Advice please - need to convince midwife that I am not 'high risk'!

[KelaS]

Hi all

My local hospital (Watford General) basically has two options for birth - the main delivery suite, or the midwife led birthing centre. I desperately want to be booked into the birthing centre, but currently don't meet the criteria - they will only accept 'low risk' births, and my BMI is too high (criteria is BMI of 18-35, mine is 46).

However, they have said that this can be negotiable, assuming I have no complications, and my midwife said that we could discuss it at my next appointment (Fri, when I will be 35+5) and she would see what she could do. So far, despite my excess weight, I have had no complications whatsoever - blood pressure is fine, no issues with blood sugar etc, iron levels are fine even considering I am vegetarian, no swollen hands or feet - midwife has even joked that my pregnancy is so normal it is boring.

So, my question is - does anyone have any advice as to what kind of arguments I can use to convince them to let me book into the birthing centre - I am quite happy to promise not to make a fuss if they want to transfer me if there is the slightest complication, but not sure what else I can say to convince them. Also, any idea what kind of complications they are worried about so I can go into the appointment forewarned as it were?

PS - please, no horror stories about Watford General - I am sure they are out there, but I really would rather not know - can't really go anywhere else or have a home birth, so for me, ignorance is bliss!

How quickly can you be moved from midwife unit to consultant unit if needed?

The other thing to bear in mind is that the consultant has overall reponsiblity for the women in his care - you are only being put in the cons-led unit cos (in medical opinion) its better for you. Believe me, consultants do not go looking for extra patients!

Can move within minutes - it is literally on the next floor.

And I haven't actually seen a consultant yet - it seems that the decision will be made by the midwives.

Anyway, have my appointment in a couple of hours when I see my midwife so wil let you all know the outcome then!

Grrr. Midwife was off sick so they had someone covering who wasn't prepared to discuss it. Will have to wait another 2 weeks before I see my proper midwife again

For what it's worth I had lots of ideas about the kind of birth I wanted but found once I was in labour I didn't care about anything other than standing still and being very quiet. I was really keen on a water birth til I got in a bath and hated having contractions without standing up. What I'm trying to say is I'm sure once you are in the moment your worries about location won't matter to you much.

Obesity does make you 'high risk' statistically if you read the CEMACH 'Why mothers die' report it is a factor in many poor outcomes. However, they are statistics, they are not you. If you are generally in good health that's in your favour. Birth Centres generally have the same criteria as home birth. Listening to baby is difficult when women are large, as is palpation so continuous monitoring is probably easier for the staff. Most midwives genuinely have your best interests at heart!

Risk is about statistics, that's what risk means.
And a BMI of 46 is not just obese but "morbidly obese", it's really pushing one's luck.
I hope you get what you want, Kela, but at the least you might have to accept some modifications to the usual protocal, for instance, agreeing to the principle of transfering you out of birth centre to delivery suite, if things aren't perfectly straightforward, much more quickly than they might a woman with smaller bmi.

oh yes, I am perfectly prepared to agree to things like that. And although my bmi is very high on paper (I think it makes it sound like I am bigger than I am - I am a size 24-26), I am very healthy generally - have never had any weight related health problems, no complications whatsoever during pregnancy at all, just want to be given the chance to have the kind of birth I want, whilst accepting that there may be higher risks.

My main issue is though that although I understand the extra risks during pregnancy (gestational diabetes, high blood pressure, difficulty hearing heartbeat, feeling baby etc, none of which I have had), I can't find out what the extra risks actually are during birth. Can anyone help me with that?

Well, labour is like running a long race. Labour while very unfit and/or very obese (the two don't have to go hand in hand, I exercised loads when I weighed 17st)is like running a long race without training. And unlike the long race you cannot slow to a walking pace or drop out. That puts a lot of strain on your body, including your heart. An emergency caesarean under general anaesthetic is very risky for dangerous for you, and they may want to interfere sooner than normal so it does not come to that.

I really sympathise with you, and it is clear you want the best for your little one. All you want is the information so you can make an informed decision and I can't blame you. I must say that personally with your BMI I would settle for a hospital birth.It is a question that I would have had to ask myself a few years ago but I was lucky and able to shed the weight before conceiving.

Keep asking the questions until you know what you need to know. All the best.

OP wants a hospital birth, though, just on the next floor of the hospital.

I was a size 26 when I was pregnant with my DD (now a size 18)

Here is a USA site which I found useful.
www.plus-size-pregnancy.org/

I would arrange an appointment to see the consultant and calmly discuss it. The consulatnt could give me no convincing argument to have an hospital birth, based on the research I had done. So he OK'd a home birth for me and I should of been on the midwive led unit if transfered into hospital (Sadly in the end I was forced into hospital and had a terrrible typical 'waterfall invention birth')

BTW the continous monitoring leads to far more interventions and does not give better results than intermittant monitoring. My wishes and birth plan were ignored the moment I entered the hospital.

If you can afford it a doule or an independant midwive would ensure they at least treat you like a human being with choices in your treatment.

All the best and please note my experience is not common for mothers and I am biased as I still have nightmares over what happened to my body and baby. I understand a lot of mothers have reasonable times in hospital. So weight my comments as needed.

"My main issue is though that although I understand the extra risks during pregnancy (gestational diabetes, high blood pressure, difficulty hearing heartbeat, feeling baby etc, none of which I have had), I can't find out what the extra risks actually are during birth. Can anyone help me with that?"

Probably is not about finding extra risks but about understanding the real meaning of the ones you ave been told about.

I really don't know/remember much about these things but from my own personal experience a couple of things you mentioned are ringing some bells (or sirens if you wish!)

First is that you are assuming that everything will be perfect (which is a very healthy way to deal with the situation! I must say) but... have you considered what would happen if your baby entered in distress and the midwives couldn't realise about the problem in time because they could not really monitor heart beating as they would do in the other unit? yes the other unit is upstairs but, there is no guarantee that a bed and a consultant would be available at the minute that you need them, so perhaps a good reason to get there as early as you can. To be honest, if you are in the high risk group I really don't understand why you want to risk it further for the looks of a unit.

I know you don't want to hear bad stories but during DS's birth, the maternity ward was packed, all the midwives were running with the extra load and... when DS entered in distress it was me who realised what was going on (thankfully we were not relying in doplers!), Dh went to find the midwife who came a few minutes later, the consultant took even longer to arrive and tbh, seeing the fainting heartbeat of your baby getting weaker while the midwives had a go at my midwife telling her she should have called for help far earlier than she did, it is not an experience I would like to risk having just for the better looks of a midwive led centre.

The curious thing is that through out the pregnancy I told them there was a risk of that particular problem happening (very common with the women in my family) and they didn't want to hear, my midwife assured me things were perfect and I wouldn't have any problems. If I had been monitored properly during the labour, by somebody who were aware of the posible risks, I would have received the help I needed straight away instead of labouring for 27 hours before they realised things were not going to be the way they optimistically expected them.

Kela, I just want to offer my support and hope that your next appt goes a little better. I think it's obvious that you are not basing your decision on the 'looks of the unit' and I wish you well. Your feelings about where you give birth can and do have enormous effects on your labour and its outcome, so don't feel pushed into doing anything that doesn't feel right.

There is absolutely no evidence that continuous monitoring improves outcomes. It increases the chance of ending up with an emergency c-section which, as another poster has pointed out, is a genuine risk for someone with a high BMI. It is certainly no guarantee that a problem would be picked up 'in time' - you're far more likely to be left alone in labour for long periods of time than if a mw has to physically monitor the baby's heart rate every 15 minutes, for example.

Equally, there is a very good argument that labouring naturally in a birth centre will place far less strain on the heart. For example, there is less likelihood that you will end up epiduralised and having to do valsalva pushing to get the baby out within arbitrary, non-evidence-based time limits. This places a huge strain on both the mother and the baby's cardiac/respiratory systems.

To my mind, kela, you are being positive yet sensible, trying to make an informed choice, and that ime is the very best way to approach birth You are open to transfer if necessary - I can't see any problem. Your situation is as individual as anyone else's, so make your decision based on what you think, how you feel and where your comfort zone begins and ends. Best of luck.

Thanks Snaf, that makes me feel a lot better. Hopefully when I see the midwife again in a couple of weeks I will get more of a discussion about it. Also, the midwife I saw yesterday did say that I can still ask when I go in, and if the birth centre aren't too busy they may still accept me, so will keep my fingers crossed for that (when we had our tour they only had one woman in the whole birth centre!!)