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?

James - from your post, I now see a bit clearer why you were so hacked off. Perhaps we need the perspective of people with high/low BMI where it did affect their pregnancies and birth plans to fully understand. Surely consultants recommend GTTs based on past experience, but perhaps now, they may be offered theoretically, which is clearly not right.

Northern - perhaps you're right, perhaps we do go along with what we're told far too much in this country, I'd imagine partly because the services are free so we accept them without research or question.

I have 6 weeks to go, so not long thank god. Knackered from severe anemia, so feel like I'm dragging myself round really.

6 weeks - ooh exciting Hope you feel a bit better soon. You're absolutely right about the perspective - it's not the tests themselves (although with bad morning sickness like mine fasting for a GTT then swallowing a ton of glucose drink would only have had one result - copious vomiting and possible faint)it's what that test then leads to.

stressheaderic It's about the extra fuss for me.

I can see where you are coming from with your situation but what I weigh has never had an impact my health or my life. I have no issues in the way you mention for yourself.

I want all decisions relating to me care to be made on the basis of a medical judgement not, like Northern says, a knee jerk reaction because my BMI is over 30 so I must has a,b and c wrong with me.

Oh and good luck stressheaderic, not long to go

Definitely think there is too much bossing around from midwives and clinic staff. I have refused GTT in two pregnancies and had to argue it out quite forcefully that I could not see the need. My crime? Ticking the PCOS box... That my bmi is too low and there is no history of diabetes in my family or first pregnancy did not count in the slightest.

Mrsseed- as I said before I don?t see the point of going when I am aware of increased risks and problems with my urine/bp or fundal height will be picked up at comm. Mw appts.

Dickytum- Because there is little the consultant can do that the midwife cant ie going to the appt is not going to ensure the health of me or the baby any more so than the care I receive from the comm mw

stressheaderic- this is not a weight issue. I weigh 14st9 and am 5ft2, so my bmi is 37.1, I know I am overweight, im not particulary happy about it but I had a stressful yr last yr and piled on over 2st, ideally I would of lost weight before becoming pregnant, but with PCOS I wasn?t expecting it to happen so quick.
On the other hand ive actually lost 9lb since beg of december so that is a step in the right direction(I don?t mean losing weight as such, just managing it/keeping it stable and trying not to put much on over the course of this pg)

Northernlurker-I agree wholeheartedly with your post and the baby is due in july

James I'm absolutely horrified to read about that way you're being treated. I'm afraid the temptation for me because I'm a head-in-the-sand kind of a gal would be to do it at home on my own. James - the medical profession are possibly just wondering how it's possible you're pregnant! Very un-mumsnet hugs for you though. x

My BMI puts me at overweight - don't even get me started on how angry this makes me given that I've been "triathlon-fit" and with a resting pulse of 52 at that weight!

Anyway, I was asked for my weight at my initial consultation - although I was NOT weighed. My weight will not be mentioned again and I am having a homebirth with a midwife.

I suppose the one "advantage" of being "overweight" is that I am extremely aware of what I put in my gob and so far have only put on a pound (12+5).

I didn't mean to offend, everyone had the right to choice. I'm sensitive about my weight I'm 5ft8 and normally a size 12 though does go up to 14 and my BMI does fall in overweght 27. I've put on less weight than last time (3 and a half stone last time, 2 and a half this time) and at 40+5 feel like a tank. My MW has asked me quite a bit about my weight as my dd was 9lb6 and this one also looks quite big.

I' m not sure if anyone wants to hear the medical perspective?

First and foremost james, you should NEVER be treated rudely. Your views should NOT be dismissed.The days of paternalism in medicine should be over.

However, northern you are wrong to state that there is no evidence of increased risk in higher BMI. One of the longest running audits in medicine was started in the UK and its aim is to prevent maternal deaths. Their triannual report highlighted that obese mothers are at higher risk of adverse events(CEMACH- Confidential Enquiry into Maternal and Child Health).

I do believe that health professionals are trying to identify high risk patiens. I hope that they are suggesting investigations to ensure the health of mother and baby.And as an autonomous individual you have the right to make informed decisions about these.

A lot of obstetricians&anaesthetists feel it is impossible to review all patients with BMI' s over 35 or even 40.Reality is there are too many of them.

I would still encourage you to go to appointments. Even if only to discuss.

What might an anaesthetist 'change' about you/your pregnancy when you see him/her? Posibly nothing. But equally you don' t know what issues they are looking for or trying to address.

I hope this helps.

Always happy to hear a medical view but I didn't think I did say exactly that did I? I certainly was not intending to give the impression that obese women have no higher risk - as a group clearly they do. I know I said 'What pisses me off is that consultants look at an obese woman and just expect normality not to continue based on no evidence whatsoever.' - what I meant was no evidence specific to that patient other than BMI - sorry, I can see how that could be read. What I understood at the time of my last pregnancy - 06/07 - was that there was no evidence to demonstrate that outcomes were improved by identifying women through GTT done on the basis of BMI alone. Yes obesity increases some risks - as does being underweight, too old, too young etc etc. I think what patients such as myself object to is that one factor being used by some professionals to determine a whole pathway of care. I am encouraged to read that many are not now routinely reviewing high BMI women. I would certainly prefer my consultant to spend his time reviewing women whose specific risks are higher than women such as myself who are progressing entirely normally.

It's so reassuring to read the above. My bmi is probably around 35-40, and I'm 34 wks. Saw consultant yesterday who told me that I have gained 2 1/2 stone and cannot gain an ounce more otherwise I'm pitting baby at risk- then she went on to tell me she gained 3 stone in her pregnancy! Wtf?! Cried for hours and hours as she made me feel so guilty- she even advised me to diet in last 6 wks!

Add that to the fact a midwife told me I'd probably test positive for gestational diabetes when I had my GTT, and if I did it would be my fault- incidentally I don't have GD- and I'm frankly disgusted with the level of care I've received. Considering lodging an official complaint against both ladies- is that any way to talk to a woman in first time pregnancy?! Grr.

I have been under consultant led care for all my pregnancies. DS1 because I have asthma, DS2 the same and previous PND and DS3 because of asthma, previous PND and high BMI.

With DS1 and DS2 the consultant was fine with me having a homebirth (with DS1 I did, with DS2 I transferred to the labour ward because of PROM and meconium). With DS3 they weren't keen on me having a homebirth. I was tempted to have one anyway but I knew they would nag me to go in every 5 mins and I thought that would be worse than having a natural birth in hospital. I co-operated with everything they asked me apart from the GTT. I said they could do a random blood glucose test but I had hyperemesis which was just about under control if I ate little and often. There was no way I was going to fast. I had the most uncomplicated birth I'd ever had, 2h 15m and just gas and air, no stitches. I was meant to be induced due to PROM but he came while I was waiting.

This time I want to give birth in the MLU next to the hospital but I have a high BMI again (unplanned baby, would have waited until I'd lost weight to ttc otherwise) and I can't see myself being allowed tbh.

I'm finding people saying they won't be "allowed" the care of their choice really depressing. Health professionals are skilled advisors, not authority figures.
The choices are ultimately the mother's.
To answer the op, yes, I've declined consultant care with a raised bmi. Based on having a similar one in my previous pregnancy before it was considered a risk and having been fine. I may reconsider if midwife-led care detects problems. I did have pre-eclampsia with my first so I am being vigilant and doing a lot of self monitoring, too.
I expect I may need to be assertive later on.

I don't understand this thread. Would people be so dismissive of extra tests offered because of other issues, say under active thyroid? We are fortunate to have a medical profession that seeks to monitor cases where there MIGHT be a problem, rather than fire fighting only if there is. A very high (or very low) BMI is a health concern, not just during pregnancy. It does give rise to potential issues for both the mother and the baby. It may not politically correct to tell mothers this, but we should be grateful that there are procedures in place to look after us all, and try to give us all the safest pregnancy and birth possible.

It is an individual's choice to refuse the extra care offered I guess, but I hope that those who do, don't then decide to sue if there is a problem that isn't dealt with. Remember not every woman who goes into hospital in labour goes home with a baby. That includes text book healthy mothers.

I don't have a high BMI, but I am over 40. Despite 0 health problems and one dodgy but inconclusive blood test which shows that I might potentially have some blood clotting issues, I've been labelled as 'high risk' and am currently trying to insist that I don't want to be induced on my due date or have an elective cesarean, and that I don't want a highly medicalised birth. It seems that being over 40 is the same as the high BMI issues - an instant passport to medical intervention without considering the individual.

I am not pregnant but I am fed up of the lazy short-hand of looking at high BMI correlation with other risks. I have a BMI of around 27 but I run and cycle every day and have a low resting heart rate, low chloresterol, normal blood sugar and low blood pressure. I am not saying I am not fat, I do have a layer of subcutaneous fat all over and a 'stocky' build, of course I'd rather be leaner. But that does not mean I am not fit.

I KNOW that STATISTICALLY people with high BMI are more likely to be unfit and have health issues to do with blood pressure, blood sugar and arterial plaques BUT that does not mean that I do.

I think what people seem to be forgetting here is that its the NHS we're talking about, and that they HAVE to go with the general population evidence, because they can't afford to look into each case specifically. This it just how the NHS goes I'm afraid and if you want a care system to treat you as an individual, you have to pay for it.

Make your own choices, your pregnancy your choice. That being said I don't understand why you would not take all the care offered. The evidence of increased risk due to high BME is factual and to ignore it because you don't think it applies to you is crazy. Sorry if that sounds harsh but mws, docs and medical staff are just doing their jobs (ps I am none of them)

I agree - why turn down something that could be of benefit?

And I also don't understand how people can say they have an obese BMI and are still healthy. That to me is impossible - by definition if you are that overweight then you are not healthy and need to do something about it.

If I told you all I had a BMI of 15 but was perfectly healthy and not worried about my baby's health, I'd get roundly attacked, and rightly so. So how is it different the other way around...?

BMI is a load of pap anyway

I got refered at BMI 32, went to the appointment which in our hospital is cubicles that the consultant goes to rather than you going into a room to see him

he walked into my cubicle, walked out again, spoke to the midwife and said 'is that miss sausage?' it was confirmed I was, he came back in again and said 'I have no idea why you are here, bloody BMI charts, did they not look at the person?' and then he left

I'm 6ft tall, broad and muscular, and was playing rugby 3 times a week until I found out I was expecting

If you have a raised BMI you're at increased risk of complications. Why wouldn't you want to understand some of the problems that you might face and make informed choices?

Why do some overweight people get so defensive? I've been 3 stone overweight myself in the past - I did something about it. That doesn't make me 'lucky' that I had the willpower or whatever, I made long term changes to my lifestyle - it wasn't easy but I did it and I've kept it up.

If you're overweight it's your choice. You can lose weight if you really want to - most people don't - it's too easy to buy that convenience food, have that doughnut with your coffee or go out for another meal with friends.

Agree that BMI can be rubbish - but most BMI charts do make ref to people who are of 'athletic build'. I'm in a GB team and most of the men would have an 'obese' BMI because they have top-heavy muscular torsos

I should have been classed as high risk in my 1st pregnancy, i have a family history of pre eclampsia. I slipped through the net (I didnt know i should have been high risk at the time), developed severe, early onset pre eclampsia at 22 weeks and my baby was born sleeping at 24 weeks. In my opinion everyone should be classed as high risk unless proven otherwise, I would have every test under the sun if it could prevent the pain and suffering i went through. I wouldnt care what the trigger for extra monitoring is, i would take it if it was offered. As it happens, i was heavier in my last pregnancy (BMI normal in 1st) and I had a beautiful, healthy baby. I know a high BMI doesnt mean you wont have a healthy pregnancy but I do think that the monitoring of mums in pregnancy in this country should be a whole lot better. I do understand that people do not like hospitals etc, after my experience I cry everytime i go there but i will do anything for my babies so i just go and get on with it

Thats quite funny sausagesandwich (apart from the obvious waste of your time)
I'm worried the same may happen to me and I really hope that the medical folks I come across are able to look at the whole picture. I am 5'7 and wear a size 12. Many years ago when I used to care I would weight myself and check BMI and I would always be either overweight or obese and once even grossly obese, until someone pointed out that I am muscular and sturdy rather than fat.
I do want to take on board medical advice in this pregnancy but I will be paying alot of attention to what is being said and offered. If I feel that medical interventions are being suggested because of a 'set of rules' rather than considering me as an individual then I think this thread has woken me up to the fact that I can question what is being suggested.