BMI and Homebirth Question

[Teaandcake]

OK, I am well aware that being pregnant and fat is pretty much a crime these days but I asked the Midwife at my booking in appointment the other day about the chances of a homebirth anyway.

She was utterly horrified and informed me that with a BMI over 35 that I was in a high risk group and would have to fight everyone (GP, Consultant, midwives etc) to have one but, if I refused to go to a hospital then they would (grudgingly) have to attend.

I knew this was coming when I asked the question but asked anyway.

I had a very easy and straightforward first pregnancy with no complications, and a spontanious labour but did end up with a forceps birth.

Other than the possible difficulty of having to move me if I did have to transfer to hospital during labour what are all these other risks?

how high is your BMI? there are some more risks attached to being obese/morbidly obese, but it is still your informed choice to have a homebirth. you can get in touch with www.aims.org.uk who can help you . and the supervisor of midwives should be on your side too and help you get hte birth you want

if you had a normal pregnancy first time, surely that stands you in good stead.

it can also be harder to locate and hear the baby's heartbeat and palpate accurately the position of the baby

Thank you Lulumama most helpful, the midwife just wasn't interested in discussing the ins and outs of homebirth at all.

I truthfully do not know what my current BMI is as I never weigh myself. I'm sure I will find out soon enough when booking in at the hospital and scan in 3 weeks though.

here in Holland where they really encourage homebirth , the cutoff is 30 BMI, or 115 kg. mainly because of being moved if necessary.. lots of flats with steep stairs here etc. However, I would have thought you had a right to a homebirth, they can't arrest you and force you to go to hospital. I would do some googling and see, there must be a lot of other ladies in the same situation. Perhaps you could go to a birth centre as a compromise.. best of luck!

You can choose to have a homebirth if you want one. It should be an informed choice but they can't force you to go into hospital. There's a lot of information on the Yahoo Homebirth email group - would probably be worth you joining anyway, whether you decide to go ahead with a homebirth or not.

Also www.homebirth.org.uk/ has info under the "You can't have a homebirth because..." heading

Thanks for all your responses - excellent links.

HedgeWitch, you've pretty much read my mind! I probably wouldn't go down the forced homebirth route, I don't think I have that much fight in me!

I just love the thought of being in my own home and being able to sleep in my own bed, use my own bathroom, and just have a little privacy.

I think the 6 hour discharge would be an answer though.

I really just wanted a sensible and measured discussion with the midwife about it but just got a totally hysterical response.

sorry, but i really think that you should not give up !

women have to fight for the birth of their choice sometimes, but the hospital have not given you a real reason that you cannot have a homebirth

and even if they do, you can still decide to have a homebirth

you do not have to roll over and accept their decision when it seems to be based on policy

not law!

Some women have found that the MLU suddenly becomes available when their HCPs realise its MLU or homebirth, if that would be a preferable solution for you it could be worth a try.

Re. the 6 hour discharge - their policy may say that's the minimum discharge time, but as you're not their employee you're under no obligation to follow their policy if you disagree with it strongly. Its your decision when you leave the hospital, not theirs...

You might also want to give some Independent Midwives near you a call - they're likely to be much more open minded and will at least give a reasoned response if they wouldn't recommend a homebirth. Most will be more than happy to talk through the pros and cons of different options with you and may well have experience of the way your PCT behaves, even if you can't afford to book them.

Kazbeth - sadly, I think a lot of it depends on how pro-HB your PCT and/or MW is. Some PCTs in general and MWs in specific are not supportive of HB and seem to come up with stock reasons why you shouldn't have one - reasons I was given why I shouldn't even book a HB included:

• it was my 1st
• there might not be any CMWs available
• my CMW hadn't had training in waterbirth, wasn't confident to site a venflon....

By then I was getting fed up with a variety of things to do with my NHS ante-natal care, so we booked IMs and went on to have a straightforward HB of my (breech) baby.

Many women also find "new" issues suddenly start to appear around 36 weeks (if they're even "allowed" to book a HB before then), or are told they need additional blood tests, scans and meetings with consultants before their HB can be "approved". From what I've read on here and other HB lists, you've been very fortunate in your experience.

On the plus side, nearly all the women that do fight to get a HB in the face of all of this, do seem to have a positive experience with supportive MWs so I think it is worth pushing if its something you want to do. Just appalling its made into such hard work

Tangle so you can up and leave any time you want after giving birth and cleaning yourself up? i had a 6 hour discharge with my ds but it was the longest 6 hours of my life, apparently we had to wait for pead doc to give him the all clear? so i could have left at any time? he was my first so v. naive!

Not pregnant yet! but just wondering for next time!

sorry for hijack!

I too am over weight and would push for homebirth next time.

good luck!

hannahlouhoo - legally, a hospital has no right to keep you against your will. They cannot force you into hospital for the birth if you don't want to go and they can't stop you discharging yourself if you do go in. You are not required to have your newborn checked by a paed. That said, there may be valid medical reasons why a longer stay would be sensible for either you or your baby or both and its generally considered sensible to get your new baby checked fairly soon after the birth.

What you could do is find out how/when newborn checks happen in your PCT for babies born at home - some women have to take them to a hospital paed, others to their GP, some GPs will come out to the home, and an increasingly small number of MWs are qualified to perform them. You may well be able to find a workable alternative (your GP might be happy to, as they'll get paid for it) - but waiting for the hospital paed might be easiest.

good luck

this is just a thought and coming from someone with a bmi of 35 and not pregnant ,but could you not try to lose some weight whilst pregnant and get the homebirth you want ?

Dieting whilst pregnant risks your health and that of the baby. Whilst you should eat healthily you shouldn't actively try to lose a lot of weight.

Hedgewitch - have you asked your consultant to show you the evidence that demonstrates fat women have more assisted births? I would - and I would ask him or her to show you how the influence of other factors - such as being compelled to give birth in a medicalised environment and have additional monitoring - has been discounted as a cause.
Frankly I think refusing otherwise healthy women homebirths on the basis of their BMI is outrageous. The moving them thing is a complete red herring imo - nobody wants to have to carry any pregnant woman anywhere - even Kate Moss was carrying several stone of baby, placenta and fluid around with her!
FWIW - I'm fat and I've had three 'normal' births. My last child - the one the consultant predicted would be 10lb and get stuck...was 7lb 15 and shot out!

Op - if you want a homebirth then ask for one and keep asking. You have as much right to what you want as any thin woman!

Teaandcake - have you joined the homebirthUK mailgroup? There are a lot of women on there that have had to kick up a fuss to get a HB (HBAC, too many babies, GBS, you name it). Women tend to find that, for all the greif, misinformation, scare mongering and lack of support they get to start with, if they write a letter to the powers that be explaining the situation (I've been told of these risks, I've considered them, I'm having a homebirth and expect to be supported), things suddenly go much more smoothly. Could be worth posting on there - there will be ladies that have been through it and can give you an idea of what they did to acheive a homebirth and what the impact was.

And if you do want a homebirth, don't ask them - tell them its what's happening! It isn't their decision to make.

Sorry and not meaning to alarm you but the reason that most units would "encourage" you to consider a hospital birth is not just to do with monitoring, but rather because recent research (CEMACH reports) have shown that mothers with a high BMI (>30 is increased) have increased risks for the following problems during and following labour:
Pregnancy related diabetes
Pre-eclampsia
Stillbirths
Obstructed labour (and an increased risk for assisted vaginal delivery & CSection (30-35%)
Postpartum haemorrhage (heavy bleeding immediately following delivery)
Shoulder dystocia (this is an Obstetric emergency where the babies shoulders get stuck once the baby's head has delivered and the risk of serious damage to the baby increase significantly if delivery is not completed within 5 minutes. This is normally best managed with at least 3 members of staff)
DVT and Pulmonary embolus (blood clots getting stuck in the lungs)

But ultimately it will always be your final decision as to whether you are willing to accept the level of these risks when weighed up against the benefits of a home birth! God forbid there is a problem the 2 MW's looking after will have to attend to you but can only do their best in the circumstances available and you take your chances! For the same reasons many 'low risk' birth centres will have guidelines that stipulate a hih BMI would exclude delivery on their unit.
In my opinion your best and safest option might be to consider delivery on an obstetric unit but with an early 6 hour discharge if there are no problems or a co-located Birth Centre!

I'd suggest you ask them to quantify the additional risks that you would be incurring.

Looking at the 2007 CEMACH report, which considers the period 2003-2005, there were 295 maternal deaths recorded from 2,113,891 maternities - or 0.014%. This CEMACH report doesn't consider "near misses", as that data was not available. I found it a bit confusing as to how they know that a high BMI is a significant risk factor as they don't know what the BMI's of all the maternities were - how have they put the results into context? I haven't read the report cover to cover, but the only data I could find on BMI distribution related to women in general, rather than pregnant women - are they assuming that the BMI's of pregnant women will reflect the BMI's of women as a whole?

Even if the risks are dramatically increased, they may still only be increased from a very small number to a number that is larger but still, ultimately, very small - and this report is talking about numbers that are very small. As you know, there are also risks to going into hospital in the 1st place. The risks are unlikely to be directly comparable, which makes it very difficult to say "this is the lowest risk option for you" - all you can do is choose the risk profile that makes you most comfortable.

i dont think dieting does risk your or a babies health during pregnancy ,id like to see the research backing that comment please . It can be done ,you would need the advice and support of your midwife/gp/consultant ,but if you follow a healthy eating plan ,there is no reason you cant lose weight and still be healthy . i wasnt suggesting the op crash diet .

I had one hospital birth where I needed an episiotomy, and went on to have two homebirths, despite being overweight - I'm not sure what my BMI was, but it was never mentioned as an issue by my midwives or my gp - all of whom were in favour of home-births.

Can I suggest that you talk to some of the other midwives in your team - you might find that some are more pro-homebirth than others, and there's no saying that it would be your midwife on when you delivered.

With regards to dieting whilst pregnant, if you are eating a healthy diet and the baby is growing normally, I would have thought that some weight loss might be ok - or at least, if your weight stays the same and the baby is growing properly, then your BMI could be going down, iyswim. I'd definitely discuss it with your midwife, though.

And teaandcake - I know where you're coming from when you say, 'being pregnant and fat is pretty much a crime these days...' I can't help feeling that, by being overweight, my simple existance is a crime as far as the doctors are concerned.

I've been told that a painful, swollen knee joint was the result of wear and tear due to my weight - which I knew, and was trying to do something about, by walking the boys to and from school, as well as going to the gym. I needed help from the gp so I could maintain some activity, but just got a lecture and no help at all, so ended up being able to do very little for quite a while, during which time I gained weight.

Whatever you decide, I wish you well - and I am sure that you are beautiful.

You need Howdie....can you CAT? Or even repost looking for her on here? She knows this stuff inside out

My bmi is over 35 and I am having a home water birth and my midwives are fully supportive despite the consultand scribbling the risks all over my notes.

I have spent alot of time looking at the risk factors and have found that my bmi increased risk rather than put me at high risk iyswim.

I also considered the risks in terms of my previous labours (like shelling peas) and my current pregnancy which is problem free.

I actually got very annoyed that the hospital tried to dictate my birth based purely on my bmi rather than looking at the full picture (overall health, previous deliveries etc) and am very lucky that my midwives agree with me.

If you want a homebirth and are fully aware of the medical reasons for having a hospital birth then tell them you are having one. It is your legal right.

Oh and when your consultant starts waffling on about hospital policy and insurance remind them you are a person, not a ststistic.

Hi
I have had similar problems with my consultant being against home birth due to my size. I have a BMI of well over 35, and have had a normal pregnancy so far. This is my second baby, and I managed a wonderful home birth with my first child, with no complications at all. He was 6lb 3oz. They never even mentioned my BMI that time. This time around I am a stone heavier than with my first birth, but they seem dead set against letting me have a home birth, despite my previous wonderful experience. They are trying to convince me that I will have a huge baby because of my weight, despite the fact that my first baby was small. I just can't work it out. My GP and midwife the first time around were very supportive, despite it being my first baby. You would think that this time around they would actively encourage it! I just so desperately wanted to try to have the same experience with this baby, as my first labour was just so great. I spend half an hour with the consultant lecturing me on why I shouldn't have a home birth, and then he ends the conversation with "home biths are so lovely aren't they!" He also told me that due to my BMI I am not able to have a water birth either in hospital. Again, like some other of you, I feel like my BMI is the only thing I am being judged on, not the overall picture, and past experience at all.