Devastating water birth news! Please help

[Tracey92]

Hi Ladies,

This is my first post so I am v. nervous and hopeful that I have posted in the right place!

So I am currently 31wks + 3 and doing well. I was living in Falkirk and so all my antenatal care was through forth valley royal hospital. I have since moved doctors and hospital as I am living in Glasgow. I am now registered with the Princess Royal.

I had my first midwife appointment today at the Princess Royal just to go over my notes and to be introduced to the team. I had been planning a water birth at FVRH which I was very excited about and so I mentioned this to the midwife. She then called down to the birthing area to confirm and told me that this was not going to be an option at Princess royal due to my BMI. My BMI is 43 and the limit is 40 for water births there. I am not going to lie I am absolutely devastated! I cried and cried (hormones) and to my utter shock the midwife said to me " Don't worry we have baths available on the ward so you can have a nice bath after the birth." What? I have no idea why she thought that anecdote was relevant!!!

Anyway I am now in a position where I have no idea what to do. I know I have to be flexible when it comes to labour but do I have any other options? Could I have a home birth with a pool or would they take issue with this too? I can't go back to FVRH as I have moved to far away.

Any advice would be helpful!

Also, due to PCOS I struggled to conceive for 2 years +, during which time I was trying to get my weight down and I did manage to lose some weight and whilst being pregnant I have lost a further 22 pounds. So although I know my weight is the cause of this problem I am now just trying to find the best way forward.

*positive not police

Tell me why one hospital will allow high BMI women to water birth and another wil not?

Could be various reasons- from a particular consultant believing a certain weight is OK, another not, depending on how up to date or how they interpret the data.

Could simply be that the hospital doesn't have a hoist capable of lifting a pregnant female over a certain weight out of a water bath, should they need intervention and aren't able to get out themselves.

I suppose that if the hospital staff have to be able to move someone out of the pool then their overal weight is more important than BMI. I had a very low BMI when I was younger as I was very tall and thin. If the op is exceptionally short then that will affect here BMI. What is her general fitness like?

I don't think that a self respecting health professional minds intelligent discussion.

I'm about to have this chat at my booking in appt this afternoon.

So it'll be a home birth then.

Look up Aims am I allowed.

Decisions should come from a informed place of assessing risks, benefits etc. Not imposed. You may not meet the criteria for the birth centre but you can plan a home birth with water if you want.

You have to accept this for safety reasons and I think your silly for being "devastated" over this. You must have expected to be high risk due to a very BMI. Imagine if there was an emergency and they needed to help get you out the pool, your BMI is 43, that's an incredible weight for staff to be manoeuvring.

I think it's mean to say to the op that she is silly. She is allowed to feel upset even if there are valid reasons for not having a water birth. She is a human being with feelings.

It's for the safety of the midwives having to lift you out should you pass out or anything

I'm sorry but that's rubbish. Someone might have a BMI of 43 and weigh LESS than another woman with a BMI of under 25!

If its about the H & S of staff then it should be about weight.

If its about the risk to the patient then that's something different and should be presented as that, not something else.

The fact one hospital allows it, and another doesn't makes me think its a borderline issue and therefore should be negotiable if you case make a case for it. Arbitrary cut off points are quite frankly bollocks without evidence based medicine to back them up and should be viewed as this.

They need to explain the difference in risk between BMI of 40 and a BMI of 43.

And yes THEY DO HAVE A DUTY TO DO THIS as its about the OP's mental and physical well being about why certain decisions about her care have been taken out of her hands and why they feel an alternative approach is more appropriate. (See the NHS charter about being involved in decisions about your own care). Its true they could still say they are unprepared to support the OP in having a water birth, but they do have to explain why.

How is it rubbish? I'd love you to find me a woman with a BMI of under 25 that's is heavier than a woman with one over 40 that isn't 7 feet tall. Utter crap.

Red, it's highly unlikely a woman with a BMI of 43 would weigh less than one with a BMI of 25, if the 43 woman was 5' 2, a woman with a BMI of 25 to weigh slightly more than her would have to be seven feet tall!

(And yes, I did just work that out).

"If the op is exceptionally short then that will affect here BMI."

"I'm about to have this chat at my booking in appt this afternoon.
So it'll be a home birth then."

If someone is 5 foot tall with a BMI of 43, her weight would be around 97kg (15+ stone). (Or to give other examples, 5 foot 6, 121kg, 19 stone or 6 foot, 142kg, 22 stone)

If something goes wrong (especially at home without hoists and medical help and other people close at hand), that is going to be hard for 2 midwives to drag someone who has collapsed out of a pool, while then potentially having to resuscitate the mother and the baby.

Complications are higher with an increased BMI and it is silly to ignore these in pursuit of a 'perfect' delivery. I can see why the OP would be disappointed (while thinking that describing it as "devastating" is a complete over-reaction).

Some helpful links to properly consider the risks and benefits of different plans (remembering that birth "plans" is a poor description of what really should be birth "wishes") are:

www.rcog.org.uk/globalassets/documents/guidelines/cmacercogjointguidelinemanagementwomenobesitypregnancya.pdf

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-why-your-weight-matters-during-pregnancy-and-after-birth.pdf

Unless OP is a medical professional, why on earth would they discuss her "research" and change their own rules, which were not just decided on a whim?
The arrogance of people who think their desires should trump all and that they should be a special case!

I think this kind of attitude is a major problem as it makes patients feel patronised and not taken seriously. If a treatment option or procedure desired by the patient is not suitable for that particular person, the reasons for that should of course be explained to them. Citing "the rules" without being able or willing to explain why they actually make sense is really poor, wether you're dealing with patients, customers, employees or the public.

Actually, I had this discussion with my consultant as my BMI was borderline for the trust I was giving birth in.

The reason there is a BMI limit cut off for MLU/water birth etc is because having a higher BMI puts you more at risk for pregnancy related complications, such as preeclampsia, gestational diabetes, PPH, high BP etc.

I spoke to my consultant and she agreed that provided I did not develop any of these complications, there was no medical reason for me not to go on the midwife led ward for my birth.

I would suggest that if it is upsetting you that much that you speak to the supervisor of midwives.

However, I would also say that fixating on one specific sort of birth sets you up for having an unsatisfactory experience, particularly if it is your first baby. There are SO MANY variables and if any one of them comes into play, it's likely that you will have to deliver under a consultant led unit, so please also plan for those outcomes as well as you'll feel more in control of your experience if you've factored in that these might happen. Don't let a perfectly good birth be ruined by an expectation gap.

"I'm sorry but that's rubbish. Someone might have a BMI of 43 and weigh LESS than another woman with a BMI of under 25!"

That is incredibly unlikely, redtoothbrush.

To use my example from my PP, someone 5 foot tall with a BMI of 43 would weigh 97kg.
To have a BMI of under 25 and weigh 97kg, someone else would have to be 197cm tall (6.5 foot and well above the 97th centile for women's height).

When I saw your post title I thought something devastating had happened during a water birth. I would hardly say being not able to have a water birth is classed as devastating. It's nice to have a birth plan but the chance of it all going as planned is very slim. The whole experience is very unpredictable. Plus once your baby is here and in your arms it really won't matter how he/she got here.

There are risks in anything you do. If the op uses the pool in the early stages of labour then it's unlikely she would be in position where she would have to be hoiked out of the pool. If she is agile the it's likely she would be able to climb out the pool herself without a hoist. Many women are capable of walking about for their entire labour.

How common are sudden emergencies when someone collapses unconscious in the early stages of labour? I am sure the op is monitored for pre esclampia.
I can see that doctors may have to act fast if the baby is distressed, but surely in most cases the woman can climb out of the pool herself. Most obstetric problems have some warning.

It's not unreasonable for the op to ask for an assessment on an individual basis.

There's also no guarantee you would get a water birth at FVRH as there were none free when I gave birth there. X

Is that the limit thought ggc nhs? I didn't think the qeuh had a limit?
Also what was your bmi at first appt as that can be used?
If it's Glasgow wide you're only option is to go back to forth valley which isn't that far anyway

Yes but if one allowance is made then it has to be made for all. The cut off must be somewhere and that hospital has decided on its limit. It irritates me that people are saying all should be the same - no they shouldn't. They are all unique buildings with different procedures for safety/evacuation/emergencies etc. They also might have an extremely high obesity rate in the area and it's necessary to have a cut off point. I'm alarmed that people expect midwives to hoik an obese person out of a pool just because they want it so badly. They have a cut off and that's final.

Thanks for PP agreements and doing the maths honestly I just plucked 7ft out of nowhere and it turned out to be accurate!!

A BMI of 40 is well into the obese category- it is for your baby's best interests that they have made this decision. The best thing to do is accept it and focus on getting to a healthy weight post birth.

I can see that doctors may have to act fast if the baby is distressed, but surely in most cases the woman can climb out of the pool herself. Most obstetric problems have some warning

I couldn't get my bra off for my emcs. I could not move for the pain. There is no way on gods earth i'd have got out of a pool.

I went from you're only 1cm, you can't possibly be in this much pain, we'll do a trace, to oh shit emcs now in a few minutes. It can, and does happen.

Maybe not BMI 25. It was an example to illustrate the point rather than real figures. But I think the point is being missed.

Someone 5ft with a BMI of 43.
Someone 5ft 8 with a BMI of 31.9
Same weight.

Someone 5ft with a BMI of 43 weighs LESS than someone 5ft 4 with a BMI of 39.5 who in theory would be allowed in the pool.

You need to talk about why one is more at risk than the other rather than say its about how its a H&S issue for the midwives over and above the patient...

Which is what was said by pp.

Because BMI is their crappy method of defining people. I doubt very much that people agree with using BMI generally. We all know it's flawed but nevertheless GENERALLY it's correct. Weight goes up, BMI goes up. Sadly we're all shoved into categories but the alternative is looking at every woman differently and crikey that's opening up a can of worms for subjectivity!

I thought this about birth injury :(

Which is precisely why it should be challenged as conveyer belt medicine rather than individual care based on individual cases.

And yes there should be GUIDELINES but this should also be room for exceptions to the rule too, if there is a good case to be made as to why it might be better for particular individuals.

Oh I agree it would be lovely for everyone to be looked at as individuals - wonderful! But if you think the variations between hospitals are bad now... Think about how crazy it would be when each midwife/doctor/consultant has their own policy for everything. You'd never know what you'd get!