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!!

Yes, M&S was just an example - my point is that shops/businesses put a lot of thought into using words that are acceptable/attractive. No shop would sell much in an ‘obese’ range.

No, I am the OP, just an online novice. It occurred to me once responses started coming in that changing my name to my online name on other platforms would make sense. Just a lack of forethought. Sorry for confusion! One midwife, one account.

I'm so angry, spoke to the midwife team yesterday to book me in for my booking in appointment at 10+4, she asked my height and weight, then told me my gp who I saw at 6+5 should have prescribed me higher dose folic acid. She has now prescribed it for me for the last 2 weeks to being 12 weeks!
How much impact could this have?

At what bmi do you need higher prescription folic acid? I only started taking the normal dose when I found out I was pregnant at 5 weeks (I'm 6 now). I'll have to try and speak to the gp on Monday

@Willbe2under2 I don't know, she didn't actually tell me my BMI! Just that I should have been prescribed the higher dose weeks ago.

Hello :), I’m 10 weeks with my second baby. My first baby I had a bmi of 27, but I’ve put weight on in the five years inbetween my son and this pregnancy, bmi is now 35, id like to lose weight if possible during pregnancy to bring it down a little? ----Is this something that is discouraged or is it ok? I was planning on healthy eating and cutting out snacks (although hard at the moment as I feel sick all the time and just want carbs!)

Jesus. People will avoid using the correct and appropriate term because it’s “stigmatizing”?

These aren’t children you are caring for, sugar-coating a health concern like this is yet more evidence of the NHS needing a proper going over.

You may have a perfectly healthy baby if you smoke too, but we don’t avoid telling women not to smoke during pregnancy to avoid stigmatizing them.

@wibblewobbleball Yours is a familiar story to me! There are few things here. First and most important - it sounds like you had a previous uncomplicated pregnancy and birth and have an uncomplicated pregnancy from what you say? The Royal College of Obstetricians & Gynaecologists guidelines on this state that if your pregnancy is uncomplicated, in labour you should be cared for according to routine ('low risk') guidance. They do also recommend that women with BMI>35 should give birth in a consultant-led unit BUT your situation really needs an individualised plan, made by you and ideally a senior midwife, one who can gatekeep for the birth centre/midwife led unit. NHS Trusts have a designated senior midwife who see/phone women who wish to give birth 'outside of the guidelines' and a lot of this refers to maternal weight. Then you can look at the evidence, guidelines and come to a plan that's right for you.

I'd stress that your previous uncomplicated - and quick - birth is a HUGE tick in the 'uncomplicated' box. Your body has grown and given birth to a baby with no problems so as long as this pregnancy remains uncomplicated (I don't know your full history and situation) your clinical picture is very different to someone with a first pregnancy for example - that is how I'd anticipate a sensible senior midwife would approach it. Feel free to stay in touch and I'm on instagram: theheavyweightmidwife

I am also curious about your wording of plus size vs obese.

Are obese women more likely to require intervention during labour? What’s the best birthing position for them?

@HappyChloé2 agree with you totally. I understand that obesity-related issues cost the NHS billions.

Hi @grosgirl I'll answer as best I can! I'm not going to comment on the particular clinical findings you've included, but as you say you've been given the thumbs up for a homebirth, so your midwives etc.are obviously happy.
Broadly, fundal height measurement can be inaccurate, and there is more of a chance of inaccuracy if you're plus size/ But you had the scan too so I'd be reassured.
So I can only generalise. Generally, second and subsequent babies tend to be a bit bigger each time, not always - you might have a feel for that yourself. Also, you have had a straighforward birth before (I assume, hence planning a homebirth?) so this is a huge tick in the uncomplicated box. Your body was put to that test and passed it, so you can expect it will do it again. As for a 'whopper', it might feel daunting, but in all my years in labour wards/birth centres and when I worked in a homebirth team, big babies were born without complications and weren't observably across the board harder births. I just don't think it's that simple! Not very scientific but a baby being born is a BIG thing, whether it's 6lb or 10lb!
Is there anything you're particularly worried about?

Thanks so much for your reply, it's so reassuring! Yes pregnancy has no complications and I have no existing condition. I really appreciate you taking the time to do this, it will be helpful to so many of us.

@Matildahoney Try to feel reassured that you have been taking folic acid, and it's now at an increased dose. There is some evidence that an increased dose is better with a higher BMI, but definitely taking it at all is the key thing.

Thank you. Appreciate your response.

@FrancescaContini Upright positions and keeping mobile/changing positions are better for anyone in labour - where possible. Positions which are more comfortable for the woman are obviously a big consideration. Lying down works against gravity.

@FrancescaContini @HappyChloé2 I did my PhD about stigma in healthcare - I'm aware there are different views on this, but in my work I try to establish good relationships with people I'm communicating with. When people are stigmatised they disengage and it doesn't help them to make any changes that they want to make (this applies to smoking too).

@theheavyweightmidwife such a helpful reply and actually, the fact that you haven’t observed this huge difference between the births of smaller babies and bigger babies makes me feel a lot better. I don’t know what I was expecting but I guess this idea that as soon as a baby was ‘big’, there would be this whole host of problems that otherwise didn’t exist!

Honestly, with my very limited knowledge of birth, based on one very straight forward labour and birth, my fear is that she’ll be too big to birth, there will be shoulder dystocia or something and then I’m 40 mins away from the nearest hospital by choice. I know this is something I just need to decide but I am worried about making the wrong decision and putting myself and baby in danger.

On the other side of the coin, I didn’t enjoy being in hospital for my first. Midwife led unit but the journey there really disrupted my labour and then the birthing pool completely switched my contractions off. Arrived at 11pm at 9cm dilated but didn’t give birth until 9am the next morning. It was pretty exhausting. No pain relief at all so I don’t feel I need access to it. Was then (not nastily) ignored for 15 hours, when desperate to go home, while everyone’s time was taken up with a pretty tricky family on the ward with me who had extensive social services involvement. They kept leaving their baby: “just watch him for a min for us” to go out to smoke. Finally discharged at midnight, in the middle of November. Not an experience I’m keen to repeat!

Where is the best place to look up data on the outcomes of pregnancies where the mothers are very overweight. Is there a strong correlation between different socioeconomic groups or with different racial groups or with differently aged groups.

Hi @Yespmed So the slightly vague evidence-based answer here is that we do not have the evidence to demonstrate that losing weight in pregnancy is safe. So it is not recommended. Obviously there are women who do lose weight during pregnancy for a variety of reasons and everything's fine, but it wouldn't be possible/ethical to set up a trial to test the safety of it.
We also have no national recommended weight gain guidance in the UK. Sometimes midwives might quote the US ones, but NICE in the UK have explicitly rejected those.
I strongly recommend eating real food, avoid processed and especially ultra-processed food and most importantly, restrict sugar as much as you can. So with nausea, even just having crackers and avoiding sugary biscuits will make a difference. Sugar is the enemy of all of us!

@Willbe2under2 The best advice I was given was 'Drop your standards...IN ALL AREAS OF LIFE!! ' Followed by maniacal laughing.
Worked for me! I had three under four in the end x

Not sure my standards can get any lower to be honest but that's good to know 😆😆😆

@grosgirl I can't state strongly enough how important it is you've had a vaginal birth before. It makes it so much more likely everything will go smoothly and to plan this time. Re. shoulder dystocia: this is rare and unpredictable, so midwives are always ready to respond and regularly update their skills on managing this problem. But I'll stress it is rare AND in over 80% of cases it is solved in seconds by using a simple manoeuvre that we are all trained to conduct - just moving the mum's legs. So it is EXTREMELY rare that any harm comes to either a mum or a baby. I'm aware it causes lots of fear and the chances seem to a be a little higher if you are bigger, but the risk is still very very low.

@SweepItUnderTheCarpet There is no neat one place sadly! MBRRACE (which reports on maternal deaths) will report on factors like ethnicity, BMI, age, parity etc, and individual Trusts collect and audit outcome data. We have clinical trials results and other observational data, so we do know a lot about various intersecting factors (but there is also a lot we don't know about the why, and this means we are very bad at predicting who will and who will not experience complications). So for e.g. there are more women with a high BMI who are socially deprived, from certain ethnic backgrounds (e.g. south Asian) - and with higher chances of certain complications e.g. diabetes in some ethnic groups - and at an older age. But it is extremely complicated, all collected at population/trial level and therefore not always helpful for an individual pregnant woman trying to navigate pregnancy, her care and her choices. Also, most of the above factors can come with at least a degree of stigma, and there is emerging evidence about the detrimental effects of stigma over time on psychological and physical health. Thanks for the interesting - and v complex - question. It's all fascinating to me!

Hi @Loulou1712 This is really disappointing - I hate stories from women about being made to feel bad. It is a) totally unnecessary and b) detrimental on a number of levels. In fact, your consultant cannot say you increased weight CAUSED your baby to be bigger. Nobody can demonstrate that as causative. So why say it? As I aid elsewhere, second and subsequent babies tend to be bigger than previous babies (obvs not always), so please try to draw a line under this consultant's insensitive and inaccurate communication failings. Perhaps if they'd focused on the brilliant news that your GTT result was normal, you'd be feeling good - you should be. Feel free to DM and follow me on insta - I'll have a website soon.
Not sure about your whole clinical/pregnancy history but you sound focused on health, healthy eating and doing all the right things. Keep it going x

@grosgirl feel free to DM - follw me on insta and look out for website x