Consultant has scared the crap of of me, am I being over sensitive?

[Welikethemoon]

First appointment with the consultant yesterday. I'm 13 weeks with my second. I have a high bmi, I'm 36 and I had a c section with my first because she was breech (she is now 3 1/2) pregnancy was uncomplicated apart from spd. I was keen on attempting a natural delivery this time.
I was expecting the consultant to say I needed to take asprin (I had to last time) and that I might need more scans to monitor growth. I did not expect to be told to sit down in a little room then have her literally stand over me and reel off the long list of horrible things I'm at risk of and what they expect me to do about it. Basically I'm at risk of dvt, bleeding, diabetes, splitting my scar, spitting down below, eoesiotomy, shoulder distosia, she told me there would be a high risk of them hitting the panic button in delivery and having hundreds of people come in to get the baby out in a hurry (her words) or emergency c section. So I asked if it would be better for me to have an elective section instead and she said "oh no! The risks are much greater if you do that!" I will need to take asprin from now, will need to do daily fragmin injections from 28 weeks, glucose tolerance test and she basically forced me to sign up to slimming World. She also wanted me to decide there and then if I went over due if I would consent to having an elective c section (after telling me the risks are even higher) as being induced would double the risk if my scar splitting. I refused. I don't have a clue which is better and she made no attempt to explain or reassure me further. Just said she would ask again at the next appointment. I also have a history of anxiety and depression (which she knew as she asked me about it) and this was a lot of information to take in! She then set about dictating a letter to my GP in front of me repeating all the risks and problems. Am I being over anxious or was this a really insensitive and unusual experience? I get I need to know the risks, but there are surely better ways of reassuring me that they are going to manage it and it will be OK in the end? Should I complain? My DH thinks I should. I'm not sure if I should suck it up as its my fault anyway.

Do you weigh about 16 and a half stone at 5ft 1?

That's probably twice a healthy weight. You cannot consider yourself otherwise healthy at that weight. The amount of fat around all your organs is dangerous.

I assumed your bmi was in the 30s. I now understand why the consultant went nuts. At your bmi the risk of stillbirth, let alone the risks to you is scary. Please do something about your weight while you still can.

Your risks are huge but now you know about them and can start thinking about it and tbh I don’t think going on a diet would be a bad idea. How do you manage to run round after your toddler?

I manage just fine thanks. I keep up with my toddler, work, with a reasonably manual job, I'm my spare time I take part in amature theatre and tap dance! And contrary to what you probably think I don't exist on ready meals and takeaway. I have a healthy diet. I am otherwise healthy. I have pretty much always been on the larger side. They only time I wasn't was when I spent over an hour in the gym 6 days a week and ate no carbs. I didn't like myself much then. I can't keep that up now I'm a mum and I have made my peace with who I am.

I mean this kindly, but if you are going to take the position that you are “otherwise healthy” in spite of a very high BMI, you’re going to have to develop a thicker skin.

The consultant didn’t have much bedside manner, but she wouldn’t be doing her job if she didn’t try to impress on you very strongly your risks. You don’t have to do Slimming World or anything else she says, but you do have to accept that failing to take medical advice is going to frustrate the doctors caring for you.

I’ve always found the way to deal with consultants is to try and meet them on a professional and adult level. So you could say next time “yes my BMI is high but we are where we are. How can I have the best birth for me and my baby? And what information can you point me to so I can fully assess the risks?”

I think in the context you are being sensitive, and you have to be honest with yourself about your risk profile. If she’d said “look don’t worry love, it’ll all be fine” she be medically negligent. It’s your choice but you have to know the risks.

I’ve always found the way to deal with consultants is to try and meet them on a professional and adult level. So you could say next time “yes my BMI is high but we are where we are. How can I have the best birth for me and my baby? And what information can you point me to so I can fully assess the risks?”

Hahahahaha, have you done this?

Never act like a consultant* to a consultant, they’ll shut you down quicker than a branch of BHS.

*clinically informed, clued up, confident woman

Oh and with one of mine my pre-pregnancy BMI was 22, he was measuring large (not huge just a bit big) and I also had to agree to a c-section if I went over due by any time at all. I was also under 35. Try not to take it personally.

PaulHollywood absolutely yes. In several pregnancies, and dealing with my kids and my own medical needs.

I didn’t say anything about acting like a consultant. I said an adult and a professional. I’m also always unfailingly polite, respectful of their expertise, and ask lots of questions. I don’t always do what they suggest, or will negotiate an alternative. Lots more doors open with that approach than going in with a combative mindset.

Talldrink you’ve made some spot on points in your posts.

I’m sorry op but you come across as being in denial with the level of your obesity. It really doesn’t matter if you eat takeaways or huge portions of pasta, your BMI is too high. A BMI of 44 IS incredibly high risk in terms of pregnancy complications.

That’s amazing that Slimming World is funded in your area. Try it, dont automatically rule it out because you think the information wasn’t delivered to you in the desired way. You have a right to be given the hard facts even if they are not what you wanted to hear.

This sounds like a consultant I had during my pregnancy. My list of risk factors as long as my arm included the usual obesity related risks but also things like acute and chronic heart failure, need for intensive care and death.

They have to inform you of the risks. I'd far rather have a consultant with little beside manner who is shit hot at their job, than the other way around.

As it happened, my pregnancy was absolutely textbook despite my risk factors. I was induced as planned at 38 weeks (agree with what TallDrink says about, they were going to let me go to 40 weeks but when I gave my reasoning for a 38 week induction, the consultant agreed and it was booked immediately). Labour was all fine until baby's heart rate dropped and they couldn't get it back up. That's when the emergency button got pressed and "hundreds" (about 6) people came rushing in. He was delivered by forceps (which was the plan all along anyway) and nothing that happened (heart rate drop, forceps, tearing etc.) can happen to anyone, much like a lot of the things you mentioned.

A BMI of over 40 is medically considered morbidly obese. So I don't think you could describe yourself as healthy as such.

She can’t tell you everything will be ok because she doesn’t know that.
She needs to tell you all the risks clearly and without minimising them because that is her job and if she doesn’t she is not doing it properly.

It was always the plan that I would have a c-section (fibroids). However, at 30-odd weeks check ups, another consultant told me that I 'could die', need a 'hysterectomy" and that 'my life would be prioritized over my baby's'. His words 'Giving birth is like a plane taking off, it could all go wrong and you crash'.

I complained about him. It turned out consultants had just that week been informed to reduce the number of C-sections. I had a natural birth in the end, bled like a horse and cervix not closing after labour. Panic button was hit.

C-section would have been (in my case) probably less stressful.....

I don’t think she handled it very well but sounds like she was angry, doctors see so much obesity and they see the negative impact it has on outcomes and the horrendous complications it can cause. Perhaps she is getting frustrated with patients not taking it seriously and putting their health and that of their unborn child’s in jeopardy. I’m not judging as some people naturally carry more weight and it’s far more of a battle than for somebody who has a fast metabolism. But I think doctors have their fill of obesity after a while, and they just want to see patients give their utmost to losing it, instead of minimising the risks

Put your anger / annoyance to good use by losing weight. Whether thats exercise and low carbs or slimming world .

You are foolish too think that attacking the messenger will change the message.

Telling everyone here how healthy you are is a waste of your time. No one will believe you. We all know people who claim to eat nothing but lettuce and 99.9% of the time its bollocks.

Please just take the doctors advice. She may not be the most tactful, but you wont care about that if you have to have a crash section .

BMI of 44, 5 foot 1, 16.5 stone and a size 18? I doubt it being as I'm 5ft 1, 14,5 stone and squeezing into an 18!

You have to understand that your consultant is right. Imagine she didn't outline the risks and something terrible happened? Who would you blame then?

Hi OP

I'm in almost the same position as you. Similar BMI but no other medical conditions and so far everything has been completely fine. I'm 25 weeks now and had my first consultant appointment a couple of weeks ago. Also had the risks talk (which I was ok with) but also some unhelpful comments from the consultant more along the fat shaming lines. Realistically we are where we are.

My midwife has been a lot more reassuring and sometimes I wonder whether it's because if everything goes smoothly the obstetrician doesn't really get very involved so naturally obstetricians see far more of the complicated births than the straightforward ones. Of course it's good to monitor everything and have a plan for if things don't progress smoothly.

I don't know if you have come across the American website plussizebirth.com which is really helpful on keeping the risks in perspective. It has great tips on how to be as healthy as possible during a plus size pregnancy but also reminding you that even though the risks are higher, the most likely outcome is still that everything is fine. Some of the advice is very geared towards the American healthcare system but I found the positive stories of those who've been through pregnancy at my size and larger very encouraging.

Keep going - you're doing fine and you are aware of the risks. Don't be afraid to advocate for yourself. As for every pregnant woman, having good information, asking intelligent questions and trying to make informed decisions about your health is the best thing you can do. Being fat is not the end of the world. Of course things could be easier at a lower weight but nobody is perfect and pregnancy is the unknown anyway - everyone faces risks of one kind or another.

Was your BMI as high when you had your first DC?

She could have had a better bedside manner but I think you’ll need to develop a thicker skin as you may get a load of comments about your weight and this pregnancy.

Prove her wrong. Look after yourself during the pregnancy. Try slimming world & do some light excercise and hopefully you can have the birth that you want. It is totally fine to lose weight in the first and second trimesters if you are carrying excess weight. Just follow the medical advice and prove her wrong.

"I don’t think she handled it very well but sounds like she was angry, doctors see so much obesity and they see the negative impact it has on outcomes and the horrendous complications it can cause. Perhaps she is getting frustrated with patients not taking it seriously and putting their health and that of their unborn child’s in jeopardy...But I think doctors have their fill of obesity after a while, and they just want to see patients give their utmost to losing it, instead of minimising the risks"

I don't think that's true at all, or it shouldn't be. The Doctor needs a healthy mother and a healthy baby, sadly in that order. The primary goal is to have you both alive and well, but if they have to prioritise one over the other, it will be the mother every time.

To avoid having to make that choice, they are giving you all the information they can, now, while you can make changes that will have a positive impact on your labour. The lower the risk, the lower the likelihood of interventions. The fewer interventions, the lower the chance of complications.

So hard as it is to hear that a BMI of 44 is high-risk when you feel that your function isn't compromised, you do need to take the advice.

BMI of over 40 means you're morbidly obese, not just "overweight".

There are some horrible, unhelpful, 'fatshaming' posts on here.

OP you are at higher risk because of your weight but that doesn't mean you will have a terrible birth.

Read up as much as you can. I find medical professionals helpful if you are honest and open with them.

If you can try and lose weight before the birth. It all helps.

Like you I have always been big and was high bmi when I had my children.
I was treated with the upmost respect and with care.

With dd2 I insisted on a planned cs as I researched and thought this was safer than vbac.

I didn't develop diabetes or any other complications. The birth by c-section went well, no complications. I didn't have aspirin or injections pre-birth, just injections for 5 days post-birth.
I was up pottering about as soon as the spinal wore off and only had a one night stay in hospital. I recovered very quickly.

I did lose weight (around 2.5 stone) between the booking in appointment and birth. I made sure I was as healthy as I could be.

You won't necessarily have complications. It is just statistically you are more likely to have them than someone of normal bmi.

Good luck

From your post, in my opinion, I think she wasn't professional.

She could have sat down and talked through everything she said in a way that IF she was truly worried about you, showed she cared... instead of being nasty - which actually, doesn't shows she cares, it just shows she has bad manners.

So either she is a nasty person, or being a consultant, she has now lost the meaning of why she entered medicine in the first place.

above post for OP

Hi OP. Firstly just wanted to join you in the high BMI camp and welcome to the world of comments from professionals that do really hurt!! But try to remember they are just doing their job. I've learnt that as my pregnancy has progressed.

In terms of BMI, mine was 35 at time of booking in and I was so shocked. Having never been bigger than a size 14 in my life and not owning a pair of scales I had no idea how much I weighed but figured I was a 14 so it was Ok! Honestly....the BMI shock hurt. And although your BMI is 44 and you're a size 18 which as you say, isn't abnormally large, it is very unhealthy, as is my BMI. Like you, I have no other health problems but I have come to realise that those numbers wouldn't show unless I was actually unhealthy. I'm 5ft4 just for the record.

The time is now to make a change to do the best for both you and your baby. I'm 27 weeks pregnant and I joined SW under midwives advice at 13 weeks. I've currently lost 10lb and although that isn't masses, I just think imagine where I would be if I hadn't ever started. Probably 2 stone up from this point. It's about reducing the risks now whilst you can...still birth is three times more likely, and although it probably won't happen, for me it broke me into 1000 pieces knowing that I'd even put my baby in a position to allow that risk factor to be so significantly increased. SW has been amazing, I feel bloody brilliant and it's been so easy with amazing support from my group.

I just urge you to take it all on the chin with the way it was phrased but really take note of what was said and see what you can do now. This is coming from the girl who cried solidly for 3 days because 1 of my 5 scans read "scan technically difficult due to high bmi". So I know how pissed off and upset you might feel. But with time you realise this ain't about you anymore. It's about baby.

You're weight and age shouldn't stop you from having a baby, but as my midwife said when I told her for the 100th time how gutted I am about my BMI "just let it go, you have to let it go"....It's time to let go of the frustration and just do the best you can from here on in. You can do it xx

I was going to say that she was over the top. Then you dripfed that you are well into morbidly obese. Which pretty much makes what she said factual.

OP being in late 30s, morbidly obese and a previous c section you are hugely high risk.

If she doesn’t point all the risks out to you and then something bad happens and you claim you hadn’t been informed she would be negligent

Everyone wants a safe easy birth and yet seem to think their personal risks are of minimal consequence

I’m sorry the conversation didn’t feel supportive or was hurried- sadly she was probably hugely under pressure time wise and trying to get all the facts out there. She wouldn’t want to knowingly terrify you and perhaps overlooked the gravity of all that info in one go. Not an ideal consultation for sure.

But no easy way to say essentially you are massively higher risk due to age and size.

Losing weight in your pregnancy can be done and would improve chances of a good outcome. So take that bit on board at least and do your part to help them keep you and your baby safe.

No one with a bmi of 44 eats a light healthy portioned sensible diet. I’m sorry they don’t. Some people are naturally heavier but a BMI of 44 is not simply explained by that.
You kid yourself if you think you are healthy.

Sorry OP I know that is tough to hear.

Look forwards, take her points on board with your birth plan and try and lose some weight in the next few months. Good luck.