Calling all midwives!

[Littleblueowl]

Just looking for a bit of guidance.

What would you say are the main problems/concerns/dangers regarding pregnancy and childbirth in an obese woman?

Thanks in advance

[VivaLeBeaver]

Diabetes

Shoulder dystocia

guidelines saying need to monitor fetal heart through labour so cascade of intervention. Hard to pick up FH with obese women, so end up on bed, not mobilising, don't progress, have the syntocinon drip, epidural.

[VivaLeBeaver]

But it is just raised risks. There's plenty of obese women who sail through pregnancy and labour no problems.

And a world of difference between a bmi of 30 and a bmi of 50.

[Littleblueowl]

Thanks viva. What is the protocol for monitoring pregnant ladies with high bmi? Is it more regular than that of a woman with normal bmi?

[VivaLeBeaver]

Recommendations are for more scans in third trimester to get a more accurate picture of baby's growth as it can be hard for community midwife to tell. Not sure how many scans as I don't work in community.

Also for a gtt test at some point to rule out diabetes.

Consultant led care which normally means one appt with consultant where they say they'd recommend that baby's heart beat be monitored all the time in labour, advised no to home birth and pool birth.

[Meplusyouequals4]

I have a bmi of 32 and I've not had a bad pregnancy. I've got PPGP but had that with DS and DD and had a much lower bmi with them.

I've had 2 extra scans this time (which is lovely)

don't worry to much about it I know women much bigger than me who have had a very straightforward pregnancies.

There was a thread on here with other women I'm similar situations and could be very helpful

[JennyBlueWren]

I'm obese but the only difference has been getting extra folic acid.
Bump was measuring 4 weeks bigger at one point but baby is within the normal scale (although seems to have long legs!).
Physically I've been doing fine -or at least relatively so.

[Jackieharris]

It depends how high it is.

Mine is over 30 but it hasn't moved me into a high risk category and the consultant actually recommended home birth.

[MissTwister]

My BMI is 33.4 and they said nothing different happens unless its over 35 so proceed as normal, birth centre and all

[onthematleavecountdown]

Mine was 30 so technically 'just' obese. I developed gestational diabetes so you don't need to be massively obese for these things to affect you.

At my hospital bmi of 35 triggers additional checks.

[fattymcfatfat]

My bmi is 30, ive been told to have the gtt and thats it. Other than that nothing different

[Slongette]

My bmi is over 40 - with my first pregnancy I had to have a GTT (sugar levels perfect no GD) and was under the consultant who saw me once then said he did not need to see me again and transferred me back to the midwives.

Birth slightly complicated as waters broke then failed to progress (no contractions for 24 hrs) so had to be induced, epidural, baby back to back, forceps etc etc.

2nd pregnancy and I'm 20 weeks on Monday. Fully expect to have no problems as before.

Bmi is bullshit but I am fat.... I'm also fairly fit (dog walking twice a day and now toddler wrangling) so that plays a major factor in having a problem free pregnancy.

[GoooRooo]

I had a BMI of over 40 last time, and just under that this time. I had GTT (no GD here). No high blood pressure or any problems during pregnancy except my legs swelled up in the last two weeks - but I've a history of DVT so that might explain that.

Saw the consultant once. Had an extra scan at 36 weeks because they were concerned the baby would be big.

Waters went at 37+1 then didn't progress for 24 hours so was induced. Had an epidural (but that was nothing to do with my weight - I found the internal exams really painful. Won't bother with an epidural this time). Baby born with no problems and weighed 6lbs 8oz so not a huge monster at all.

[naty1]

Im not obese bmi 21 or so. I do have pcos though so bad control of blood sugar.
I had pretty much the intervention though (except shoulder distocia (sp).
So natural labour and rupture, lack of progress, syntocin, ventouse and forceps. Baby was only 7lb 10.
(My dsis just had a 9lb baby despite a bmi of under 20 with probably GD.
The risks may be higher with obesity, but they are always there for everyone.
What would concern me is, from obem it being more difficult to site an epidural so it might only work on 1 side etc.