BACKGROUND:
Approximately 50% of childbearing women in Australia have larger bodies and are vulnerable to weight stigma in maternity care. Larger-bodied women also experience higher rates of adverse perinatal outcomes, prompting efforts to improve those outcomes. Policies, guidelines, and individual clinician practices are key contributors to weight stigma. As the primary care providers for women during the pregnancy, birth and postnatal period, midwives have a profound opportunity to shift women’s experience of care.

OBJECTIVES:
To generate national consensus on Best Practice Principles for Weight-Inclusive Maternity Care.

METHODS:
Mixed methods including: (1) Photovoice study with larger-bodied women, (2) interviews with weight-inclusive maternity care providers and (3) a modified Delphi process to generate consensus on best practice principles.

RESULTS:
65 women shared 261 images, demonstrating that they experience maternity care as weight-centric and stigmatising, characterised by environments and care practices that exclude them and erode their confidence. Interviews with 24 maternity care providers mapped the reflective learning and concrete actions that can lead to a weight-inclusive approach. From these data, 71 candidate best practice principles were developed. The Delphi process (n=253 round one; n=126 round two) was used to shortlist, refine and rank candidate best practice principles, culminating in a National Consensus Workshop where 57 stakeholders from across Australia, including endorsed representatives of midwifery, consumer and medical societies, achieved consensus on 5 overarching principles: Acknowledge, Educate, Resource, Partner and Care.

CONCLUSIONS:
National consensus on Best Practice Principles for Weight-Inclusive Maternity Care is possible.

KEY MESSAGE:
Efforts to improve the perinatal outcomes and experiences of larger-bodied women must address weight stigma in maternity care. Midwives have a key role to play. Pregnancy - complications