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??

Also thunder, you do realise that there is a middle ground between constantly dieting and worrying about every calorie that goes into your body, and overeating to the extent that you become obese. Why do you think that you cant enjoy food, but just know when to stop? It is possible you know!

Thunder-I am not a serial dieter, although I have dieted/adopted healthier eating regimes in the past. With varying degrees of success.
Of course anticipation can be a big part of the enjoyment of food, but my issues go beyond that. My life, my relationships my waking day is defined by it and that is not proportionate, healthy or right. I don't loathe myself per se, am not depressed, know my worth/strengths but I do loathe my inability to have a relationship with food within normal perameters.

I'm with Thunderbolts here, in that for me it's really not about discipline and self-control, it's about being in tune with what your body wants. I eat what I want, I am a normal size, but I am not perpetually saying no to myself. I love food, love cooking, get a lot of enjoyment out of food, but I don't believe my body is an enemy that will force me to eat more than I want. I do believe we live in an obesogenic society, but it's not the mere availability of food, it's the fact that we are surrounded by messages to eat more and more unhealthy food. If I listen to my body rather than those messages it all sorts itself out.

I found the post that said 'Being aware might include doing stuff like looking on the back of a packet to see how many servings it is supposed to be' very telling - it would never cross my mind to do that and it sounds like some people have no faith in their own ability to decide what a portion is.

Samstown, I'm not saying that. Quite the opposite.

As usual people are having the conversation with the imaginary Thunders.

It's other people who are saying that they have to exercise iron self control otherwise they'd binge out of control and become obese. I'm the one saying that if you feed your body nutritious food, and pay attention to what it's telling you, self control is not required to control appetite and eating

Custard, that article is too full of mights and probablys. It's speculation not fact. They might be right but they only have speculation at the moment.

Custard didnt say she would binge. You are the one going after Straw Men.

Delicious, I would seriously suggest you look at the No-S diet which really might help you.

Also I think that dieting can definitely lead to ongoing obsession with food and concerns about lack of it and being deprived.

I was on a diet once for a day, when I was a stupid teenager and everybody was doing it, and I felt so deprived and thinking about food non-stop I had to stop. I have no self control so luckily I couldn't do it. But I can't imagine the long term effects if I'd been able to. My friend who did actually diet was obsessed.

1. The leaflet seems to mix up obesity and morbid obesity, which doesn't really help with any informed assessment of risk.

1. Consultants take a more nuanced view of all this stuff - what do pregnant women's blood tests say? How fit are they? What shape are they? What is their track record in terms of pregnancy and labour, general health, and so on? Just lumping an entire group of people together so you can throw them a leaflet aimed at anyone weighing between about 12 stone and 26+ stone is utterly pointless, especially considering that women of non-obese weight may be eating terribly and starving their babies of nutrients.

YANBU grouping everyone with a raised BMI into one homogenous group is not helpful, I am disgusted by the authoritative tone of the leaflet and the langauge used and I am a student mw who is well aware of the risks a raised BMI entails. However normally people are lumped into this category with a BMI of 35 plus as that is what the NICE guidelines normally class as high risk. I am the same height and was the same weight thereabouts as you in pregnancy and if iI,m right then your bmi is only about 30 ish? hardly morbidly obese is it? (not that 35 is of course) however the hospital where I'm training is the same and classes bmi of 30 as high risk, so women are told they cannot use the pool or have a homebirth, absolute crap! I am not a massive fatty I dont have loads of flab or overhang and mws had no problem visualising my cervix.

Custy, I have read similar research, and I agree-I happen to think there is more than a grain of truth in it with regards to cravings!

I went on a low carb diet a few months back. Not for the first time. This time I lasted 3 weeks. The longest ever on low carb. After day 5 my cravings had subsided. I was able to stick to the plan without cheating from the outset. My motivation was high. I was eating well. The weight started to come off, but by week 3 there was a plateau. Which from having spoken to Low Carbers on here, I now know to be normal-even if one has a lot to lose. I'd never made it past day 5 on previous attempts to didn't know.
I became demoralised and had a carb fest. Not because I had an overriding craving I couldn't resist, but subconsciously, I think I thought "why should I deny myself the foods I love (bread) long term, for minimal gain"-at that point I'd lost 10lbs. Madness.

It's 3 extra stone I am carrying. It could be worse I know, but it's significant. It's a toddler, FFS!

There was no physiological reason for falling and now staying off the wagon....it's about a misplaced and skewed sense of denial/the importance of food-certain foods, that life/eating can't be pleasurable if cutting out/limiting. That's bullshit. It's not loving yourself. It's not healthy.

I don't believe my body is an enemy - Nail on the head, Elderberry.

I'm a bit evangelical about this stuff because I've had eating disorders. One of my relations is currently anorexic to the point where she's just staying out of hospital - and my mother says she looks wonderful. She is the third woman in my family to be diagnosed. I was the first. There are others, who clearly are eating disordered but haven't needed treatment yet.

I finally fixed mine using a plan based on Susie Orbach's work, which included filling my cupboards with more crisps and chocolate (my binge foods) than anyone could possibly eat in one session. There's more to it, of course, but that was the lynchpin. It worked.

But that's enough about eating disorders. Have a look at this page about women's body image instead.

Was that your personal insult, Cote??!
I'm sure I've seen worse

delicious - You are right, you shouldn't" deny yoursef basic foods you love like white bread forever. You should eat carbohydrates like white bread with every meal but you should be careful with quantity* - one slice of bread is perfectly fine. Three slices of bread not so. 3-4 spoonfuls of rice or pasta that takes a quarter of your plate with tomato sauce is fine. A full plate of pasta with pesto sauce is not so.

I had this conversation with my consultant, as I have a BMI of about 31 or so, and the risk seemed to have been overstated to me as well. She said pushing pregnant women on weight is more of a public health communication issue than anything else, and not to be too concerned:

• If your BP is normal
• If your diet is well balanced
• If you are of average fitness or above
• If you are a non-smoker

However pregnant women are generally an exposed group of healthy people in a medical environment and the temptation is always to medicalise everything as far as they are concerned, including their shape.

FWIW I have regularly been told I am too fat over the past 20 years by medical professionals, with BMIs ranging from 22-31. It seems what constitutes overweight/obesity has as much to do with fashion as anything else.

On a more amusing note, I would like to see the term "Ladies of traditional build" like Mma Ramotswe if they are going to be fictional like this.

BoffinMum this is what I was trying to say a couple of pages back. There are huge differences in health risks and I think these leaflets are unhelpful when they lump everyone over a certain BMI in together. The risks are not the same.

I do agree that this information needs to be provided and I was thankful to have the possible risks pointed out to me in a sensible polite way for having a BMI of 30. Unfortunately not everyone gets the same treatment and some are left feeling judged. I would have been frustrated to have received a leaflet worded like that.

I meant I had a BMI of between 22-31 on each occasion.

It would be a lot better if there was an extra specialist clinic check where you were able to discuss diet, exercise, food diaries and get your health checked in more detail to find out if your body was coping OK with the demands of pregnancy.

But no, a leaflet full of rubbish is supposed to suffice.

Boffin - I just calculated my BMI and it is 22. I'm a size 8-10 and will be running a 5K race tomorrow. I find it baffling that a doctor could have said you are overweight with my BMI.

Delicious, you did exactly what happens when you deny yourself food. You fell off the bandwagon and binged. It's a physiological response. That's what weight loss dieting does for you. It is not a good idea to cut out a whole food group. And it may also explain why you're constantly thinking about food if you've been going on those kind of diets.

Christmas is a really good example of when people willfully lack self control and gain weight as a result. Its almost seen as correct, acceptable and the done thing to gorge yourself as its a celebration. To not do so is somehow, grinchy. Result; the average Brit consumes 7000 calories on christmas day. Thats got to be something to do with a poor cultural and national relationship with food on a massive scale.

Eating socially can be a total minefield. If I go to a restaurant I HAVE to leave food. I do not find it easy at all. I could eat it all easily especially when its great food, and want to clean the plate. I think its a hard mindset to break. For me, I'm very conscious of it, as I already get "anorexic" remarks and accused of "looking like a vegetarian" whatever that is supposed to mean. I do feel guilty, judged and as if I'm being rude at times. The reason I do it, is because I have a realisation that I don't HAVE to eat everything on my plate to enjoy it just as much and that the same meals are eaten by grown men who are twice my size. This is one of the reasons that I feel some women find it particular difficult in controlling their weight. I shouldn't be eating the same as them. I don't think its an unhealthy relationship with food to do that. (plus my husband loves being my bin!). At the end of the day I feel better at the end of the night for it, as I don't feel bloated.

Another bug of mine is that when you go to McDonalds (yes I admit to liking a burger once in a while) it says on the side of a burger the recommended number of calories for a woman is 2000. For my height and weight I need 1500 daily. A Happy Meal is about 500 calories. A Quarter Pounder Meal is 1100. I can easily eat either; which should I be eating? I don't enjoy either less. But theres nothing like getting strange looks for ordering a Happy Meal when you've no kids...

I'm very aware of just how much social pressures can affect the way you eat. I really don't blame anyone and say they have a lack of control. Its not as simple as that and to suggest that is way too simplistic. And I'm far from perfect - I have eyes bigger than my stomach and get reminded by my DH at times of it. I feel lucky in that I don't have to have iron-will since I have a hungry husband who thinks its his duty to steal my food! I certainly don't think less of other people for overindulging, and I hope to god that others don't think I'm being superior or patronising in what I'm saying (its not intentioned like that). Its not about that. I couldn't give up whole food groups. I'd go nuts.

I think we could all do with changing some of our social relationships and ideas where food is concerned. I think breaking a lot of social conditioning, excessive lifestyles being encourage and the way you are trained with your manners play a massive part too. Diets are the work of the devil.

Its about everything from plate sizes, to restaurant portions, to being trained to finish your dinner, to chemicals being added to food, to high sugar content, to convenience food, to ability to cook, to understanding what a balanced diet, lack of exercise, being conned by various profiteering 'magic diets' is etc etc all conspiring together. Once upon a time, food was just something you had to survive. Now its about pleasure. Its TOTALLY different and we still have less understanding of that than we should. I really do reject the idea that we shouldn't be saying anything because of mental health issues...

I think women have things stacked up against them. But going back to the OP, feeling as if someone is being rude, when they are simply trying to point out risks and offering help isn't an attack necessarily an someone or trying to make anyone feel bad or guilty about it. It needs to be done, to focus attention. I'm not sure there is ever an ideal way to break the "it won't happen to me" mentality, until its too late. I don't think its possible to 'get it right' for everyone as there will always be someone who gets knickers in a twist over it. You can be over sensitive too.

Perhaps I don't have an idea of how hard it is to loose weight; but I DO have a good idea of how hard it is to stop gaining it, within a modern day culture when everything is designed for people much bigger than myself. I don't go round looking at women going "fatty" or pitying them, I'm not the enemy, and I wish that other women wouldn't see me as such. Tact and understanding can be very hard to achieve in both directions.

Very good post quietly

I think one of the issues with bingeing is people who aren't adequately nourished. Bingeing is the body's response to malnourishment. Many people consume a lot of food but aren't getting adequate nutrition from it.

quietly - Restaurant portions here in France are much smaller than those in the UK. I can't say if it's cause or effect but obesity is also unheard of in the parts we live.