BMI increased during pregnancy - wont let me in MLU/ home birth anymore

[Shantotto]

Looking for some advice. I'm 35 weeks and my BMI has gone from 30.7 at booking in to 35 now. All along I've wanted to use the MLU or think of a home birth - is first DC.

At my 34 week midwife appointment, I was weighed and talked about the MLU or home, and midwife didn't say I was too heavy now. When the home birth midwife came to see me a week or so later to discuss, I did ask about MLU again and she said my BMI was now 0.7 too high and I wouldn't be able to use it! She also said she thinks it's too high that they would advise against a home birth.

Shouldn't they take booking in BMI into account for this? I'm really upset as I wanted to avoid labour ward as much as possible - I get very anxious and have read too much about high stats for needless interventions on wards. I am hopefully going to see the midwife who manages the birth centre and home birth team but wondered if I had any argument about them using my booking in weight for the MLU?

I'm over 6ft so my BMI always seems a bit out of whack, I'm measuring bang on in number of weeks, I do t have any of the risks associated with high BMI - it's really stressing me out and upsetting me. I know I can just insist on a home birth, in fact the midwife who and to see me has no problem with it, she just has to refer me to the manager, but I think with my anxiety I wouldn't want to if it wasn't officially given the ok.

Just not sure what I can do about it. :(

How old are you? it might be that you now "tick" too many boxes. Any blood clot risk or anything? I've not been weighed since my booking in. With ds I was 30 at booking in and they never weighed me again- I was allowed to use the MLU (ended up in delivery rooms but nothing to do with weight). With this pregnancy I was bmi 30 again and told i was low risk and referred to MLU (again, it's all gone to pot subsequently but, again nothing to do with bmi!). Talk to the manager at the MLU.

They can only 'advise', the final say lies with you and what you decide - have a look at the homebirth website (www.homebirth.org.uk) including the section on being overweight

That's quite odd as booking for place of birth should be done on BMI at booking. Guidelines are pretty clear on that! I would ask what policy this decision is based on. If you want to push for MLU you can always request a meeting with a supervisor of midwives (and remember that anyone can have a home birth, it might be against advice but no one can tell you you can't have one.)

I'm 35 - not at risk of anything at all! Nothing about blood clots has ever been mentioned, I don't have gestational diabetes or high blood pressure. I suppose they can't tell pregnant women to restrict their diets - no one ever said oh mind your weight if you want to go into MLU / home birth!

Hopefully can see the manager this week, and have a midwife appointment tomorrow and will talk about this - got quite upset on the phone this morning when I rang her about it especially with her saying its your choice where you go - when I pointed out my BMI is high so they'd refuse me she just said oh yeah! She never mentioned this two weeks ago when she weighed me again and I discussed MLU and home birth as part of birth plan chat! Just feels like this has come from nowhere with no warning and I'm really unhappy about it.

Thanks for the advice - the leaflet I found for my trust and high BMI said that 'if during labour your BMI is 35 or greater you can't use the birth centre' so it seems this trust has different rules?

It is worded slightly oddly! I know I can push for home but I think if they weren't keen I don't know if my worries would mean I could just insist anyway. That's why the MLU seemef such a good option.

I'll check the home birth website - thanks.

I think is standard, but you should have been made aware of it as a potential issue earlier. My midwife did tell me the BMI cut-off point for a water birth (at my local MLU - the fear is that they couldn't easily get you out if the water if needed) because I was close to it. In fact I went over the limit but as I still wanted a water birth, and my midwife was impressed by how fit and active I was even at full term (I've always tended towards being fat and fit), so she wrote to the head of midwifery asking that they made an exception for me. In fact, I ended up with an ELCS for unrelated reasons, so never tested.

But yes, they can only 'advise'. I did consider a home birth, but I did tick too many boxes - first child at 40, high BMI etc. I decided against it.

It's weird because I'm 6'1" (maybe a smidge under!) and a size 16. I can't imagine how I'm too difficult to be helped out of a pool or so overweight that I'm too risky to just have midwife led care! I've put on two stone.

I had one consultant appointment as I've had abnormal cells removed and no one mentioned anything about my weight then either and I went back to being seen by a midwife as it was exactly the same process just with a longer wait!

Ok, so, you can give birth wherever you choose, whether that be home, in a field or in your garden, wherever.

A mw HAS to attend you if you phone and say i am in labour, i am not going anywhere, they will come.

Go back to your mw and say that you have researched the risk, you understand the risk, but WILL be having a homebirth.

Be strong and stand up for what you want!

I don't know if it is the home birth I want now though - I'm so confused what to do for best.

The midwife who saw me said she couldn't see why I couldn't if it was up to her. It was almost as though I felt more secure at home knowing if I changed my mind I could pop along to MLU! Now my anxiety is super high I've lost my confidence in home especially if they don't recommend it - I know this sounds like a mad jumble, sorry!

Trying to calm down until I talk it through a few more times with midwives but I can't help but catastrophise about the labour ward. So silly I know. I'm also not wanting to eat as much. I know that's also very silly at this stage. I just feel unhappy and so mixed up.

Ok, so, you can give birth wherever you choose, whether that be home, in a field or in your garden, wherever.

Well no, OP cane't go wherever, specifically she can't go to the MLU which is what she wants! And I suppose you're right she could choose a field, but good luck finding a midwife to turn up there too!

OP, you need to talk all this over with the midwife. Chances are you'd have much the same labour and birth in the main ward, MLU or at home, you pretty muc get what you get. You hear a lot of horror stories but thats not the experience for the majority. The main thing is to calm down and relax....and the end of the day its a few hours, maybe a day or so, and one way or another the baby will come out and all will be well. It's not a good idea to get so worked up about how it comes, since so much of it is totally out of your hands anyway.

Winter has it spot on when she says you "pretty much get what you get."

I was all soft music, low lighting and relaxation in the water pool for the first several hours of labour, but then DS had other ideas. Totally out of my hands!

Don't get hung up on the idea of "needless" intervention either. Sometimes intervention is very much needed. DS and I would have both died without it, to put it bluntly.

Sometimes things can go from fine to not fine, very quickly. I had an easy pregnancy, no risk factors at all, and no indication whatsoever what birth would be anything other than straightforward. I'd done hypnobirthing and yoga,I was fit, and I thought I was ready for whatever labour threw at me.

But I got what I was given, and once I was in that situation I didn't care about the theories of needless intervention - I just wanted Ds out alive.

I don't say this to try and scare you,not at all. I just say it to reiterate the fact that wherever your birthing experience begins may not be where it ends, chances are the "plan" will have to change along the way, and you may just have to see what your baby has in mind.

But however your baby comes out, and wherever, isn't such a big deal after they're born as it I'd before - at least not in my experience, and that of all my friends. I've got homebirthing friends who ended up with emergency sections who, before the birth, would have been aghast at the idea. But after - really not a big deal.

Talk it through with your midwife, see where she recommends is safest for someone with the added BMI risk factor, and best of luck with whatever you decide.

To be honest, if you needed to transfer in from home, it would probably be for something only a CLU could help with anyway - it would be highly unlikely you'd transfer from home to MLU anyway.

There's very little they can offer in a MLU that they can't support you with at home. They should use booking BMI anyway - there's no way of knowing how much of the weight gain is you, what is baby, fluid, increased blood volume etc - which is why weighing through pregnancy isn't usually done as standard.

Your bmi is a risk factor, there always has to be cut off when that comes into play. Its the same for blood pressure, glucose levels etc. You have been informed of a small but not insignificant risk work with your midwife, maybe get a second opinion. Midwifes are generally very strongly against unnecessary medicalisation of birth but safety of mum and baby has to come first.

"Chances are you'd have much the same labour and birth in the main ward, MLU or at home, you pretty muc get what you get."

No - there is clear evidence that where you have your baby is highly influential when it comes to the likelihood of having an uncomplicated labour.

Nicole - could you link please? As someone who had a nightmare first birth, to the point where I'm considering a ELCS with my second, I'd like to learn more.

I know that the plural of anecdote isn't data. But I was in the water pool with low lights, soft music and calm when everything went tits up. I'd done hypnobirthing and yoga, I was doing my breathing exercises, but my body didn't behave as the books said it should.

I genuinely believe there was nothing more I could've done to try and get a simple birth with no intervention, but it just didn't happen. I also believe that if I'd had a home birth, DS and I might both have died.

Runningupthathill - the birthplace study 2011 showed that healthy women who opt to give birth in a CLU have double the rate of emergency c/s compared to similar women who choose other settings for labour.
Doesn't mean that all women who labour in CLU's will have hard labours ending in interventions or that those who opt for home like settings will all have a straightforward birth!

I do understand that, Nicole. I'm not stupid.

I'm struggling with trying to make some important birth choices, and am genuinely interested in looking at relevant studies.

First time round I chucked the research out of the window, listened to my yoga teacher and the hypnobirthing course, had faith in breathing and active birth positions... and ended up feeling completely misled. This time round I'm going to be pragmatic rather than optimistic.