to be completely shocked and disgusted at the leaflet I've just been given by my mw???

[mummylovesnancy]

This leaflet, titled 'Raised BMI in Pregnancy' was passed on to me by my midwife at my booking in appointment yesterday. Along with the words 'You can't have a home birth, you probably won't deliver naturally and you'll be given consultant led care.'
I'm 28, I have 2 PERFECTLY healthy children who both have perfect height to weight ratios, eat well, are active and are generally normal children. I weigh 13st and I'm 5'2 which puts me in the 'obese' catagory according to the good ol' BMI index of wonder. I have been roughly this weight and exactly this height for all of my adult life. I am overweight, I accept that, but what I don't accept is being told to read this sodding leaflet which tells me, among various other little pearlers, that:
*I will have raised blood pressure. (Not 'I may', 'I WILL')
*I will be prone to urinary tract infections. (never had one in my life!)
*'Bigger Ladies' (exact wordage) get more blood clots. (Dumb Fuck)
*Examinations will be difficult. (Why? Because you have to part all my layers of fat to get to my vag?! How fucking degrading)
*I will have restricted mobilisation. (Will I? Because I don't now, will it automatically come with being fat and preggers?)
*Putting in a drip will be difficult. (yeah because my hands are so freaking chubby.)
*Breastfeeding will be challenging (I've managed it with two babies, now because you've changed your guidelines I think I might struggle.)
And my favourite one yet:
*The risk of stillbirth or your baby dying in the first 28 days is increased in 'larger ladies' (Thanks for that one, nhs, I just had a misscarriage 8 weeks ago. Was it because I'm fat?)

It also mentions on about 7 occasions that I may want an epidural. Is that to keep me quiet?! It also offers to refer me to a dietician and a counsellor.

I have been overweight (or a larger or bigger lady, as the nhs prefers) and given birth naturally twice with absolutely no complications and one of them was a home birth. I can't believe I have to read all this shit. The idiot who wrote this doesn't even know how to place an apostrophe or comma ffs!

Does anyone agree with me that this is a disgusting, degrading, scare mongering piece of shit or am I being an unreasonable pregnant wreck??

yy JV.

BMI is quite a crude measure actually - lots of professional athletes (rugby players, weight lifters etc) are technically obese but it is widely known that they are incredibly fit. BMI makes very crude assumptions about lean mass v adipose tissue that are not relevant at an individual level - so if you had a lot of lean mass (which is heavy) you could easily be classed as overweight by BMI reckoning. Allow me to pass the salt for large pinch to be taken thereof.....

actually not too much salt, it'll play havoc with your blood pressure

Polly read the thread.

Appropriate rebuttal to your appalling example of an athlete's BMI and why this is not suitable has been given

worra, that third example actually tells me something I can imagine, 16 rather than 9 in each 1000.

YABU. I can't believe so many people think that because BMI isn't an accurate reflection for professional athletes they can just ignore it! It is obviously a pretty good way to assess the vast majority of people, and bringing up the old rugby player chestnut is just an excuse. How many people on here who dismiss BMI measurements have the fitness levels of a professional athlete!

Have you read the thread, polly??? That very point was raised, dissected, discussed and we have now moved on :)

Clearly, a raised BMI in an individual woman would be only part of an assessment.

But the research is crystal - women with raised BMIs are an at-risk group as a group. Individuals within that group may temper their risk because they are world-class athletes and their bulk is not fat but muscle. This is readily ascertained by any competent midwife when she takes a history, and uses her eyes, too.

Polly - FFS - she is 5'2" and 13 stone. I am 6ft tall and 11 stone and I still have a gut on me.
In the case of the OP I think we can safely regard the BMI as a pretty useful tool don't you?

Double the risk is still a VERY small risk and does not warrant the consultant led care the NHS bangs on about.

I was morbidly obese and accussed of trying to kill myself and my baby with my mad plan of home water birth. I booked an independant mw and we had a truly beautifil birth experience.

The woman's whole health should be taken into account. I used to swim competitively, I didn't smoke or drink and ate healthily throughout pg. I never had the high blood pressure/gestational diabtetes I was told I WOULD have by nhs mw.

Make women aware of the risks but don't give guarantees that bad things will happen to fatties - it's not always the case just more likely.

Haven't battled my way through the whole thread yet but in answer to towisalford, underweight people do get picked up. I had a low BMI and had consultant care until after the 20 week scan. They were just happy I gained weight and the baby was fine, consultant said to stick to the gym and eating well. I gained 3 stones during both pregnancies.

"Ah I see the old 'althletes are obese according to BMI therefore it must be bullshit' line is being wheeled out again! Funnily enough usually by people who are obese themselves and trying to justify it."

That's interesting Samstown. Can you tell what size my body is just by looking at the words I've written on the screen?

Posts saying 'overweight women should not deliberately get pregnant' is so bloody rude I don't know where to start.

Errrrm..... Women who are obese during early pregnancy have a significantly increased risk of their baby dying before, during or up to one year after birth

It depends on how 'overweight' we are talking as to whether it's 'bloody rude' or not surely?

...And lost it both times. I haven't ended up 6 stone overweight!

0.9% more likely is significant statistically, but doesn't warrant the bloody rudeness.

dieting and pregnancy - not a good idea

DoMeDon - of course you were right to make an informed choice of a home water birth with an independent midwife. But in order to make that choice, you needed the information to decide whether the increased risks of needing medical intervention were ones you were comfortable with.

Women with raised BMI absolutely need the chance to select consultant-led care for themselves as well. And the NHS are right to offer this - this is evidence-based care in action. Why would you think this was wrong?

No one is saying that every overweight or obese person will have all these problems, but it is a valid message that excess weight leads to an increased risk.

I know the OP stated that the leaflet in question stated that overweight people will have increased blood pressure, but I would assume that that is a typo which should be amended to may or are at increased risk of having.

It seems to me that the OP is upset at the general message, which is understandable at a personal level, but personal upset does not negate the duty of the NHS to give this type of advice/information out to people.

People make their choices and take the risks with all in life. We cannot have 'nanny' interferring with people's choice to get pg. Significantly increased is still not that many babies dying. That's like saying there's a risk a baby may die so noone should ever get pg again- utter tish tosh plosh.

Some one was asking about this - cavet - do not know how good quality of the study is. It was just the first uk related one I found:

"Maternal obesity is associated with many risks to the pregnancy, with increased risk of miscarriage (three-fold) and operative delivery (20.7 versus 33.8% in the obese and 47.4% in the morbidly obese group). Other risks to the mother include an increased risk of pre-eclampsia (3.9 versus 13.5% in the obese group) and thromboembolism (0.05 versus 0.12% in the obese group). There are risks to the fetus with increased perinatal mortality (1.4 per 1000 versus 5.7 per 1000 in the obese group) and macrosomia (>90th centile; 9 versus 17.5% in the obese group). Maternal obesity is associated with an increased risk of obesity in the long term."

Source: Obesity in pregnancy
CKH Yu,a TG Teoh,a S Robinsonb
a Department of Obstetrics and Gynaecology and b Department of Metabolic Medicine, Imperial College School of Medicine at St Mary?s Hospital, London, UK
2006.
rcogcourses.org.uk/topics/obesity%20in%20pregnancy.pdf

Thunder if you are obese, this does not necessarily apply.

If you are very very big, depending on other factors (after an appropriate clinical assesment), it may be acceptable to not gain any weight at all and in some cases, desirable.

Yes well that will teach me to skim read the thread and scatter-gun post.

I have just read the links - I did not know that there was such an increased danger in obese women in pregnancy.

I will just shut up now, I don't know much about the subject (evidently) - I can see though how overweight women would get upset when told that they shouldn't get pregnant.

When I was pregnant the second time, I was overweight. I honestly had no idea that it could affect my pregnancy in the ways outlined in the leaflet that you got, and if I had known, I would have kept a much closer eye on what I was eating during pregnancy. Thankfully, I had a good pregnancy and birth, but maybe having someone being straight with me about the very real risks I was putting my child in would have encouraged me to take responsibility for my own health and that of my child.

We cannot have 'nanny' interferring with people's choice to get pg

And yet people expect "nanny" to be there when the shit hits the fan don't they? Personal responsibility. Eat less. Reduce the risks. It isn't rocket science.
Obesity is costing the NHS a fortune. Hospitals are now having to invest in oversized beds, operating tables - even ambulances to fit people in.
Obesity is a lifestyle choice.

I don't think that's a response to anything I've said chicleteeth.

Dieting in pregnancy is a bad idea and probably a lot more common than people like to talk about. A lot of women are obsessed by their weight, probably because our society is also obsessed about what size women should be.

The sort of scaremongering messages in the leaflet the OP mentions are part of the problem not part of the solution. "x, y, z will happen" is unscientific scaremongering.

You posted a link to dieting in pregnancy thunder that's what I'm responding to.

If you are very slim or of a normal weight, or even just slightly overweight, you should put on during pregnancy.

However, the bigger you are as a mother, the less evidence there is for this.