Implementation of The Respectful Maternity Care Approach in Caring for Pregnant Women with Obesity: A Phenomenological Study

Abstract

The increasing prevalence of obesity in pregnant women poses a significant challenge to midwifery and public health practice, particularly in ensuring dignified and equitable care. Although numerous studies have addressed the medical risks of obesity in pregnancy, limited studies have highlighted how the principles of Respectful Maternity Care (RMC) are applied to obese pregnant women, particularly from the perspectives of both mothers and health workers. This study aims to fill this gap by exploring the experiences of obese pregnant women and midwives in implementing RMC in midwifery services in Bengkulu City, Indonesia. This study used a descriptive qualitative approach, with data collected through in-depth interviews with 7 obese pregnant women, 5 midwives, and 1 head of a community health center. Thematic analysis yielded six main themes: (1) maternal perceptions of self and pregnancy, (2) experiences of stigma and discrimination in health services, (3) the meaning of RMC-based midwifery care, (4) challenges for midwives in implementing empathetic communication, (5) family support in managing healthy lifestyle behaviors, and (6) transformation of self-awareness through dignified care. The results showed that empathetic and non-discriminatory communication increased maternal confidence and adherence to healthy lifestyle behaviors, while limited time and training were barriers to consistent RMC implementation. This study emphasizes the importance of institutional policies that strengthen RMC training, involve families in care, and build a more humanistic and inclusive midwifery service system for pregnant women with obesity.