More harassment for pregnant women with high BMI on the cards.

[dizietsma]

Article in the Guardian

"Obesity in pregnant women can lead to all sorts of problems, including the death of the mother, or the death of the baby through stillbirth or the baby having foetal abnormalities, or the woman suffering pre-eclampsia or gestational diabetes, or needing a Caesarean section because either she or the baby is too big," he added."

What total BS! Puts me in mind of this article citing two studies that pretty much confirm what my experience has taught me- the medical community is intensely prejudiced against the obese.

My whole pregnancy every medical professional seemed almost to be wishing me ill health for having the temerity to get pregnant whilst fat! It took so much work to prove to them that actually my pregnancy was perfectly healthy, the birth was perfectly normal, and my baby was average weight thank you very fucking much!

I think you're right - intense prejudice is pretty much the norm although thankfully not so much in the country I'm living in. My midwife didn't bat an eyelid at my wanting a home birth.

Funny though, I know someone with pre-eclampsia and she's very slim. My mother got gestational diabetes - she's 5'8" and was 10 stone full-term... the heiffer!

Perhaps you needed to explain to your doctor that your partner still wanted to fit you despite those size 10s not going over your knees...

So... you reckon that obesity is absolutely not a risk factor in negative pregnancy outcomes? And neither is obesity a risk factor in any negative health outcome?

The problem is that a lot of people (health care professionals as well as normal people) seem to think that risk=definite.

I am not overweight in this pregnancy but I was in my last and I am glad that was in Oz where everyone is much more relaxed about pregnancy and birth and don't view the whole thing as a massive medical emergency. Have been deeply amused by some of the stuff that is done here as routine.

This is quite an interesting part of the article:

"That includes evidence that 35% of women who die in childbirth are obese ? they had a BMI of at least 30. About 30% of pregnant women are overweight or obese."

So not that much of an increased risk then?

I would flatly refuse to be weighed at every appointment if it was suggested to me. I know my body, I know what it is up to and I know what it is capable of.

I'm not sure that regular weighing in pregnancy would help. I have issues with my weight, pre pregnancy I work hard to maintain my weight but during both pregnancies I have piled on the pounds, it isn't through extra eating, the only extra things I eat are yoghurt as I am aware that I have very little calcuim in my diet.

When I had my nuchal scan I was distressed to find out that I needed to be weighed, I knew that if I found out how much weight I had gained I would struggle to maintain a healthy diet and would want to go on a diet. Eventually I agreed to be weighed as long as the nurse didn't tell me what the weight was but when my nuchal results came through the letter had my weight on and I had put on 3kg which is a lot considering I was only 12 weeks pregnant and only 5.2.

I am eating healthily but I only have to look in the mirror to see that I have continued to put weight on, I do suffer from water retention in pregnancy and this may be part of the problem although my midwife told me to relax and not worry about it as my blood pressure is normal.

Before I got pregnant my BMI was in the normal range but I suspect it is now in the obese range, I really don't want to know. If I was lectured on my weight or forced to be weighed it would take a lot of willpower for me to continue eating normally. My weight gain is out of my control, what good would weighing me do?

I had a normal BMI when I got pregnant and only put on two stone and had a nearly 10 pound baby and am also sick of people constantly making this link between mother's weight and babies weight.

The risk of pre-eclampsia and GD is increased if you're overweight, but not by much. the inferrence seems to be that if you have a high BMi you're guaranteed to have problems and that simply isn't the case. My BMI has been around 35 for both my pregnancies and I have been completely complication free (am 32 weeks with 2nd DD). DD1 was a normal birth weight and I had an unassisted natural labour with just gas and air. This time round I'm having a home birth. I was weighed at my booking appointment but an issue was never made of my weight. I haven't been weighed since.

The Guardian article is very misleading - obesity does not cause the death of a mother or the still birth of a baby. pre-eclampsia can cause both but high blood pressure is certainly not a condition limited to the overweight. I have friends who had pre-eclampsia or GD in their pregnancies and they were classed as having a normal BMI.

Another typical example of media scaremongering and exaggeration IMO.

It is the dumbing down of women part that annoys me. If you are overweight you know you are at increased risk of some problems. So the current chat at booking in is sufficient I think. Women are not stupid, we don't need to be treated as such.

So, if 35% of mothers who die in childbirth are obese then 65% are not obese, non? Pr am I reading this statistic wrongly?

I for one never had a problem with any health professional over my weight, despite being rather oerweight particularly when I had DS1, when pregnant, but I fail to see how giving people a hard time will help. What are overweight women supposed to do, have a termination once they are pregnant? Or is this to tell women who are overweight that they need to lose weight. Well, thank you, I imagine 99% know that and have tried and will continue to try to do something about it.

I realise that my obesity (God, how awful to actually write that!) puts me at risk, however, I don't smoke, I don't drive fast, I have never taken drugs, and I don't binge drink on the streets of town. I've never had an STD. I have never been in a fight, and I manage minor illnesses in the home. I vaccinate my children, and always attend my smears. We eat all our fruit and vegetables, and oily fish. I go to the gym 3-4 times a week, and I am quite fit for a fat girl. This is NOT to berate anyone who does any of these things, just to point out that risk is relative, surely?

Surely, everyone's situation should be taken in their own context; I too know of many slim women who had pre-eclampsia; that doesn't mean that they ALL will. You might have a BMI of 24 and smoke like a chimney all through your pregnancy and indeed some of the early stages of labour like almost every mother on my ward when I had DS1 - who presents more risk there?

I know I am being defensive here but I am weary of this whole debate - yes obesity is awful, but there are very few people who choose to be that way, and most are trying hard a lot of the time to change that - negative press, rather than supportive press is so detrimental to the cause.

B.M.I is a rather compromised measurement it is true. .. this doesn't take away from the fact that obesity can cause complications in pregnancy. Just because a number of you are obese and have had no problems doesn't mean that this is true for the population as a whole. . . . although I would qualify this by adding that it is a high B.M.I at that start of a pregnancy that is most concerning to practitioners.

There are practical restrictions when supporting obese women; for example, excess stomach fat makes it harder to perform scans on obese women and feel the baby when palpating, so some anomolies or presentation difficuties with placenta and baby can be missed leading to later complications. This is not discrimination, but it is far, far easier to scan and palapte slim women accurately.

Also,some women are now too big for standard beds in delivery, post-natal and theatre which can lead to delays in assessment or treatment whilst a bed capable of supporting their weight is located.

Very obese women can be too big for arm cuffs when measuring BP and it is harder to taken blood as veins do not present easily under fat.

Statistics do not tell the complete story, and yes, overweight women can be healthier than 'normal weight' or underweight women. However, it would be more useful to break figures down to reasons for death in childbirth. E.g of the 30% of obese women who died, how many had underlying health conditions/ how many had obesity as
the only factor/ how many caused by malpractice. Out if the remaining 70% how many had underlying health conditions/ how many caused by malpractice etc

"That includes evidence that 35% of women who die in childbirth are obese ? they had a BMI of at least 30. About 30% of pregnant women are overweight or obese."

That is sloppy writing really. The risk is increased, for 35% of women who died were obese, wheareas 30% of pregnant women are overweight OR obese. A smaller overall percentage of pregnant women are obese.

So how would weighing someone at every appointment during pregnancy assist with any of those problems libertybelle? No-one here has said that there isn't any increased risk just that making a women feel shit about herself and worry that she is hurting her baby is not going to achieve anything.

with regard to the iuncreased bmi and pre eclampsia. I had sever pre eclampsia with ds1, i was under 10st when i became pregnant and only gained weight at the end of my pregnancy, ( although i have bigger bmi now than i did at full term with ds1) with ds2 i had a much higher bmi and still suffered with pre eclampsia but not to the extent that i did with ds1 (we have a joke that he tried to pop me off before he was even born!) the only problem with larger ladies i find is when we are trying to do their scans and it is near impossible to get decent images and this can result in not having the baby not beong checked properly. of course there is still links with bigger ladies and gestational diabetes but ladies with a history poly cystic ovaries are also likely to develop gestational diabetes to. its swings and roundabouts really.

Morloth - I don't agree with weighing at appointments. In fact within my PCT this isn't done by midwives (against trust guidelines though), although they do ask weight at the booking appointment. You do not have to consent to be weighed, if this makes you uncomfortable.

Presenting facts about obseity isn't trying to make pregnant women feel bad, but I don't understand what medical professionals are supposed to do with the information? Not publically disclose? Like tobacco companies in the 60s and 70s?

And we are not talking about women being a bit overweight or not conforming to a media generated fantasy. Article and concerns are about very fat women who are entering pregnancy at a massive disadvantage to themselves and their baby who face practical hurdles to getting the very best care because their weight makes routine checks far, far more difficult for midwives and sonographers.

It may be upsetting to be in that situation, and you may not wish to hear the views of medical professionals, but that's akin to someone who smokes 40 a day not wanting to hear the possible complications of nicotine addiction!