rule based on her weight. This approach rejects the idea that a larger body is automatically a medical risk, while still allowing for necessary clinical judgment.

The paper concludes that these principles offer a vital shift away from the old, weight-focused model. By moving toward a system that values the whole person, the framework aims to rebuild trust between women and their healthcare providers. The authors note that while the principles are now established, the real work lies in putting them into practice. Future efforts will need to focus on training staff, updating policies, and ensuring that services are actually equipped to deliver this kind of inclusive care. The study represents a significant step forward, providing a shared language and a clear direction for making maternity care a place where every woman feels seen, respected, and safe.