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??

I'm not an obgyn thunder and she was discharged from my care when she improved so I never saw the baby. I do know that a subsequent scan after losing weight (because her earlier scan wasn't clear) was all clear and was also much clearer. That's the extent of my knowledge.
She never had to come back to clinic after giving birth either, which patients often do, so I never got to ask.

Chicleteeth, are you a dietician? Are you the sort of person I'll have an apt with next week? What will happen?

Also I've been approached to take metformin during this pregnancy for a study. Do you know anything about that?

I didn't keep asking you, you asked me first.

No of course one person is anecdotal I gave you the specifics for one. There were many more people whilst a small study and the data pool is building and the statistics look good.

Keep checking pubmed over the next year (I know it's a long time but it takes time to gather the data), there are several groups worldwide researching this to my knowledge and so something should be in a decent peer-reviewed journal in the near future.

I don't care what you look like, that's the point I'm making. You implied I did.

You need to see your GP ditziness or ask for a referral.

I will not advise medically online.

Btw, sorry don't really get or care what you two are arguing about. Fi d it amusing though! You both sound passionate and respectful to me.

I've got a referral. Probably with someone like you. Was just wondering what would happen as I'm terrified. But as you were. Keep arguing.

Chicletteeth - you have gathered that data on that patient with her consent for a specific purpose. Drawing broader conclusions is part of that purpose. Presnting to professional colleagues at a conference is part of that purpose. Using the data to bolster your arguement on an internet forum is not part of that purpose. It IS unprofessional of you to post in that way. If she recognises herself she would be justified in making a complaint.

As far as the broader issue goes - weight has a bearing on risks of some complications in pregnancy. So do many, many other factors. It's fat women though who are treated as if they are 'naughty' and who need to be 'controlled'. Plenty of overweight women will have normal pregnancies and deliveries. Some won't. It would be helpful if HCPs simply looked at the woman in front of them instead of seeing the FAT woman in front of them. It would also be helpful if it was universally remembered that interventions and tests may be suggested NOT mandated. All treatment is optional - yes even for fat women.

Don't be terrified ditz.
Just ask lots of questions so you walk away with all the information you need.

Did it say on the patient consent form that they gave consent for you to use their details on social forum while arguing under a pseudonym, chicleteeth? Research ethics are a lot stricter than NHS confidentiality guidelines. To use this data to prove your point without being unprofessional, you should cite the source and not imply that this was a patient of yours. This is not an academic context. I very much doubt that the patient gave consent to have this data shared in this way.

And there may very well be several groups researching this, but until there is a substantial body of evidence in peer-reviewed journals, it doesn't actually mean a great deal. I am surprised that someone in clinical research wouldn't present information like this to be honest. All researchers I have ever worked with are very cautious in how they disseminate results, highlighting all potential caveats etc.

X-post

You don't follow up the outcomes for their babies when you've helped them to actually lose weight in pregnancy. Seriously? Even though you present their data as a "success" at a medical conference. Wow.

Also I asked you once if you were a dieter. On the other hand you kept insisting I was a failed dieter and I was overweight. Remember:

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

"I don't care what you look like, that's the point I'm making. You implied I did."

No I didn't. You're having conversations with people who aren't in the room again.

It is in the public domain and it totally anonymous.
All anecdotal medical data can only ever be about one person, you can present it so long as anonymity is preserved.
There is absolutely no way she would recognise herself, there is simply not enough information and the figures I gave are a dime a dozen; very very common indeed.

I think pregnant women generally are treated as if they need to be controlled, weight issues aside. But that's another thread.
You are right that HCP's need to assess the person in front of them, I have said it time and time again an it is what I try to do.

Of course you can only advise a patient what to do, not sure it says anywhere that it isn't?

Mind you I'm not surprised you're getting shirty if you're actually doing research into how to get women to actually lose weight whilst they are pregnant. Nothing like getting published to make a name for yourself in medical circles and boost your career.

Can I give you a top tip though - see how it turns out for their babies too. That small part of the equation is quite important.

chicleteeth is not talking about dieting in the sense that some people here seem to understand. She is talking about a change in eating habits rather than going hungry. Frankly, I don't understand what you are arguing against here.

I lost 10 kgs several years ago with the help of a dietician who showed me how to change my eating habits. It wasn't a "diet" and it still isn't one, as I have continued to eat the same way. I still weigh 60 kgs and wear size 38 and will be eternally grateful to her

I'm not an obgyn thunder why would I?
The obgyn deals with the baby. If a patient is discharged from my care because they have improved sufficiently to do so, why would I need to see them for something that is outside my remit? Talk to the NHS if you have issues with that. Baby is born, paediatrician steps in.

Working as long as anonymity is preserved, ethics clearly states it can be used. You can doubt away, but due to webinars and other web-based means of media (neither of which actually take too different a format to this), it is allowed to presented over the internet providing the patient isn't identified. Sorry to dissapoint you.

I have said clearly it is early days, but the improvement we see in metabolic dysregulation merit further investigation.

Why would you not investigate something that is so far, seen to improves individuals health?

Anecdote and medical data are not the same thing, not sure what anecdotal medical data is?

You are also wrong about the ethics of this, sorry. Remember those forms they had to sign? Remember that lengthy process? You would have been totally justified to write "I was at a conference where data was presented about a primagravida, 28, caucasion yada yada". You are not justified to present or comment on the feelings of a patient in relation to a treatment, even though it is anonymous. Seriously, you have been through NHS ethics? I couldn't even write on an information sheet that a computerised reaction time experiment for teenagers was a "game" as it was considered potentially coercive. There is not ONE chance that presenting this data as you have done here would be deemed an ethical use of data by an NHS review body.

Anyway, I've said my piece. You will believe what you choose. Have fun arguing.

Thunder I am not getting shirty or worked up.
Clearly you are trying though.

"Ethics clearly states it can be used" - in what context? This is not an academic context, this is not a webinar, you are not presenting as yourself, you are not presenting for an academically or clinically relevant purpose. Are you joking???

Medical implies it's about a person.
Anecdotal data could also apply to an intervention done on one rat for example.

I have been through NHS ethics repeatedly working.

Anonymity is preserved, that's the important thing.

Yeah, you tell yourself that. Perhaps you would get away with it, I have been through NHS ethics too and I am dubious but I think it is a misuse of patient consent to use data for the sole purpose of making a point on Mumsnet and if I were partaking in an unpublished clinical trial as a participant, I would not be happy.

"chicle is right in her assertions that 'dieting' during pregnancy is NOT good for you"

It was me who said that, not chicle. She took issue and this whole argument started.

thunder I have said people shouldn't diet.

I have said that clearly.

Changing your eating habits and dieting are not the same thing at all.

I think you'll find you've been argumentative thunder
Read back through the thread. You've argued and argued with everyone who disagrees with you.

You can think what you like, it's called free will and you can exercise yours as can everybody else.

Why you would assume that after being referred due to ill health, a consultant is trying to harm you rather than help you, is frankly, quite puzzling.