High BMI and epidural

[MrsCK]

I've just come back from my first consultant appointment. I was referred due to a bmi of over 35 at booking in.

Essentially what came out of it and in the consultant's words ..they would prefer me to have an epidural over anything else. I was sneered at for bringing up my wish to have a water birth and the conversation was always brought back around to an epidural. There was no balance. no information about the pros or cons of an epidural and if I'm honest I hadn't considered an epidural before now as I wanted to try hypnobirthing with gas and air first as well as using water. I feel like I've been put in a corner with not much of a way out.

anyone else with a high BMI had a birth that didn't involve epidural?

Mine was 32 at booking in and I had a home birth with no pain relief except tens, paracetomol and hypnotherapy. Have they told you why they think you should have it?

I think you've been unlucky. There is no medical reason to push you to have an epidural for high bmi. Active labour is just as good for people with high bmi as normal bmi.

Research and when you next see the consultant, if they still try to push ask for a change of consultant.

BMI of nearly 40 here. Consultant said continual monitoring (without even seeing me!), so I booked an appointment and we've come to a compromise on the monitoring, which means I can have a water or active birth (the water birth is tricky as the hospital only has one pool!).

I have been lucky in that I've had a straightforward pregnancy, however I do wonder if the statistics of high bmi mothers having slower labours is a bit of a chicken and egg situation, because of course being stuck to a bed because of monitoring or an epidural means you can't even try to help things along with activity/gravity.

Nobody can force you to have an epidural if you don't want one. In some places, they get nervous about ladies with a high BMI getting in the pool because it can be difficult to get them out in an emergency, but if they're happy from that point of view then you should be able to give it a go.

From an anaesthetic perspective, it can be harder to site an epidural in larger ladies, because the very small space that they are aiming for is further away from the skin surface. It is made even harder if the woman is in advanced labour and unable to stay still, hence why it is sometimes suggested to get it in early-ish on. A GA is also riskier in people with high BMI, more chance of them regurgitating/aspirating when sent to sleep, and more likely to have difficulty securing/maintaining the airway. So having a functioning epidural means that if you did have to go to theatre (slightly more likely with a higher BMI) they would hopefully be able to use that to anaesthetise you rather than having to struggle with a spinal in a hurry or send you to sleep. On the other hand, having an epidural does make it more likely that you'll need an instrumental delivery so it's partly a self-fulfilling prophesy.

It is worth finding out a bit more about epidurals (the Obstetric Anaesthetists' Association website is very good) before your labour, but you don't have to have one - just be aware of it as an option.

You can be monitored without an epidural, I was. What reason are they giving for you needing it?

39+5 here & with BMI if 37 and no one has mentioned anything about constant monitoring or having an early epidural. I will have to go into the hospital birth centre rather than mlu but apart from pools the facilities are the same.

With my first I didn't have anything until right at the end when I had a spinal as needed a trial by instruments and ds came out with a little help from a ventouse

Year on year it has been reported that women with raised BMI are at increased risk of complications during childbirth. As a result national guidance states that women with a booking BMI greater than 35 should be counselled in the antenatal period regarding this risk and how to reduce the risk. Hence your appointment.

Some trusts only see women with BMI >40 as there are too many to see otherwise.

As Sock outlined above, for many reasons it is really desirable to avoid a general anaesthetic in raised BMI patients. The way to do this is to have a working epidural in place, so if there is an emergency, you already have a functioning anaesthetic on board.
From a purely practical point of view, in larger mums is much more easier to place the epidural in early labour, rather than later on when you can't sit still or only in certain positions. If it is difficult to put in, or doesn't work well, then if you have it early there will be time to do it again or troubleshoot it.
Your consultation should have included pros and cons. Maybe ask to see again?

It is perfectly reasonable to suggest that you'd like to see how things go, try alternative methods of pain relief first, but if labour is not progressing to plan or in a text book way, and if intervention seems likely at some point, think about getting that epidural on board sooner rather than later.

I think they dissuade high bmi women from water births as its more difficult to be pulled out of the pool if you suddenly developed complications

I declined to be weighed at booking in and also declined the Consultants appointment - my bmi is almost certainly around the 35 mark although I haven't weighed myself in years. I have had two home births with no intervention and hope this one will be the same. Just because something is recommended, doesn't make it a foregone conclusion and it can't happen without your consent. Research the risks for yourself and then tell them what will be happening based on what you feel is best for you and baby!

Vichill - I worked out that someone could be a stone heavier than me, but 10 inches taller, and would therefore have a lower BMI and 'safer' for a pool birth. I work with people who do manual handling training and they've confirms the height of the person being lifted isn't a factor, just the weight. This is why I don't agree with a BMI limit (a set weight would be fine, but a BMI limit potentially means a heavier, taller person could be deemed 'safer' than a shorter person).

I had a bmi of 37 at booking in appointment and was immediately placed under consultant which I was annoyed about as although heavy I am very active and otherwise healthy. I felt My antenatal care was overshadowed at every opportunity by constantly being told that I will have a difficult labour and will require intervention and an epidural. This only got worse after being diagnosed with GD. I was originally booked for induction however my waters broke at 37 weeks after a very long walk but no contractions. I was sent home after 40 mins monitoring with an induction booked for 24 hours later if no progress. 12 hours later my contractions started. I arrived at the hospital as my contractions went from nothing to 3 1/2 minutes. 1 hour and 24 minutes after arriving I gave birth to my ds with no pain relief and no intervention. I had no tears either. I was thrilled and it was the natural labour I had hoped for and knew that I was capable of. Whatever people tell you listen to them but go with what you feel is right and if you want something fight for it! Good luck!

How much your BMI matters to your care is so so dependent on your midwife I think. My BMI was right on the cusp of consultant led care this time (35.1) and I had a huge stress that midwife would insist on me seeing a doctor. When I went in for my booking in I told her this and she said that frankly unless I wanted the extra support she wouldn't recommend it. I also told her I didn't want to rule out a water birth and she agreed and said she'd do everything she could to help me have a natural and intervention free birth as possible. But then she's exactly what I want in a midwife: basically just leave me to it to push the damn thing out without complications (when possible)!!

I had a higher BMI than you, when i had DS 8 years ago (and do this time too, but haven't seen anaesthetist yet this time!)

I was pretty much told i would be having an early epidural, which i really wasn't happy about (i'm aware of the reasoning behind it, but like someone else said, feel its a bit "chicken and egg"). For me, i feel its the start of a likely cascade of intervention, and something i want to avoid.

In the end, the wonderful midwife didn't allow the anaesthetist to see me when i was in labour (which she knew was what i wanted, despite it being plastered all over my notes that i "must" be seen when admitted...), and i had a lovely, natural birth!

Having seen the anaesthetist prior though, it was at least in my notes that should a general be needed, i had to have an experienced anaesthetist present (combo of obesity and other factors, in my case though).