I'm a plus-size pregnancy specialist midwife: ask me anything!

[liftis44]

Hi, I've been a specialist plus-size UK registered midwife for 15 of my 20 year career. Nowadays I'm a PhD midwifery lecturer/researcher. I get lots of questions and worries from women on this topic, and I'm all up for myth-busting, information-giving and reassurance! ASK ME ANYTHING and I'll give you an evidence-based response ASAP!!

What advice would you give to someone with a high bmi who is ttc?

How do we get the message out there that women with higher BMIs need higher dose (prescription strength) folic acid ideally before they conceive? Any ideas?

I'm interested as to why you use the term "plus sized" as a healthcare professional when the medical term is obese. I'm not being facetious but curious.

Thank you so much for starting this thread it's so kind of you. I'm expecting my second and my BMI was 40 at booking in. I was told I would be consultant led but I've just had phone appointments where I've been told my BMI was high so I'm high risk - no further information or advice given, just the standard questions like do I have signs of pre eclampsia. My first birth was rapid - 3 hours from 0cm to delivery, and I had a natural straightforward delivery with no pain relief and no interventions like forceps. I've been told it's against the rules to use the midwife led unit but I have to be reweighed to see how much weight I've gained at 36 weeks to see if I can or not. However no one told me that at the start or has offered me support in anyway, and were very surprised when my fasting glucose was 5mmol and my post test glucose was 5.1mmol. I know I'm overweight but I am also still active, my BP is spot on etc. I'm more concerned about the speed of my last labour but no one seems interested in this? How hard can I push to use the midwife led unit? If I have another fast delivery I would rather feel comfortable than be stressed about a medical environment. I'd like a water birth but im not even going to suggest that as apparently they will tell me no in case I have to be hoisted out like a whale

@theheavyweightmidwife thanks for starting this thread, it's something that's been on my mind since finding out I'm pregnant with my second last week. My BMI is currently 31 as (being quite honest here) I've eaten too much and done too little exercise since DD was born a year ago (my bmi was 26/27 when I became pregnant with her).

So my question is - should I try and lose weight/restrict calories to get it firm down or should I just focus on healthy eating? And can I do some exercise? I used to workout regularly at home pre-dd so did carry on when pregnant with her but I'm worried my body isn't used to it now.

Lastly, I'm worried about the impact my weight will have on my pregnancy and birth - are complications likely?

I'm not overweight myself but hope you don't mind answering. I always felt a bit miffed my BMI was recorded at 10 weeks as I pile on the pounds in the first trimester (truly ravenous, but it averages out over the 2nd and 3rd trimesters). Don't you end up categorising people as overweight or obese when prior to pregnancy they were a healthy weight?

@topandtailem this one will take a bit of time. I’ll get back to you tomorrow. Or DM me? Here or Insta : theheavyweightmidwife

@babysteps22 hopefully you’ll be doing your bit for it here! It’s a fairly new change - I know it’s years but it takes time for messages to really gain traction. I’m hoping to develop a platform around plus size pregnancy positivity to enhance the usual NHS and public health messages.

Not at all- this is a really good question that goes straight to the heart of the problem. How can we build great relationships and provide reassuring care for women when the word or category we use to describe them clinically is socially and culturally demeaning to most? (I’d maybe argue all!) In short, I use plus size because that’s what M&S would use. People like M&S and I want people to like me! (And talk to me - and engage with what I’ve got to say)

Indeed, BMI is a blunt tool, designed for use at population level and to gather mass datasets. Not great for individual pregnant women. 🤗

@theheavyweightmidwife thank you for your answer. I was just surprised not to get the guilt trip of being overweight/obese yet again. And being treated different to those with a BMI <26. I had been stressed by it before the booking appointment. I'm a size 16 so one the large side of average.

(My three pregnancies at 37, 39 and 41 were not successful. I did not meet the criteria for IVF due to AMH levels although I did get the referral I needed and had the AMH been OK would have met the criteria. (Had to Reduced BMI to 29 for IVF))

Is “plus size” genuinely the term used in the NHS now instead of “obese” or “ morbidly obese”?

If so, what exactly does it mean?

@Willbe2under2 (I’ve been there!!) DM please for detailed reassurance. This is hugely important: complications are UNLIKELY for ALL women if any weight, unless they have a pre-existing serious medical condition (particularly cardiac). Nobody can say whet your individual chances if complications are but with your BMI, statistically they are LOW.
i would focus not on weight loss now - we do not have good evidence that it’s safe - but on eating ‘real’ food, the biggest one…. avoid sugar wherever you can and yes, exercise as you did before )maybe not much with a baby?!?!) or just make sure you’re active in a way you like each day. Please do feel free to DM x

You don’t appear to be the OP, but are acting as though you are speaking for her. What’s the story; multiple accounts?

Oh this is fantastic! I’m currently 33 weeks pregnant with my second baby. I have been planning a home birth. My BMI at booking in was 30 and this didn’t trigger any additional monitoring but I did have a GTT anyway as I was diagnosed with PCOS about 10 years ago.

GTT was negative. Since then, my fundal height has been measuring three weeks ahead. This has been consistent and hasn’t gone up or down. I’ve had a growth scan,
which put baby on the 66th percentile and was discharged back to midwife care and told my home birth could go ahead.

I guess what I’d love your opinion on is whether my fundal height has been impacted by my weight? Or if it’s possible my baby is going to be big because I’m overweight.

My first DC was 8lb 15oz. I’m cautious of going ahead with the home birth if this baby is actually going to be a whopper!

Thank you!

I had a consultant appointment today (34 weeks) im being monitored as my last baby DD2 was 'small' but she had velamentous cord inserton and because my bmi is 37 however I have gained nothing so far this pregnancy.
Baby is measuring above 95th centile, so I have another scan at 38 weeks. I asked the consultant today what will happen if he continues tracking along this line, I had a traumatic birth with my first, and despite DD2 being 'small' at 7lb I still had a deep 2nd degree tear so I'm worried about delivering a 9lb+ baby. Consultant replied by asking if I'm heavier this pregnancy (I am slightly) and saying that's why thid babies bigger and my pelvis should accommodate a decent sized baby .... feel a bit 'fat' shamed. I passed my GTT, and haven't gained any weight, so yes I'm overweight but I eat well so why should me being heavier be an excuse for baby being bigger? (Babies head, stomach and legs all measure big) x

Thank you for your response! Yes essential hypertension was the term I was after!

Although I was monitored heavily (was a familiar face in the day unit), sadly the level of care varied greatly. I was consultant led and at each consultant appointment I saw a different face and had to fill them in each time, which didn't fill me with confidence.

I was suspected of pet a month before but they managed to control bp with lots of meds. Looking back at pics though I was so swollen and wonder if things we're going wrong already? One dr told me I had it and one told me I didn't. :/

I was also told as I have essential hypertension that I should have my BP measured manually and I was treated like an inconvenience every time I asked for that and and a large cuff.

Thankfully there wer amazing members of staff: midwives (including brilliant students), drs, hca too.

Hi, I’m also interested in the language. Is ‘plus-size’ used, and in what context? Do you use ‘healthy’, ‘overweight’, ‘obese’? Is this language still in use? These terms used to go alongside the whole BMI stuff. Is ‘morbidly obese’ ever okay or useful? Does what you say to patients differ from what you write in notes or discuss with other healthcare professionals? A consultant wrote in my notes that I ‘appear underweight’, I was at the lower end of BMI, definitely not below 20, I felt really miffed, and judged, but may just have been triggering due to ED history.

This is a really interesting thread. I have PCOS which hugely affects my weight. I conceived DD using letrozole and gave birth in June 21. I was BMI 28 at booking and all through my pregnancy worried about how much weight i was gaining, but generally these concerns were shrugged off by the midwives. Then i had pregnancy induced hypertension at the end of my pregnancy and didnt come off the labetalol until nearly 3months pp. When DD was born, she was suspected IUGR (5lbs 12oz) which ive always wondered whether it was due to my weight. Lo and behold, DD is now 14months old and I've barely been able to lose any of the weight gained.

Im 36yrs old and we want to start trying for baby #2 but my BMI is now 32 and I'm really worried about a) how i will be treated with a BMI >30 and b) the health implications for me and a future baby.

@HappyChloé2 The op has said that she changed her name to her Instagram name so people could look at her account.

Hi @HappyChloé2 The clinical term remains ‘women with obesity’ but I find 99 out of 100 clinicians will not use the O word in consultations with women. Which is good as it’s stigmatising. To me this creates a problem from the get-go, as it fosters awkwardness, not knowing what words to use, and often for worn men a sense of ‘you’re not saying it, but I know you’re thinking it’. A more open approach is needed that acknowledges stigma and focuses on what woman's priorities & concerns are. So plus size is not a clinical term, no, but to me it doesn’t refer to particular categories of BMI or whatever, just to women who are concerned about their weight or their pregnancy care.

Thanks @theheavyweightmidwife! One more question.. am I more likely to have a large baby? My first was 9ibs 2oz and born at 39+6 so pretty much dead on my due date so I'm a bit nervous this one will be even bigger.

Any tips for surviving 2 under 2 having been there? 😆

My BMI is only just over 30, and I bet if I had taken my shoes off and hadn't just drank a glass of water, it would have been 29.9. So should I care about the extra precautions taken for BMI over 30 since it's an arbitrary cut off? Like, the jump from 400ug to 5mg of folic acid is a really big one if you're near the cut off! And the same for the blood thinning injections.
It seems strange to me that all this extra care can be determined based on weight that fluctuates day to day, and people with a BMI of 29.9 don't need it, but a BMI of 30.1 do. What's the evidence like for a BMI over 30?

In short, I use plus size because that’s what M&S would use. People like M&S and I want people to like me!

M&S is no yardstick! A biological man, as long as she identifies as a woman, can now work in the lingerie department/ fitting rooms/train to be a bra fitter and the company see no reason why they would have to inform women of this policy change. M&S is no friend to women, of any size, but particularly women who's religious beliefs mean they can no longer shop there.

Hi @smooththecat Doctors do not get taught enough (often at all) at medical school how to talk to people sensitively. Midwives do but they often still do it badly! Often it is something they feel might be upsetting to the patient if they say it- but putting it in notes where they’ll be seen is SO insensitive - I hear about this a lot sadly. Things really really need to change.

My message is that you - and your pregnancy- can be healthy at any size. The key thing is whether a woman experiences complications in pregnancy - and most women don’t, whatever their weight. I hope simply by present the evidence and guidance in a different way to reassure. I coach 1-2-1 and I’ll soon be offering online courses to pregnant women, as many of the experiences on this thread resonate with me over my years doing this work. It’s really needed.,

in terms of language/words - there are categories of obesity - 1 2 and 3, for BMI above 30, 35 & 40, rather than any longer using ‘morbidly’ as a descriptor. Clinicians avoid the O word because they know it’s offensive to many, but it also creates awkwardness. ‘Raised BMI’ is often used. Plus-size is my chosen term, which is more from the world of fashion - where they put more thought into using the right words!!