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!!

@matildahoney no, absolutely not a concern!

@theheavyweightmidwife how much weight is OK to lose in the first trimester if you're already overweight?
In my first pregnancy I lost a stone by 12 weeks because of the nausea and food aversions. But that obviously wasn't a problem for me as I had more than that to lose anyway, and the baby was perfectly fine. And I started putting it back on in the second trimester as the baby grew.
This time around I've already lost 6 lbs and still have weeks of nausea ahead of me.
My midwife didn't seem concerned but at the same time it says to contact GP if you lose more than 5 lbs. Is the 5 lbs guidance only for people who are already a healthy weight?

@ancienthouse there really isn’t evidence around this to give a satisfactory answer I’m afraid!! I don’t know where the 5lbs comes from but it isn’t from an evidence base. Lots of women lose weight early in pregnancy and it causes no problems - as with you. Sorry I can’t do better than that. But do keep asking GP midwife if things change or you feel unwell or can’t keep food down - or if you’re worried.

Signing off for now. Find me on instagram - theheavyweightmidwife. I’ll be back on here soon too. Best wishes to all x

This is not a size related question but is it normal to have a slightly open cervix in your second pregnancy. Last week I went to triage at 22 weeks pregnant with period like pains. The doctor who examined me said my cervix was slightly open but this could be because it was my second baby and that I could go home if the pain stopped. Is this normal or should I be worried?

@ElephantGrey101 your cervix never returns to the firmness and 'complete closedness' of prior to your first birth. This is one of the reasons why often second and subsequent labours can be quicker. So - difficult to describe and obviously it wasn't my observation - but she is probably referring to your cervix being softer, shorter ,and slightly open (but not kind of stretched open cervix that you get in labour). Another way to explain it would be that prior to your first birth you cervix feels as firm as the tip of your nose and a midwife could not stretch it to fit their finger inside, whereas after it feels like softly pursed lips, and her finger would usually fit inside it. Hope this helps a bit!

The miscarriage rate for women who are overweight is significantly higher than for women who are not plus sized. Is it known what actually causes the miscarriages?
Whats the most common and significant problem that you come across with pregnancies where the women are overweight? I know it’s rare to effect the baby but what is the most common impact on a baby?
Is there any link between babies going into nicu’s and overweight mothers.

Im curious about trying to understand what the actual risks are. The increased risk of miscarriage does seem very worrying if you just look at the stats. As a lay person though I know it’s easy to misinterpret the raw stats.

thank you

Oops just realised I’ve posted under a different name. I’m justSweepItUnderTheCarpet. I name change regularly

A baby and the associated fluid etc weighs 25-30lb, right? So if some women are being told not to gain weight during Pregnancy, isn't that being told to eat in calorie deficit and lose weight? And isn't that contrary to the advice not to try to diet?

@LollingAround @ehb102 I'll get back to you on these -important questions!

Hi @LollingAround So the miscarriage rate is a bit higher in larger ladies but it is still low overall, which is what I think is list in all the focus on risk. I personally think the guilt and anxiety experienced during pregnancy is a very significant problem - I’m not able to name ‘the most serious’ problem here as it’s a very complex issue. I appreciate you’re interested and happy to discuss!

@ehb102 yes indeed if you’re advised to maintain weight it is in fact a fat loss if you are gaining baby, placenta, fluid, blood weight. I know some women are advised this but if stress ageing there are no uk recommended guidelines for pregnancy weight gain.

I think it is very unfair to essentially tell women to diet when pregnant but pretend that isn't what they are saying.

Having lipoedema myself and being at my absolute fitness and thinnest when pregnant it was direction that would have damaged both me and baby.

Thank you for answering my questions. I love your positivity and passion for ensuring heavier women aren't made to feel guilty or worried however it seems like you are avoiding talking about any of the actual increased risks associated with higher weight pregnancies. I was wondering if that was on purpose or not? I completely understand that you wouldn't want to discuss the statistics but it would have been interesting to know what problems being plus size can cause. I think you can do that and still be a very positive voice.

Im not sure this feels like an AMA 🫣

@LollingAround not sure if this might be useful, but the Royal College of O&G and the labourpains.com website (the patient info part of the Ob’s Anaesthetist association) have useful information leaflets about being overweight in pregnancy and anaesthesia in pregnancy respectively. HTH.

My first was a 10lb baby, induced on his due date he got rather stuck and I had an episiotomy with a tear. I'm currently 12 weeks pregnant with my 2nd and already worrying about if I'll be given birth choices. I know I can't do much until I know estimated size and have a 34 week scan due to my BMI but worst case scenario and I grow another long baby, what's my best option? I don't want forceps and that much intervention (the propess worked quite quickly though!)