Anyone refused to see consultant over BMI ?

[GlastonburyGoddess]

Just wondering. MW said I will probably get a letter asking to go and see him and be under his care because of my raised BMI. I have had two normal pg and births and want a water homebirth this time. I am completely aware of risks more so than most people and will have a hb if I think its safe to do so and providing there are no complications during this pg. I do not see the point of going to the appt when hes going to tell me Im high risk, cant have hb, must be cons led care etc etc

so has anyone else declined a discussion with their consultant? and what happened next?

ok. That seems simple enough to do. Did you have a HWB in the end?

my bmi is 36 and i haven't seen a consultant. i told my mw of my wish to have a homebirth at my first appointment when i was about 8 weeks and luckily she has been v supportive (my bmi was similar for my 1st pg and that was complication free). i was supposed to see a consultant after my 20 wk scan but just didn't go as my mw had already told me she wasn't going to refer me (i was referred by the lady who did my 12 week scan....she didn't even tell me she was referring me).

I haven't heard anything else from the hospital re missing the appointment or demanding to see me, so I have decided they can't want to see me that badly! I'm 33 wks now.

To be honest I just couldn't see the point in going........I don't see the point in having to sit there and be told i am at increased risk of this that and the other. If I do develop any problems then they should be picked up at my mw appointments anyway.

Yep, I did. My BMI is 39 and I am in excellent health and planning a HB. My midwife was fine with it, I am however quite happy to have all of the GTTs and stuff. I have done this before with no problems whatsoever and am having the same sort of pregnancy.

I have a raised BMI and went to see the consultant. I didnt get any lectures,and didnt have any problems. There was no suggestion of not being able to have a home birth ( I didnt as a reassuring atmosphere to me is having all the medical kit around me!).
I got to hear the heart beat etc more often and things like protein and blood pressure more often which to me was a good thing. But there were definatley no lectures about my increased risk and losing weight etc. So cant really get my head around why you dont want to go.

mrsseed - good to hear that you had a positive experience and more appointments etc. I was told that even if i was consultant led i would still have appointments at the same intervals as i would see the midwife (i.e no extra appointments unless i developed a complication) so that was my main reason - the midwife should be able to pick up on wee or bp problems just as well as the consultant IMO. Plus I see the mw at my drs surgery up the road and the hospital is further away and has a habit of overbooking every appointment (not good for the bp!!)

gosh, 7DW, that's a strong letter!

"any attempt to persuade/co-erce either me or my partner ( Mr 7DW) into accepting such testing will be seen as harassment, and further action will be taken."

out of interest, what was your objection to the "further invasive medical procedures"? IMO it seems that you have turned down the opportunity for thorough healthcare for yourself and your baby!

still i hope that the pregnancy proceeds smoothly with no problems and that if god forbid problems were to arise you would not seek to lay the blame at the health care providers! (i can't help but wonder how you would respond if, in the event of problems they wrote to you stating ""any attempt to persuade/co-erce healthcare provider into accepting responsibility will be seen as harassment, and further action will be taken."

Just a thought!!

/\ just re-read and noted that the pregnancy did proceed well!! Glad to hear it and congrats- still my query remains!!

can't see why you would refuse something that was put in place to help ensure your health and the health of your baby tbh

I went to see the consultant because of dd2's heart defect. Whilst we were there he mentioned wanting a GTT because of my BMI. I declined that in pregnancy with dd2 and did so again. The consultant discussed that with us and was unable to offer any evidence that having the test would improve the outcome. On the contrary the midwife we saw on the same day said she agreed that just having the test could have an adverse effect on the pregnancy because she felt in our hospital it did place the patient on a more medicalised pathway. The consultant's concerns in my case centred around the probable size of the baby - something which is very hard to predict and control in any case. When dd3 was born she weighed a pound less than her sisters NOT the 10lber he had wittered about.

Personally I would go to one appointment just so you can be very clear what you want if normality persists. What pisses me off is that consultants look at an obese woman and just expect normality not to continue based on no evidence whatsoever. Yes, of course, if the universal tests show signs for concern then further investigation is needed but what I was not prepared to accept was increased testing based on broad sweep evidence not me, the patient, when everything about ME contradicted the need for that testing - iyswim?

i agree Dickytum especially with a first pregnancy!

better to be safe than sorry and regardless as to how small the risk i would do anything to try and negate that risk.

I see 7DW letter as rather rude. A healthcare provider tries to do a thorough job and is threatened with "further action" for their troubles!! (as a solicitor i question what "further action" she would be successful in perusing??! i can just imagine the letter now;

"how dare you offer/advise this lady in her first time pregnancy that she may benefit from further testing for her sake and that of the unborn child. Preposterous!")

we should thank our lucky stars that carers will seek to go above and beyond- no doubt countless lives have been saved as a result of such an approach!

I think we should all just have our children in Sub Saharan Africa. Just the way nature intended with no bothersome doctors or mw around who (god forbid!) might insist on helping us.

I think you can refuse it but I dont really see the problem with going. I have had consultant appointment regularly throughout my three pregnancies and will do through this one and have had nothing but good experiences. the tests are there because risk ARE higher if your have a higher BMI (and I have a BMI of 32 so I know what its like!) .Also I have found that the consultants have been far more interested in my personal choices than the midwives including wanting no painkillers etc which the midwife insisted I would need since I was being induced (for preeclampsia).

I was so glad I just missed the threshold here. I was expecting that they would make a lot of fuss about my weight (am an 18/20 pre pregnancy) but I didn't even have to do the glucose test. My SIL is bigger than me and had to do it so I assume I just came a fraction under the weight ratio (goodness knows how)

With a perfect health record, low blood pressure, a reasonable level of fitness and a resting heart beat of around, no history of obstetric problems in my family and no medical indicators of risk I would have been really unhappy to have been forced into consultant care only because of my weight - and plenty of large women give birth perfectly naturally.

Since I got pregnant I have actually lost weight, blood pressure has remained the same and I have had a textbook pregnancy. I think it is outrageous that some trusts refuse to allow women with raised BMI to give birth MLUs or to use birth pools when there is actually little evidence to show that you are at a greater risk giving birth as a large mum with an otherwise "normal" pregnancy.

sorry, meant to say resting heart rate of around 76

I don't understand why anyone would not want as much help/advice/support for their baby. There are risks with an incrased BMI and whether it is your choice to be that weight/through illness/life choices/not bothered and happy with your size or whatever the reason you are at a higher risk you must surely see that? I grab every appointment to check the health of my baby and myself that I can!!

It's not about not wanting help and support. It's about declining intervention that you feel is unnecessary. Every woman has the right to do that.
Having a high BMI doesn't mean you wave a white flag and give the medical profession the right to make every choice for you. The risks quoted in pregnancy don't tell you what will happen to YOU. They tell you what would happen to say 10 out of 100 women who are like you in one or more ways. That's not the same at all as saying 'you have x symptom which makes y more likely so can we do z' I've never seen anybody on here actually outright refusing something in those circumstances.

Had my dating scan and blood tests today and actually declined to be weighed! I know my BMI (32) and consultant led care doesn't kick in until a BMI of 35 here but I don't want any risk of an arbitary measure that I don't agree with being the basis of decisions in my care.

I am willing to undergo any tests or investigations that are needed on medical grounds (including GTT if urine test comes back showing a need) but not on the basis of my BMI alone. All other aspects of my pregnancy are low risk - no health or lifestyle complications, good blood pressure, still active and following slimming world to manage any weight gain.

I know I have a high BMI and do understand the potential risks and will always listen to my midwife is those risks do come to fruition.

However I maintain that I am very big build, quite muscular and don't carry a lot of abdominal fat (been having trans-abdominal scans since 7 weeks and seen bean and heartbeat clearly everytime)

Have got to say though 7DW - that is a very strong letter and don't think I'd ever go that far.

Yes but Northern, you actually went to the consultant and discussed the options didn't you (which seems eminently sensible to me). Just as you would have done if you had high BP or severe asthma or something else where they might need to keep an eye on you. Always better to go and then discuss the options I would have thought. At least you have all the information then and they can hear how you feel!

I may be confused here, and if I may ask a very forthright question - is this a weight issue, or a not wanting extra fuss/intervention for the sake of it issue? JamieJay stating that she refused to be weighed made me think there was something behind this thread.

I am underweight (BMI 17.5), having previously had an eating disorder. This has caused a few complications in my pregnancy, and although I have tried to do everything I possibly can to maintain my returned good health, I am still deficient in certain groups.

I am embarrassed that I had an eating disorder, and that people know about it and refer to it...however I have accepted any extra help, advice and care so that I can try to give my baby the best start. I am not clear why someone might decline extra tests to show up any issues - I understand that invasive procedures might be turned down, but optional routine tests?

Forgive my ignorance as a first-timer, I probably need to look into this a lot more to understand.

In all honesty I would have been tempted to refuse had it just been to discuss BMI but it was also to discuss the chance of a heart defect in dd3 after dd2 was found to have one. p[;;;;;;;;;;uvb============ ==============================l==p;===================

sorry - cat on keyboard!

My bmi is 50+ so you can imagine how much choice I appear to have in my maternity care.

My first pregnancy and birth were utterly normal and problem free but I still had to have two growth scans, a GTT and they made me see an anesthetist who pretty much told me I was probably going to need a c section. In the end I didn't, I had no interventions. They also kept telling me he was going to be very large but in the end he was 7lb 2oz.

I'm 22 weeks pregnant with dc2, I'm still perfectly healthy and baby's growth is right on the 50th percentile, as ds's was throughout. And it's all starting again - growth scans planned, GTT planned, anesthetist planned, I've already seen the consultant who was rude and dismissive, and I know there's utterly no chance of a homebirth or a waterbirth, never mind going to the lovely midwife led unit 5 mins from my house. Instead I'll have to go to the hospital 30 mins away and be forced to labour the way they want me to (on my back strapped to half a dozen machines again) to their fucking schedule.

So yeah I can understand why you'd want to refuse all extra tests and poking and predictions of doom and disaster, especially if it's not your first and the first went ok. It just feels like they're more concerned with shoving you into a category than treating you as an individual these days.

stress - that's just it - tests such as GTT aren't regarded in many hospitals as 'optional routine tests'. They're what they wheel out because your BMI means they expect problems. When they have nothing to go on apart from your BMI in expecting said problems, patients such as myself reserve the right to say we're not convinced by that reasoning. Like you say it is optional. Disappointing therefore that so many seem to frown on that option being exercised At the hospital I attended the consultants very obviously expected every woman to toe the line and have a GTT. I didn't accept any test that I didn't see the reasoning for and this was no exception. They same applies to you and to any pregnant woman. It's not about not wanting the best care for your baby. It's about not being a tick box patient. We should be fully informed and fully consenting to all procedures, having them because we understand the benefits to US. Birth is medicalised to some degree in this country and I chose to be selective to what degree I participated in that.

You are absolutely right to be trying everything you can to maximise your health, as an overweight mother I did that too. I just don't think accepting extra tests is a necessary part of that. All the best with the baby - when are you due?

Crossposted James - sorry you're having such a rotten time . I think you're probably right and there's bugger all chance of the MLU but they can't make you accept the monitoring and consequent lack of movement. Could you ask the consultant to explain why the constant monitoring is required. Say you want intermittent monitoring as delivered as standard to all other women so you can be mobile and see what response you get. I would do this in letter form copied to the head of midwifery too tbh. Now you've laboured once and as they will know the baby is of average size what risks do they hope to pick up from CM that IM wouldn't detect?