Consultant Led Care - High BMI

[fr4zzledmum]

I've just had my midwife booking appt at 8+5 and been told I'll be consultant led care owing to my BMI (39.something) - this is my second baby and I had a much lower BMI then.

Although it was mentioned that this will entail more scans and additional appts with the consultant (like those with the midwife), and that this starts at 26 weeks, I don't have any further info - and can't find anything online for my trust. (I'm in Wales).

Can anyone enlighten me on what to expect with the consultant both during pregnancy and also during labour?

Likely you'll be given:

Growth scans (probably 3 or more)
Extra appointments
Glucose tolerance test
Monitoring during birth

Just remember though it's your baby/your body and they can only give you advice they can't make you do anything. You don't have to attend the appointments or have extra monitoring during birth

Also you need to be taking extra folic acid, which should have been prescribed to you

Nothing much changes. You'll have to see a consultant after each scan (with a midwife present too). You'll have a glucose test, I had 3.

Birth will probably be on the labour's ward rather than midwife led unit (although you can protest) with extra monitoring for baby (although you can refuse).

You'll have consultant appts as well as mw appts, apart from extra scans, a GTT and higher dose folic acid care will be routine but with added conversations about your increased risks all the way through. At 36/40 they will make a plan for delivery.

They'll advise you deliver in an obstetric unit with continuous fetal monitoring but the midwife care will be the same. Midwife will still deliver your baby unless you have an instrumental or section.

Any recommendation is an offer. You don't have to do anything they say. If you want to have a home birth for example and your only risk factor is BMI then go for it.

The evidence for pregnancy delivery complications due to bmi is sketchy so I recommend you do your own in depth research and ask lots of questions. Don't allow yourself to be coerced into intervention after intervention for reasons that aren't based on evidence.

It may also be worth exploring their criteria for referral to an anaesthetist clinic. While lots of women with obesity do have normal pregnancies and deliveries, anaesthesia in an emergency can be more difficult (depending a bit on the distribution weight) and it's worth giving them the opportunity to make a plan with you for how to deal with those scenarios if they arise. Different places with have different thresholds for clinic appointments (locally having a BMI in the 30s alone probably wouldn't get you a clinic appointment, but if there were any other medical issues on top them it would). HTH.