Dreading hospital birth but high bmi so I "have no choice"

[JamesAndTheGiantBanana]

3rd baby, previous two absolutely fine pregnancies and textbook vaginal labours, in hospital. Two healthy normal sized babies, no induction, no drugs, no assistance. No gestational diabetes, perfect blood pressure throughout. But I'm fat. So naturally throughout they've had me under consultant led care for all three. I've just had my diabetes test and growth scan, no diabetes again and baby is absolutely on the 50th centile line on the chart for growth, same as its siblings who were 7lb.

I'm dreading another hospital labour though, every time they want me flat on my back, constant fetal monitoring, bright lights, loads of people in the room, painful IV in "just in case" etc It's absolutely the opposite of what I want, and in my last labour, I was contracting nicely every three minutes but as soon as I got to the hospital I got so scared everything stopped and I had to have a painful sweep and walk around for hours to get the contractions going again. I put this down squarely to fear of the midwives and doctors. I can't relax in hospital, I feel hugely defensive about it right now, literally worried sick.

All I want is the chance to labour like low risk women do, soft lighting, peaceful, allowed to trust in my body (which is actually great at giving birth, thank you!) move around and maybe labour in water. Instead I feel like I'm facing an uphill battle and will have to argue my corner unsupported and vulnerable against stony staff who view me as nothing but a potential lawsuit.

I fantasise about buying a birthpool and just getting on with it alone, just getting my other half to call them when I know its too late. I know birth isn't without risk but if you'd have seen me last time, all my arms and hands severely bruised from their multiple IV siting attempts, blood all over me from my wrist (they eventually sited the sodding unnecessary IV out the side of my wrist so every time I moved I dripped blood all over the bed) bearing in mind that at no point has anything ever been wrong with me. It feels wrong to let them do that to me again. I just don't trust them! It doesn't feel like they have my best interests at heart, I'm just an unpleasant and inconvenient vessel that they have to pry the baby out of, under strip lighting.

I can't sleep for worrying about this, what should I do?

[JazzAnnNonMouse]

You are 'allowed' to give birth where ever you want. It's only medical advise that you be in hospital.
You have laboured well twice before which is great and if you feel you want a home birth then do it. Remember though that supposedly every baby/pregnancy/labour is different so I guess as long as you're aware of the risks/choices available you make your own decision based on that! Good luck.

[ChunkyPickle]

I don't know.

I do know that my first DS was born in Canada where I was high BMI (about 40), but they had no problem with the idea of a home water birth (didn't work out in the end because over-due/low fluid - culminating in EMCS). Also a totally fine pregnancy - BP, no GD, no weight gain, 50th centile baby etc. - I had to assure them that I was aware of the risks, and that DP would be able to haul me out of the pool if needed but they took me at my word (as an adult) and had no problem with it.

Having my second in the UK, and they are freaking out about my BMI (identical to before) - wanted me on aspirin, growth scans, GTT, consultant care, anaesthetist appointements etc. - home birth isn't feasible where I live right now so I haven't bothered with that battle and I haven't even considered broaching the subject of water birth because I know they'll be against the whole idea.

Say no to things you don't agree with. I will not be being induced, augmented, there will be no canula unless it's needed - no negotiation. I'm fully aware of the risks and consider them minimal in my case. If you strongly want a home birth, then tell them that! Get the battles out of the way now, the last thing you want is to be fighting when in labour.

I say this blithely.... I suspect that it's still going to be a battle just for those little things - the crazy bit is it's the consultants that are going mad, the midwives are very matter of fact about it all and seem much more likely to let me just get on with it.

[JamesAndTheGiantBanana]

Thanks, I live 30 min from the hospital (there's a mw led unit 5 min up the road but it's only for low risk women so not allowed to go there...) I haven't actually suggested a homebirth because I think they'll just laugh in my face and rule it out - and all this talk of "have to" and "not allowed" is really pissing me off so I've been trying not to bring anything up. I've gone along with all the tests and scans in the interest of not appearing difficult. They've all come back ok but I know from experience this won't make a damn bit of difference to the outcome of my "care" because they're so convinced something horrible will happen despite it all being ok twice before.

Thing is I wouldn't mind being in hospital if I had some measure of control but I know as soon as I step over the threshold they'll start dictating what I'm allowed to do.

[scaevola]

You could opt for a home birth (but please don't try to free birth).

Or see if you can go into a "home from home" MW led unit. Is there one near you? With two straightforward deliveries already, unless your weight has dramatically shot up since, I would have thought you would have a persuasive case.

[Norem]

hi op, congrats on your pregnancy
please go and have a look at www.home birth.org.UK
it is a great site with loads of info and a very active chat list too

[marzipananimal]

I'm planning a homebirth against medical advice so it can be done. It hasnt even been difficult. If your own midwife is unsupportive, contact a supervisor of midwives. It's their job to support you in your wishes. Good luck!

[ExBrightonBell]

I was "high risk" for my pregnancy, and also had persistent high bp (not pre-eclampsia) throughout. However, I was supported in planning a home birth by the midwives and the consultant. Didn't end up with one as I went overdue and ended up in hospital being induced. But, had I gone into spontaneous labour near my due date I would have been at home.

You might be surprised by the reaction of the consultant, and you could always ask for a second opinion and change consultants. Also, if you do end up in hospital, thy absolutely cannot do things like put a cannula in without your consent. State to them clearly "I do not consent to x" and insist on them considering an alternative approach.

[JamesAndTheGiantBanana]

Aargh, lots of replies, bear with me!

scaevola there is a lovely mw led unit not 5 min from my house, but I can't go just because of my weight.

Norem thanks for the link, I've had a thorough look through that site (at 3am when I can't sleep for stressing about this!) and plus-size-pregnancy.org, I'm reasonably well informed on the arguments for size friendly care, homebirth, waterbirth etc, but I am scared of actually facing down the medical staff. I don't really want to free birth but I'm so sick of my life being affected by their job iyswim. If they were supportive it'd be different, I suppose.

Chunkypickle I'm getting to you lol

[scaevola]

I think my previous post crossed with yours. I was thinking of a "home from home" within a hospital, not a separate MW unit: anything like at near you?

For I think they may be more persuadable to admit you there, knowing transfer is just down a corridor if it is needed, rather than a move between buildings. You may need to be thinking who you want as a birth partner - someone very assertive!

[JamesAndTheGiantBanana]

Chunky, I think that's the crux of it, them taking your word as an adult. They won't take any risk here, they don't believe your word on anything. I remember last pregnancy the consultant flicking through my notes going "So this is your fiiirst... pregnancy....?" and I was saying "No, second. It's my second. Um, I have a son" and he wouldn't even look up, wouldn't accept what I'd said til he'd been through my notes and seen it written in by some bloody midwife. I've been told that I can't feel movement that I can feel, told that I'll almost definitely have a c section, based on nothing at all - grrr!

Maybe you're right and I should just fight the little things rather than aim for a homebirth. It's just sad because I really get on with water as pain relief, and I always labour fantastically at home until I get to hospital and they make me lie down so it gets excruciating.

Last time I saw the supervisor of mw's to fight my corner, she was nice but even then I read through my amended birth plan and it was all "I'd prefer not to have _ but understand that I may have to" so in other words giving them permission to do whatever they want.

[ILikeToMoveItMoveIt]

Find out who your head of midwifery is and speak to her. Say exactly what you have said here. There often is a middle ground to be found.

You don't have to do anything you dont want. Your body, your choice.

Having an advocate for you who fully knows and understands your wishes is a must I think - whether that be at an appointment or in the labour room.

They cannot lawfully rule out a home birth. There is something called duty of care which means a woman must be attended by a MW. They may well try and guilt you out of the idea, but they cannot actually refuse you. But that means you have to be strong and stick to your guns - this is where having an advocate is essential.

Good luck

[JamesAndTheGiantBanana]

Scaevola, as far as I know there's only one labour ward in hospital, in fact I think I've given birth in the same room twice! I know there's a birth pool so maybe they do have an active birth suite but I'm unlikely to ever see the inside of it lol

Funny thing is, they allowed me to have baths whilst in labour in hospital, so why couldn't I go in the birth pool? surely its no easier to haul me out of a bath if something went wrong, than it would be from a birth pool?

Thanks for letting me discuss this here, I can't even mention it to the midwives, last time I questioned anything about my care, they literally mentioned social services involvement! (so I reported that mw to her supervisor) - it's not fucking on when you aren't even allowed to question their decisions without basically being threatened!

[TrucksAndDinosaurs]

www.aims.org.uk/

Please look at AIMS and consider speaking to them; they are just great and so so helpful.
You could also consider a doula to advocate for you?

Good luck.

[JamesAndTheGiantBanana]

I might do that, MoveIt. I wish I had an advocate, unfortunately I only have my dp who doesn't know much about this stuff and isn't great at sticking up for anyone, even if he is on my side.

May have to go out shortly but keep the advice coming, I'm very grateful.

[ChunkyPickle]

Ha! Yes - the consultant I saw skimmed my notes, thrust a plus size pregnancy leaflet at me (which had no information in it - just guilt inducing vagueness), wrote the prescription for aspirin (with no explanation, and from my research, no reason I can find), ignored what I'd said about being induced and told me that they'd 'allow' me to go to 41 weeks, then they'd break my waters, and if that didn't work put me on a drip. She was quite shocked at my forceful 'NO' in response to that but soon got back on her track of ignoring what I was saying.....

I've looked at the risks, even the ones that they say are doubled and tripled (I note they rarely give actual figures), and they're still smaller than many other risks we all face when pregnant.

I don't know how high BMI you are - I break both the BMI 40 limit (just), and the 100kg weight limit (just) so the water pool isn't a battle I'm prepared to fight. If you're closer to their policy limits it would certainly be worth a go - from what I understood, the 100kg limit is purely because they're worried about being able to get you out in an emergency. I'd almost expect that a homebirth would be easier to push for than the water!

[5madthings]

You can insist on a home birth and I have heard that if you do they may offer you the option of the midwife led unit as a compromise. Worth a try?

But given you have had two normal preg and births your weight alone doesn't seem a sufficient reason to say no to a home birth.

[ExBrightonBell]

I would agree with the idea of having a doula with you, as an independent witness even. I'm astounded that they rewrote your birth plan to remove any definitives - how disrespectful of them.

[JamesAndTheGiantBanana]

My bmi is higher than yours, Pickle, 52 at the start of this pregnancy. I realise this is very high (it's also because I'm short!) but as I said, I'm healthy in all other respects. I don't smoke, my blood pressure and blood sugar levels are great, I walk every day, more so than I ever did with my previous pregnancies, and while I know I'm not fit, I do trust that my body can do this. It's done it twice before, sorry to be graphic but my body virtually vomited them out in just a few short pushes with barely any help from me!

I refused induction with the last baby (they wanted to simply because she was 11 days over THEIR dates... they had put my dates forward by a week based on a scan, despite me knowing exactly when I fell pregnant) so I said no to that. They weren't impressed and basically scaremongered and pressured me to submit until I went into labour naturally the next day. She came out tiny and still covered in lanugo (that fluffy hair they have all over in the womb which they shed towards the end) not exactly the signs of a terribly overdue baby!

Don't you just love them telling you what they're going to do to you? I feel like saying "well you'll have to catch me first, and I bite" lol

[ILikeToMoveItMoveIt]

If I were you I would start off from a position of compromise. The majority of HCP's want to be in total control, so initially going in all guns blazing often makes them and their attitude worse. They close down to discussion and don't listen.

If you show you are informed and willing to compromise it often gets the discussion going and moving and they become more flexible.

Also finding out why they have their rules can help come to a solution. Do they not want you to labour and birth in water because they can't continuously monitor you? If so suggest that they can manually monitor you every 15 minutes - people can monitor as well (if not better imo) as machines! The only difference being that they don't have to be in the room if you are hooked up to a machine If they are worried about getting you out of the bath if you are unwell, you can say that as soon as you feel un well you will get out. Also if there is someone manually monitoring you they will notice that you look clinically unwell before it comes an issue(something a machine cant do). These are examples but I think you probably get the gist.

[ChunkyPickle]

lol - I'm cursing not boosting my height by an inch and my weight by a couple of kilos.. it's not like they've every measured, and it would have made my life much easier!

Those are good points ILike - I shall steal some of those for my own campaigning :)

Do they have wireless monitors at your hospital? In Canada I had them and could wear them in the bath and wander around quite easily (well, until I had the drip in.. then I had to wander around with a little wheelie pole) - the hospital here says they have one set, but that their other ones are at least on very long leads so there's no need to be nailed to the bed.

[DontmindifIdo]

Can you afford a doula? It might be the best option for you.

[RNJ3007]

I'm in the same boat. High BMI meaning they wanted to do 3 GTTs, growth scans at 24, 28, 32 and 36w, etc etc. I have Hyperemesis, so now get fortnightly scan as baby is small; yet still being told I'm likely to get a c/s as 'women with a high BMI cannot birth naturally effectively'

My DD was born in three pushes... After a 3 hour labour.

My birth plan clearly states 'I DO NOT CONSENT TO AN IV, CONTINUOUS MONITORING OR PRESSURE TO HAVE AN EPIDURAL DUE TO MY WEIGHT.' at the top. I have told the consultant in no uncertain terms that unless there is medical need (ie:fetal distress/mec in waters/bleeding), I'll be refusing cervical checks too.

My body, my rules, TYVM!

[Bunbaker]

ILikeToMoveItMoveIt has some really sensible points.

What you need to remember is that these days the NHS are being sued for every little thing that goes wrong and a lot of what you may consider are obstacles to having the birth you want are simply back covering exercises.

Regardless of whether you have had easy labours before, having a BMI that high does increase the risk to your baby and yourself so medical professionals have to take that into account.

I think some of the posters here are a little defensive about their weight, but the main thing to remember is that the main thing healthcare professionals care about is a successful outcome to mother and baby.

[ChippingInWiredOnCoffee]

Bunbaker - do you work for the NHS perchance? Them spouting crap like this 'women with a high BMI cannot birth naturally effectively' does not help - especially to a woman who has birthed naturally already!

What do they consider a 'high' BMI now?

[JamesAndTheGiantBanana]

RNJ3007, sorry to hear about the hyperemesis! do you mind me asking your bmi? you don't have to answer. You're brave to write that on your birth plan, I went for the Mrs Reasonable approach last time, trying to word my preferences so gently it would make them agree - not that it really made any difference apart from to ensure a bit more privacy (the first birth they didn't bother to cover me up after the birth and people were traipsing in and out unannounced to access a storage cupboard in my room coming face to face with my ragged post birth crotch in stirrups. I found this horrifying afterwards)

Maybe a stronger approach is necessary.

Chunky I'm not sure about wireless monitors, I know they can do intermittent monitoring with one of the handheld machines but they seem to prefer strapping us down to the big machine, despite the fact that the belts don't stay on well or keep a trace through a fat belly so you have to keep it pressed on with hard pressure. At this point they usually say they NEED to put a scalp monitor on the baby (ensuring that you definitely can't move off the bed - much easier for them)

Don'tmind - I'm 33 weeks, not sure if there's enough time for a doula, plus I'm skeptical about finding one who would be size friendly, well informed about it, and assertive enough to fight my corner. I did look into it early in pregnancy but there was only one nearby and she seemed really airy fairy, lotus births and stuff.

Interesting points, MoveIt. Having been through this before they've cited reasons such as needing super strong beds, ambulances, wider doors, hoists (can I just state I'm not that fucking big, I'm usually a size 24!) and staff not being able to lift me up should anything happen. I can understand the concern with the last one, I wouldn't want to hurt anyone, but dp will be there and he's "used" to moving me on occasion!

All I can say is I've done it their way twice and nothing bad happened, no strokes or soaring bp etc. I've had the same antenatal test results as the other pregnancies, nothing has changed pr worsened, I'm roughly the same or slightly lower weight, I've lost weight within this pregnancy, and I'm anticipating the same kind of birth with a similar sized baby.

Would it really be so bad if they let me labour naturally in a darkish quiet room? I'm not asking for anything special, just the same respect and peace you'd give your cat if she crawled into the airing cupboard to have her kittens!