Has anyone been refused a water birth because of their BMI?

(54 Posts)
SuffolkNWhat Sun 07-Apr-13 11:23:59

My midwife is a bit obsessed with my BMI (currently 29) and has alluded several times that not only will I not be allowed into the MLU but also that I might be refused a water birth because of it!

Surely water is better to keep things mobile if you have a higher than normal BMI? I know 29 is far from ideal but neither am I morbidly obese!

Has anyone else c

SuffolkNWhat Sun 07-Apr-13 11:24:56

Gah posted too soon.

Has anyone else come across this? Tbh it's making me feel quite resentful towards my midwife which I don't want to be.

diamondee Sun 07-Apr-13 11:28:26

No, I haven't encountered this and I wanted a water birth with first 2 dc. I ended up not having one due to complications but at 17 st and in labour with dd they filled the pool for me.
Perhaps speak with another midwife?

I am in the same boat. I was a 16 before the bump, 6' tall and doing weights, running etc. My BMI is high, which I am happily blaming on lots of leg muscle, and the fact that BMI doesn't work so well when you're tall. I've been told that not only cannot I not have a water birth, but that I will HAVE to have a glucose test in case I have diabetes, despite having perfectly normal blood sugar levels and showing no symptoms.

They said no water birth, I'm saying, fine, I'll stay in my bath!

duchesse Sun 07-Apr-13 11:30:04

There was another thread about exactly this the other day. A lady with a bmi of 31 before pregnancy who'd moved mid pregnancy. Did you see that one?

SuffolkNWhat Sun 07-Apr-13 11:31:09

I've been to I have to have the GTT thing too despite not having last time and being smaller than I was pre DD!

My BMI is skewed because I have nearly 2 stone of breast tissue (32L cup) I'm a 12/14 on the bottom which is not big!

SuffolkNWhat Sun 07-Apr-13 11:31:45

Oh I didn't duchesse, will have a search thanks

duchesse Sun 07-Apr-13 11:32:08
CoolBananas Sun 07-Apr-13 11:34:44

If it helps I've just been to a water birth class and one of the things the midwife mentioned was that you may not be allowed a water birth if it might be tricky for a midwife to help get you out of the water in a hurry if they needed to.

SuffolkNWhat Sun 07-Apr-13 11:40:02

But surely DH could manhandle me out?! My BMI is actually dropping due to having HG so maybe I'll be lucky.

Delayingtactic Sun 07-Apr-13 11:44:11

It is about being able to get you in and out of the bath in an emergency. And no they won't be able to rely on your DH being there. I can kind of see their point sorry.

catlady1 Sun 07-Apr-13 11:46:44

My BMI was 40+ by the time I gave birth, nobody mentioned that I couldnt have a water birth. As it happened, just as a pool became available I was starting to push, so it never happened, but they would have been happy for me to get in. I had to have the GTT but other than that nothing was out of the ordinary and I was under midwife care throughout.

duchesse Sun 07-Apr-13 13:11:44

Surely if that were the main motivation then overall weight rather than BMI would be the more compelling factor? Most 9m pregnant women are pretty hefty even if their BMI is acceptable.

Maybe it's a combination of higher likelihood of complications + likely higher weight?

cupcake78 Sun 07-Apr-13 16:06:19

I was refused due to the likelihood of my blood pressure increasing during labour due to my bmi. I still don't fully understand it. As it happened my blood pressure was fine.

Going to ask this time round as well but expecting to be told its not going to happen. I will just stay at home for longer and use my bath more!

wispa31 Sun 07-Apr-13 17:13:12

bmi is a load of bollocks anyway. why they still use it is beyond me! there are bodybuilders i train with who sit around 10% bodyfat year round who would be classed as 'morbidly obese' according to their stupid bmi charts.

Rookiebfcounsellor Sun 07-Apr-13 17:15:51

MrsMango I had the same issue as you. If you ask to see the lead mw and/or consultant they will review whether the decision is sensible. Worked for me and I had my water birth after both supervisor of mw and consultant signed it off.

Notmyidea Sun 07-Apr-13 19:34:46

Certainly familiar with the policy, mostly to do with increased risk of complications and the difficulty in getting mothers out of the pool. My response, currently having the lowest BMI in pregnancy I've ever had, and having my first two children before this BMI monitoring was brought in, is to hire my own pool in my own lounge and get on with itsmile

kelli10 Sun 07-Apr-13 20:52:11

My BMI was really high when I had my son. I never really talked to my midwife about my birth plan as I wanted to be as flexible as possible. When I got to the hospital I asked to use the pool and they let me right in. Didn't end up having him in there though as it was too hot for my liking...

weeblueberry Sun 07-Apr-13 22:33:40

I've never heard of this and was really hoping to have a water birth... Did you all just ask the midwife at your normal appointment? No one has mentioned this to me and my prepregnancy BMI was 34... sad

olivertheoctopus Sun 07-Apr-13 22:41:37

Here they moan a bit if BMI over 30 and moan a lot if over 35 but mine was 30 last pg and no-one ever said no water birth.

weeblueberry Sun 07-Apr-13 22:49:14

Just checked and my prepregnancy BMI was 31.8... I admit I'd be upset if this was factored into me not getting a water birth sad

nannyl Sun 07-Apr-13 23:03:46

choose a home birth and then its up to you!

you can do what you like at home, and are not bound by those redicolous rules

4posterbed Sun 07-Apr-13 23:24:29

It isn't ok having a high BMI, it's not good for your health and it's not good for your baby. It is highly irresponsible to go for a water birth at home if you know you are too heavy for a midwife to help you out if you needed it!

Midwives and nurses can do their backs in if they don't have specialised hoists etc to lift overweight patients. Are you seriously suggesting these rules are ridiculous? How utterly selfish!

5eggstremelychocaletymadeggs Sun 07-Apr-13 23:30:51

They do have hoists etc to get women out if necessary.

Weight can be an issue, the worry would be you passing out, becoming immobile etc.

They can only advise you whats you can do, its up to you ultimately.

There must be more stuff about this if you Google but yes home birth is an option.

awkwardsis Sun 07-Apr-13 23:34:04

4poster, tell us what you really think wink fwiw, I had a water birth at a normal Bmi and I think it's fair actually to consider the possibility that someone may have to assist you and just how possible that would be at a heavier weight. I positioned myself right under the taps as they were running, god knows why, but in doing so assured everyone in the room got soaked. I would not be moved until they threatened to haul me out themselves. You might think you'd manage ok but in labour, you just don't know if you'll even be able to listen to reason. I actually had a very calm birth so wasn't delirious or anything, I just went completely into myself and ignored everyone. They could have brought in the whole team to do the can can for me and I'd have been oblivious. If it came to needing to move you, the pool would cause a big problem I think. Obviously we all hope things go fine and in the majority of births, they do. But for that tiny chance that things might not, I'd not take the risk. I've had an active labour at a higher Bmi that was just as good an experience fwiw.

VivaLeBeaver Sun 07-Apr-13 23:36:30

We don't have hoists where I work.

It isn't just about overall weight as you're more likely to have a shoulder dystocia if you have a higher BMi. If someone's pushing and has a shoulder dystocia in the pool it's going to be very hard to get them out.

They're unlikely to be able to get out themselves at that stage with the baby's head out. No hoist, I'm not going to pull anyone out the pool.

In an emergency we have to fill the pool to the top and then put a net under the woman to float them out. Would only take about ten minutes I reckon.

5eggstremelychocaletymadeggs Sun 07-Apr-13 23:42:37

My hospital had a hoist but oi have heard of the net thingy as well.

My friend had shoulder dystocia in the pool but her moving to get out dislodged the baby so she was lucky.

I had ds4 in the pool 10lb 13oz didn't even have to push. I am 5 2 and size ten. The consultant who checked on him later (he was a bit grunty as very quick labour under an hour) was horrified I had been 'allowed' to have a pool birth for such a big baby....err we didn't know he was that big, tho all my babies have been 9lb + and I birth easily, wide hips etc.

I am sure being in the water helped re stretching and not tearing, ds4's head was off the top of the percentile chart, another reason he was checked o er. He still has a big head now age 5, like his dad!

Nobody HAS to have a GTT. Like any test or intervention you should be aware of the rationale for offering it and be able to refuse it if you wish.

VivaLeBeaver Sun 07-Apr-13 23:52:14

My BMi is 31 and in the unlikely event I got pregnant again I'd refused to get weighed. grin

5eggstremelychocaletymadeggs Sun 07-Apr-13 23:53:24

Good point northern with preg no 5 the consultant wanted me to have it as ds4 had been so big. I knew this baby wasn't as big, I could feel it and I have never had any sdigns of gd in any pregnancy. My midwife agreed with me and said I just grow good sized, healthy babies.

Turns out dd was only 8lb the smallest of my five but the hardest birth as she came out back to back, still less than three hours and three pushes tho. I wonder if she was just smaller because she is a girl, my first four were all boys.

5eggstremelychocaletymadeggs Sun 07-Apr-13 23:54:01

viva grin

5eggstremelychocaletymadeggs Sun 07-Apr-13 23:54:53

I refused the gtt. I also went more than two weeks overdue... I don't think the consultant liked me very much!

MerylStrop Mon 08-Apr-13 00:00:35

I guess your midwife is trying to do the best for you in terms of managing your expectations.

I'm sure it's BS re the MLU and in your position I would do my darnedest to ensure that decision is yours and not some arbitrary hospital policy. Likewise GTT, you're within your rights to politely decline.

The likelihood of actually getting a water birth depends on so many other things beyond your control that it is not worth planning on it in any case.

Suffolk I would get another opinion. Where I am they only really worry with BMI over 35. I had a BMI of 30 at booking in an was advised that MLU or waterbirth at home are both options for me.

For the people citing midwife having difficulty getting you out of the pool, what nonsense. BMI is based on weight and height. So at 5ft 2 with a BMI of 30, i weigh significantly less that someone who is 6ft with a BMI of 26.

SuffolkNWhat Mon 08-Apr-13 14:51:23

I hear what you are saying about shoulder dysloscia however DD was a tiny 6lb 7oz and my family history is we have small babies.

Seeing the consultant at my 12 week scan so hopefully will be able to get some more answers.

VivaLeBeaver Mon 08-Apr-13 16:02:16

Suffolknwhat, small babies can have shoulder dystocias as well. A large baby is one risk factor, a raised BMi in the mother is another and separate risk factor. Saying that 29 is not that raised. I'm fairly sure where I work the cut off is a BMi of 30 at booking.

PourquoiPas Mon 08-Apr-13 16:38:01

Surely weight at 9 months would be a better measure of whether you can have a pool birth or not? I weighed 1.5 stone less at 9months than at booking (HG), and someone with a high BMI at 5'2 would weigh less than someone with a lower BMI who was 6'.

Regardless, if you can't lift anyone out of the pool at all and they can't get out themselves once the head is out what difference does it make what they weigh?

What if someone with a high BMI was on the floor or birthing stool and had shoulder dystocia - would a hoist be called for then? Should all women with a high BMI be stuck on the bed in lithomy or mcRoberts in case something happened?

FWIW I had a BMI of 31ish, as with you OP I have ginormous boobs and wear a 12/14 on bottom, 10/12 at waist. I was very fit and healthy before pregnancy, in good shape. I had a GTT and was consultant led due to issues with previous birth, then was discharged to MLU for water birth (didn't get one due to super quick labour but can't complain about that, it was running but not quite deep enough!).

VivaLeBeaver Mon 08-Apr-13 16:48:44

I wouldn't manhandle anyone out the pool if they weighed nine stone or nineteen stone. They get themselves out, or wait ten minutes to be floated out whatever weight they are.

Shoulder dystocias can be managed on the floor as I can reach their vagina and see what I'm doing. I suppose I could always jump in the pool myself but it would be hard to see what was happening.

Blimey. My BMI is 35 and I just had a home waterbirth.

I had a stand alone MLU waterbirth with a BMI of 33 for my previous child.

Are you sure this is the only reason?

No midwife mentioned it might not be recommended.

Oh yeah. I had the glucose rigmorole thing too which I turned down.

Viva Is it really difficult for most women to move/stand/change position with the baby's head out?

Only despite being pretty fat, I've always been pretty mobile and flexible in labour and every time have change position at that exact point (confusing the poised midwives each time, despite the fact that I actually told them I would do that with the 3rd). confused

'I suppose I could always jump in the pool myself but it would be hard to see what was happening.'

Lol, - or if it is one of those blow-up pools you could just pop it!

VivaLeBeaver Mon 08-Apr-13 21:45:58

Dont laugh, we used to have a blow up pool and one of the consultants always used to say that we could slash it if needed.

I've never had to ask a woman to move when the heads been out and I really don't know if I've seen anyone do it of their own volition. Don't think I have. Maybe lift a leg a bit further up, or sit a bit more upright but not a proper position change.

Ah yeah. It appears I like to push the head out on all fours, and the shoulders out on my back. confused

I TOLD the midwives I would be doing that for my 3rd but they still missed the birth again being at the wrong end of the pool - lol

I even talked them through it as I was doing it. 'Right, I'm gonna sit back now so you might want to go round the other side of the pool'. Perhaps they were wondering what the frig I meant if it isn't that usual. They already knew I was planning to feed the baby in the murkey water with the placenta still attached so they were probably just staring at each other with confused expressions.

I didn't see them though, coz they were behind me grin

VivaLeBeaver Mon 08-Apr-13 21:57:46

You would think midwives would learn to listen to women. grin

Perhaps they were. They were pretty fab in general so maybe they just saw a woman who seemed to know what she was doing given that she was able to articulate it, and so left me to it.

But I kind of push out the head in the position that feels most comfortable for getting out, but once the head is out I have an uncontrollable protective urge to bring them to me and 'cage' them with my knees and arms and receive them myself iyswim. I'm not really on my back but sitting upright with my elbows sharped against intruders etc.

MiaowTheCat Tue 09-Apr-13 12:27:14

I worked on the assumption I'd be allowed nowt for my first birth - got to ante-natal classes and made that comment to the midwife there... got looked at like I was daft and told that yep, there was a possibility I could have a water birth (wasn't in the end cos I had a slow puncture).

As for midwives listening - the one delivering DD2 has admitted to me that I totally and utterly caught her out on that one! (All very good natured though - think she was slightly worried I'd be cross but I just saw the utterly funny and mildly absurd side of everything that had gone on!)

I just wanted to pop back after having had a good chat to my midwife about this. I explained my concerns about the bloody awful labour I had last time, getting stressed and not dealing very well with the pain etc. Turns out at my local labour ward and MLU, they have recently reassessed the limits, and have increased it to BMI 35 from 30. My midwive is all for me starting in the pool to help with the pain and keep me relaxed.

Lora1982 Sun 14-Apr-13 18:46:28

Ive not read all the posts but heres my story: chose hospital one then found out their pool was broke so my midwife said to swap to the other one so i could use their pool. She did say i couldnt go mlu but said i would be allowed a water birth because its how i want to do it not the hospital. Then i roll in january in labour and wanting promised pool to be told no cos of bmi... I was offered a bath hmm well anyway long and short of it the gas and air didnt help me so i got the epidural which i wouldnt of been allowed in the pool. So even though i was falsely led it worked out best for me in the end

StiffyByng Sun 14-Apr-13 19:21:13

I am boggling slightly at the idea of someone of BMI of 29 requiring a hoist!

I have a BMI in the low 30s and have had one homebirth with water, and am planning a second. In my first pregnancy my midwives were totally supportive and I just had to see a consultant (turned out to be registrar) as a box ticking exercise - they spent the whole appointment discussing my SPD and never mentioned my weight.

This time round I have diet-controlled GD and had to be signed off properly for a home birth by the consultant. Luckily he is very supportive of HB and was happy to do so. Again, my brilliant community midwives have been very supportive and were prepared to fight for me if necessary. If I'd been left to the normal midwives however it's clear that I'd have had a big battle on my hands.

I'm glad your hospital's policy has changed. I was going to advise you to see someone senior clutching a copy of the NICE guidance on homebirth, which IIRC state that BMI from 30-35 should be no barrier providing there are no other health concerns. MLUs are often stricter on the women they'll take than on what will be approved for homebirth, if you see what I mean, but it would be a good start. And you could always consider homebirth to make sure you get a pool-that was my main reason for doing it with my first.

TheNewShmoo Sun 14-Apr-13 23:42:28

UCH refused me as I was supposedly obese at 34 weeks. I'm 5ft and big boobed, when I'm not pregnant I'm a size 8 and weigh under 8 stone hmm.

weeblueberry Mon 15-Apr-13 12:40:51

I asked about this when I went into triage over the weekend (long story - all is well though!) and they told me certainly in Edinburgh the cut off is BMI of 35 and this is based on your booking in weight. She also said that, certainly in Edinburgh again, if you didn't qualify for it at booking they'd have told you there and then. Here they consider anything over BMI of 35 to fall into the high risk category so they try and steer you away from a water birth anyway apparently.

Hope this helps. smile

SuffolkNWhat Mon 22-Apr-13 20:10:40

Just a wee update.

Met with my consultant today who assured me that my BMI was absolutely no barrier to a waterbirth and that she had 3 of them and heartedly recommended them!

She thinks my midwife might have been "over cautious" in her advice.

Also been signed off consultant led care today so all set for the MLU grin

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