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??

Look it's pretty simple. A woman's weight during pregnancy is still her weight. The doctors don't say "well you weigh 10 stone but we'll knock off 7 pounds for the baby inside you." Because hey, they can't tell how much weighs, amazingly enough.

So if a woman is losing weight whilst she's pregnant, then that's an extremely bad idea. That's all I said and you felt like you had to nitpick at it.

I'm sorry you're struggling to follow that simple argument but it did allow you to give us the benefit of your professional opinion, so thanks.

"how much the baby weighs"

"Either way, my guess is your BMI is not within the healthy range since you protest too much of its relevance."

You wish. I guess you'd feel like it was easier to be patronising if you could think of me as a "failed dieter".

Actually what I object to is the massive diet and slimming industries with their anti-fat supporters some of whom are in the medical profession, who are so smug and sure of themselves they don't even think it matters if women are given information that is just plain wrong in pregnancy.

Yes it is pretty simple.

But when somebody is so fat that you are concerned about their weight gain, you do consider the weight distribution and where it is. I didn't nitpick at you, the fact is, for a morbidly obese pregnant womoan, it's how it's assessed under those circumstances.

So thanks.

Yet again, it is not always a bad idea for a woman to lose weight when pregnant. FACT (and by this I mean weight maintenance where her weight may go down a little, or weight loss in absolute terms too)

I don't care if you believe me or not, but I'm not wrong.

How am being patronising?
When I have been either rude or patronising to anyone on this thread.

You jump in the face of scientific reasoning and medical facts and make sarcastic comments and you call me patronising? Laughable.

I care not a jot if you are a failed dieter or a size 8 sylph; psychology tells me you are the former.

What wrong information during pregnancy are you referring to?

So I was 18 stone when I got pregnant ( 5 ft 9) . That's seful isn't it? So fed up. I'm 12 weeks now. One good thing is i've had awful morning sickness so hopefully i've lost a bit of weight. So can I diet and try to lose weight? I'd like to . I was desperately trying to before I got pregnant, and lost the same half stone every month for the last year. Was so fed up with myself that I didn't manage to sort my head out prior to pregnancy. Last time I fell pregnant I was about 16 stone. Had no complications during pregnancy last time and a natrual delivery. Hopefully will be ok this time. Got apt at dietician next week and have been cycling half an hour a day, and swimming an hour at weekends. Am terrified really.

"or weight loss in absolute terms too"

Oh we finally got there. You support a woman actually losing weight whilst she's pregnant, not just weight maintenance and then the obvious weight loss because of birth.

So where is the research that approves of that approach?

Because you know if it's a FACT (although researchers don't agree on anything) I'm sure there's plenty of research to support it.

What'll happen at the dietician apt?

"I care not a jot if you are a failed dieter or a size 8 sylph; psychology tells me you are the former."

LOL, where on earth did you pick up an attitude like that? That's some faith you've got in yourself if you think you can tell the size of a person and their food history just by reading their words on a screen.

"What wrong information during pregnancy are you referring to?"

Read the OP.

Metabolic dysregulations in pregnant women pertaining to gestational diabetes and lipid metabolism as well as other outcomes, are improved with weight maintenance and situation-depending, weight loss.

I've been doing this for years and want only the best for my patients.

Why are you suggesting that I would try to harm them? It makes no sense at all. I can't even get worked up by a quack on the internet who is trying to rile me,I just can't.

The sudden rise in morbidly obese women having babies mean the data pool is not very large and it's thin on the ground in the literature since this has until reacently, not been much of an issue.

Being on the frontline I see it myself and I advise people to do what is the best for them and their developing baby.

Why do you have a problem with that?

The wording in the OP is bad.
I would never give this to somebody, although given that many of us have looked up an NHS form by that name, we see no evidence of the inflammatory text that the OP has posted.

She should really come back to clarify otherwise it looks to many that she may have just been overreacting to advice given to her because she's obese.

That said, the general message is fairly accurate and if you are obese, some of the things listed, may become a problem for you.

It is better to fully inform people.

No no actual scientific data or research to back up your FACT then.

I'm not trying to rile you. You started nitpicking at my posts, not the other way around. Oh that and calling me ignorant. You're welcome if it makes you feel good about yourself. :)

Thou doth protest too much thunderalthough I've already said earlier I may be wrong.
Yes, reading someone's words are very insightful...

Well fuck me being massively overweight is bad for you, who knew?

my local midwife says that although one should not diet when pregnant, if they were overweight, they were advised not to put on lots of weight.
As I said, due to throwing up everything when pregnant, I lost lots of weight both times. With DD I lost three stone during the pregnancy.

Well I think you'd better recalibrate your insight meter, because it's way off. And given that you appear to be feeling pretty smug about it, you need to know it's not working.

I object to the dieting and weight loss industries and their medical cohorts (lots of money to be made in anti-obesity drugs) because they are harmful to people and I'm in the lucky position of only having to be an observer of their machinations, not subject to them.

Hi thunderbolts - can you clarify please as I'm confused!

Are you saying it's better that an obese woman should not lose weight if she's pregnant?

Chicleteeth, the tone and content of your posts to thunder are really quite appalling. I particularly dislike the way you assumed she was a "failed dieter" as though people with healthy BMI's can't have thoughts on diet and nutrition! Are you one of those who has to wear a frozen mask of professionalism in the day job while seething with rage that you can't actually shout "you disgust me you fat bitch"?

My limited, non professional understanding is that there's quite a lot of evidence that dieting is quite unlikely to be successful over the medium term and that it in itself has very negative effects on metabolism. I've seen family members with obesity on and off the diet wagon for years and it often strikes me that they end up eating less than I would ever eat in a day and are fatter at the end of it. Binge/purge, binge/purge.. when really what they needed to do earlier in life was learn to stop eating when they were full. That's all. I often wonder if some of these crazily fat people had never tried to lose weight would they be thinner than following some of the nonsense they do, some of which is outrageously unhealthy and just seems to result in massive rebound weight gain.

None of this changes the fact that the OP's leaflet seems patronising, unhelpful and unlikely to enable women with higher BMI's to achieve positive lifestyle changes. "You are screwed, but stop eating anyway". What a strange message!

I think some builds could be overweight rather than obese at 13 stone. I'm 11 stone and still wear size 8/10 and I'm only 5 foot 4.

I've not problem with BMI being used as one of a number of a measures, I take issue with it being used as a crude indicator.

I have loads of data thunder but there is almost no published data.
In case you hadn't noticed this obesity epidemic has suddenly exploded, there is not much data in the literature. It will build up over time.

But here's one for you; 28 year caucasian, primigravida, OGTT fasting glucose of 10 (very high),fasting insulin 150pM (high). She weighed 20 stone and by the end of her pregnancy weighed just under 19. Her fasting glucose dropped to 6, insulin down to 110 (much better although a little high), lipid profile vastly improved. She is one of many for which minor weight loss made a difference and we are currently researching how best to implement this and under what conditions.

She was ecstatic, as others have been too and none of them dieted.

Not everybody is as bitter as losing weight as you.

I don't care what you look like or what you weigh. It has no impact on my life in any way at all.

Why on earth do you think I'm smug.

And actually working9while5 I think you'd better check the tone of thunders posts to me earlier. I have not been anywhere near as rude and she asked me first if I was a dieter. That ok with you?

Read through the thread if you want to see how I approach my patients.
I'm well liked and it's because the word diet is never used and the use of diets is never advocated.

Please read the thread first.

I've read enough to really feel uncomfortable with your tone. Are you using a two wrongs make a right argument here? I have no interest in how you say you approach your patients, you seem full of venom at the moment and I don't think you should be posting client cases, even anonymously, in this context. It is unprofessional.

How was her baby?

You don't care how much I weigh or whether I'm a "failed dieter" which is why you kept asking or mentioning it I suppose. Also "what I look like" - where does that come from? Is how people look important to you, because you're the first to mention it.

But anyway one person with a good outcome isn't enough. Not if you're talking health outcomes, and measuring whether something works and is effective or not.

"Not everybody is as bitter as losing weight as you."

That's what you get from my posts? Crazy.

"Are you one of those who has to wear a frozen mask of professionalism in the day job while seething with rage that you can't actually shout "you disgust me you fat bitch"?"

Oh my god working, you've just reminded me of someone I met once who had been a nurse on ward where they did gastric bypass surgery. She couldn't contain the disgust she had for the patients she'd looked after there. Kept going on about how disgusting their eating habits were. It was astonishing. Even more so, that she couldn't see any problem with her attitude.

I think it's important we know how much more at risk we are, as well as what we are more at risk of.

The leaflet is crap because it's lacking in that context.

'Twice as likely' is irrelevant if the normal risk is 0.1% for instance, but we're not being told.

I'm not full of venom at all.
It is totally anonymous and this particular set of data has already been presented at a conference so in the public domain. So it is not unprofessional at all given that no information in anyway identifies this person. It is allowed and even encouraged.

And thunder I didn't mean you were bitter about not losing weight (I've got no idea if you've ever done so) I meant about your attitude to losing weight.