BMI high - appointment with anesthetist!

[Butterscotchbaby]

Im currently 19 weeks pregnant - when i went for my 16 week midwife appointment she said that in my notes it said that i need to be on blood thinning injections from 28 weeks and also that due to my BMI i needed to have an appointment with the anesthetist to see if my spine would be accessible for an epidural! Im quite concerned about this - what will happen if there is too much meat round there to get the needle in? Also would this impact me having a cesarean?

Any advice would be massively appreciated 🙏

Are you booked in for a c-section? I've never heard of this. Of course they can't stop you having a c-section. What if it was an emergency. 28 isn't even that high. I'm shocked.

Sorry I misread and thought your bmi was 28. Is it really very high? Even so it's not something I've heard of happening.

It's not something I've heard off so no advice just wanted to bump your post.

I would imagine though that if not being able to have an epidural would affect having a c-section then they would need to do it under general anaesthetic which is an option. But as I say I have no idea if it affects it or not

Heard of not off

Hi

I have my anesthetist appointment next week.

But I wouldn't worry it would have to be a rare case to not be able to access your spine. It's more to cover their bases in case of emergency. So if there's a preferred spot that looks the easiest etc they can note it so if you needed it in a rush they would have a heads up. And if they really couldn't they can have a back up in place.

If you search big birthas on Facebook they have loads of conversation topics on similar things.

Best wishes

Depends what your BMI is - I’ve had c sections at both a BMI of 28 pre pregnancy and of 31 pre pregnancy and had no problems or really any mention of my weight.

what’s your BMI if you don’t mind sharing?

obviously if you need a c section you need a section they’re just seeing the safest way for you and baby to make sure all goes well!

I had a BMI of 42, declined to take the aspirin having researched, and did have an anaesthetist's appointment - he prodded my spine (I apologised it was sweaty, but it was summer and I was pregnant - he didn't mind), and wrote that it was all OK.

Which I knew, since I'd had an epidural with my first EMCS too.

Honestly, if you can feel your back bones, I doubt it's a problem

They just want to check that a) they can access your spine b) you don't have sleep apnea.

It's just generally part of making larger women feel bad for daring to get pregnant, IMHO. Another punishment to make sure you realise that you are a bad person for having a metabolism that means you find it difficult to lose weight and v easy to put it on.

I had one, it took all of 5 minutes, he wanted to know how many pillows I sleep with (indicative of heart problems), quick look at my mouth/throat (for intubation) and a prod at my back, said 'good back' in his lovely Polish accent and sent me off on my merry way. I did have an epidural, it was great, zero issues, my BMI was 45 at the time.

@BirdsBirdsBird or It's a necessary medical procedure that has to be considered when someone is obese...you know, for pesky safety issues

Assuming an epidural is similar to a lumbar puncture I think you'll be fine. My bmi was high when I had that done. It meant the consultant had to his fingers in deeper to find the gap between my vertebrae but it was still doable. It was definitely also easy sat on the edge of the bed legs on the side of the bar leant over a pillow. I'd have had no chance laid on my side I can't draw my legs up

That too. I refused the dietician and fat mums club they tried to send me to, where you look at an apple and a Twix and talk about how one is better than the other. I actually had HG with both my pregnancies and lost more weight than I gained over the nine months. I didn't need their patronising fat mums group.

@jamoncrumpets well that's easy isn't it. The twix is obviously better cos it goes hand in hand dipped into a lovely cuppa!!

@BirdsBirdsBird, I really don't think the NHS invents appointments just to fat shame. Pregnant women are sent for a variety of specialist appointments.

I would feel thankful that they considered this in advance so that any potential issues are avoided.

Ah thanks for all the replies ! I will look on facebook for that group :)

My BMI is 45 - im already taking asprin so thought i would get away with the infections but it seems like i wont.

Thanks again xx

There’s a patient info leaflet on the labourpains.com website (which is run by the obstetric anaesthetic association) which discusses some of the things an anaesthetist might want to chat about and may be worth looking at so you can think of questions you might want to ask.

Often the appointment doesn’t take that long and may feel like a bit of a waste of time, but it really is easier to understand how obesity (and more importantly weight distribution) may affect things in an in-person appointment rather than over the phone/ just by reading the notes.

The appointment is usually partly to discuss pain relief options and partly to think about a plan for what would happen if going to theatre for anything becomes necessary. It will also be to see if there are any other problems that might have an impact on pain relief/anaesthetic options as well.

Epidurals (and spinals) are sometimes, but
definitely not always, more difficult and that depends a bit on the distribution of weight (some women carry more around the lumbar region than others). Reflecting that it may take longer to get an epidural in they may advise having one sooner rather than later in labour if it’s part of your plan. They may also discuss that an epidural that’s in and working nicely can often be ‘topped-up’ to give anaesthesia (rather than analgesia) quicker in an emergency than a spinal anaesthetic can be achieved. Some women take injected blood thinners and the anaesthetist will be able to advise how much time has to have passed since the last injection before having a needle in the back.

A GA can also be more challenging for pregnant women with obesity and part of the appointment would be to plan for whether any modifications/extra kit etc are needed to keep things as safe as possible.

Hopefully none of the emergency planning will ever be needed - many women with obesity ping out babies with no probs at all - but it’s far better to have a plan before the day rather than to wing it in an emergency! Hope it all goes well!