overweight and wondering about a homebirth

[CherryPie3]

Hi guys

Hopefully you lovely ladies will be able to offer some words of wisdom.

I'm a plus size lady weighing a shameful 18 stone which has been accumulated from 2 previous pregnancies and I never got round to losing.

I'm 5'7 and my BMI is 39.5 and I'm currently 19+1 pg with dc3.

I have already been denied delivery on MLU, am under a consultant for a previous prem delivery (35 wks).
Wondering if I get to 37 weeks complication free - would a homebirth be a possibility? Would my weight cause any issues?

I should probably add that I haven't yet discussed this with my MW yet, want to make sure I'm requesting something reasonable first.

Any advice appreciated Surely I can't be the only person in this situation.

Im not an authority on this..but i believe high blood pressure can be a problem and possible heavy bleeding. But in any case i would discuss with MW and weigh up pros and cons..and maybe make your decision based on that.

If you have all the antenatal tests and they come back clear, and if you've had uncomplicated pregnancies and births before, then there shouldn't be any reason for them to say no, (but that doesn't mean they won't!)

They can't force you to labour in the hospital if you really don't want to. If you face unfair opposition, ask to speak to the supervisor of midwives, to discuss your options. They may agree to the MLU as a compromise.

Read some of the stuff on this site: www.plus-size-pregnancy.org/firstindex.html

Then consider getting militant. I'm the same BMI as you (shorter though, so a little lighter), I guess I'm lucky though, as they don't have any problem with my choices.

Apart from the weight I'm totally healthy (bang on blood pressure etc.). You've presumably also already had 2 healthy pregnancies, so they should be able to tell you some good reasons (with backup research, not just vague old wives tales) for not wanting to push you into the hospital.

Even if you are advised against a home birth, you can still do it. I was told that i would be doing it against medical advice because of a suspected big baby (my BMI was 36.4 but this was never mentioned as an issue), but that they would send midwives to me at home. The only stipulation was that the consultant midwife would put in writing to me that I was birthing at home against medical advice, and explaining what the risks were. That way if anything were to go wrong I wouldn't have been able to sue them!

In the event though I ended up in hospital in consultant led care because of a couple of high blood pressure readings the week before I went into labour.

If you really want a home birth then you should definitely persue it.........jump through all the hoops with the hospital (see a consultant, have a GTT etc etc) and remain firm with your wishes.

Thank you all so much for your responses.

I think I will enquire about it with my midwife, consultant lady is a bit scary but will discuss with her also - see how far I get before they tell me I'm too fat

On the other hand - dh seems to have come full circle, now deciding that the excitement starts when you're on your way to have a baby, contractions in the car etc. So seems I need to re-talk to him. Although I partly agree with him. I'm concerned about childcare really I think as I have 2 kids already who will be 3 and 4yo by the time little cherrybaby comes along, I have a lot of thinking to do about it, dh being pretty firm about me labouring in a medical building. The MLU would be a good compromise indeed!!!!

Thanks very much for answering my post - I do appreciate it

What were your previous deliveries like?

I'm a gasbod not an obstetrician.

Locally as anaesthetists we see every woman with a BMI of >37 as they are deemed 'high risk'. This comes in part because the last report into Maternal Mortality (Saving Mothers Lives - it's available online) highlighted that overweight women run into life ending problems much more often than slim ones. Their babies are also likely to do less well.

The way to manage this is controversial and currently lots of clinicians are playing safe & recommending full monitoring and early epidurals etc. Info from the anaesthetic side is available on the OAA website patient information section (www.oaa-anaes.ac.uk)

There is a big observational study ongoing at present in the UK about woman with high BMIs. The results should be out soon and will make decision making easier.

You can of course choose to do anything you like but believe me as professionals we don't go around suggesting stuff just to be awkward.

(For example I'd love everyone to have an uncomplicated drug free birth because quite frankly I'd rather be asleep than siting yet another epidural........)

OP if 'highrisk' is above 37 then maybe you could get your BMI down during the pregnancy?
I had a BMI of 28 at the begining of my pregnancy, it's now 24, (at 8months pregnant)
I have had food poisening and lost 10kg though, but was amazed by how easily BMI can change, if you're heavier weight can drop of even faster.

Thanks gasman and anotherusername

My previous deliveries were very straightforward normal deliveries.
With dd, my water broke at 35+3 and she was born at 35+4, with gas and air and pethidine. Length of labour 3 hours 24 minutes (not bad for a first eh?) She weighed 7lbs 3oz - some questions about whether she was dated correctly tho.

With ds, he was born at 39+6, ARM performed during labour, no pain relief until 8cms when I started using gas and air. He weighed 8lbs 6oz. Length of labour 9 hours, 54 minutes.

Epidurals scare the hel outta me!!!

I'm working on reducing my BMI - healthily of course, not starving myself or anything (like I could .

I'm considering myself as lucky as this pregnancy has put me off sweet things like chocolate/cake etc. Instead I've been craving apples/satsumas/grapes and jacket potatoes/white rice etc.

Hopefully that will make a difference

Gasman, I've seen you post on a similar thread before and it's always interesting to read your input regarding high bmi pregnancies, would you midn if I picked your brain?

I'm on my second pregnancy, both v high bmi, (56) so considered high risk but normal pregnancies with no complications, last labour was 11 hrs, normal vaginal birth with gas and air, short pushing stage, no interventions or problems.

I have 10 weeks to go til the next (last!) one is due and my anaesthetist has recommended an early epidural which I'm very tempted to take purely because of the pain which I didn't handle very well last time, but I'm a bit worried about the second stage because the first time round my body pretty much just expelled him, I just helped. Do you think it will do it again even though I'm numb?

gasman.do you think epidurals are used to often and sometimes not really needed. I have had 4 straight forward and dare i say it easy births..with just gas and air towards the end. Although i found that the midwife during my first was trying to push drugs on me saying that i had a long way to go. Im very stubborn and once id set my mind on no drugs..i wasnt going to give up lol

bugger just typed and lost a v. long reply.

James a BMI of > 40 makes me as an anaesthetist a bit worried (and as a group we tend to be pretty calm).....

The rationale for early epidurals is twofold:

1. They are difficult in people with bigger BMIs therefore asking early gives us the best possible chance of getting one in and working

2)giving someone who is larger a GA is more difficult than giving one to someone who has a BMI of 21.
Therefore if your baby gets distressed and you need an urgent LSCS it is much better for both you and the baby if you have an epidural in situ which can be "topped up" with stronger local anaesthetic.

Having an epidural is associated with an increased risk of instrumental delivery (forceps/ ventouse) but then so is having a big BMI.

Lots of women with epidurals do go on to have a "normal" delivery and having done it once you are statistically more likely to do it again.

BITCAT
Anecdotally the epidural rate is rising but this is mulitfactorial.

All of the women I put one in consent to it.

Many of them arrive in hospital requesting an epidural before they are even in established labour - I'm not sure if this is because epidurals get a good press in the local community (eg. my mates sister had one) or the first tranche of contraction pain puts them in a total tailspin for which they can envisage the only control being an epidural.

The epidural rate also appears to be influenced by local midwifery practice - eg some units are quite pro epidurals and others are not. The unit I am thinking of that has a low epidural rate is also quite socio economically deprived so there are other aspects such as maternal knowledge and the clientele themselves are younger.

There are also a group for whom an epidural is quite clearly medically recommended - high BMI, maternal heart disease, known obstetric issues.

Gassman - do you think that women asking for epidurals as they arrive in hospital is because there are so many stories of women NOT being able to get one when they really need it because the anethetist is busy elsewhere?

Hi,
I was the same height and weight when I had my homewater birth. It was also my first child and about 25 minutes by ambulance to hospital.

Very interesting all this. I had a BMI of 46 with DD and realistically, I will be similar next time. I begged for an epidural but they wouldn't give me one. As it happened, labour was only 4hrs but I worry about giving birth at the same hospital in the same sort of circumstances.

Hi Cherrypie

Not sure if you've checked this already but I found the homebirth.org.uk website to be invaluable when I was deciding whether to plan a homebirth. It certainly gives you a good run down of the risks and it gives you a platform to start discussing things with your midwife.

Good luck whatever you choose

NewLeaseofLife You give me hope!! I'd be happy to settle for MLU for the less-stressful atmosphere and to give dh the chance to drive me to have a baby, bless him.

Caitni Thanks for the link - think I've practically lived on that website gathering ammunition information

Good, I was lucky that my midwife was ok about it all really. I think it was her first home water birth too. I hope you get your way as long as it is the safest option. MLU sounds like a good compromise.

I completely agree. If it's the safest option for me to have the baby in CLU then I will - as long as their answer is based on my care and not what some statistics say about high BMI births etc. I've had 2 very straightforward births, yes one of them was early but if/when I get to 37wks then that would be irrelevant anyway wouldn't it?

We shall see...going to see mw of Friday. 20wk scan tomorrow ;)

gasman - a question

I had epidural in 1st labour and didn't work - resited x3 including by consultant who came in from home to do - numb left leg but felt every contraction and the birth but with one leg out of action couldn't be active in labour - consultant told me I had some abnormality possibly congenital of my vertebrae

just had G&A in 2nd labour and no problems

30 weeks with no 3 - bp fine, sugars fine etc

i absolutely do not see the point of me having an epidural - am I going to get lectured if i say no?

With that history I wouldn't expect so.....