Consultant Led Care because of high BMI

[cinnamongreyhound]

I am 10 weeks pregnant with my second baby and have had my booking appointment with my midwife today. She has told me that I need to have consultant led care as my BMI is 35. She explianed everything about the extra appointments I will have and the glucose tolerance test but nothing about the actual labour.
I obviously had a lover BMI last time but was only a few Kg's lighter. My son was back to back and I had to be induced. Eventually had drip and epiduralbut delivered him with no assistance.
I desperately wanted no intervention with my son and was gutted when I had to be induced. I hate all of the monitoring and spent a lot of time laying down which I really didn't want to.
I was hoping with this pregnancy to have a much more natural delivery and if possible in water.
Does having consultant led care mean that I will have a very medical delivery? I want to go to hospital as I believe it is the safest place to have my baby but I would still like it to be as natural as possible. I have read one places that you cannot have water birth if you have a high BMI.
I will ask all of these questions at my next appointment but would really like some answers now to put my mind at rest.
Thank you x

No

tell consultant what you want

I think the reason they object to water birth if you have a high BMI is because they would be unable to get you out of the pool in an emergency. It may be worth querying the fact that you need to be consultant led - my BMI was 36.4 at time of booking and I have been midwife led all the way through.......I guess it just depends on the area you live in. Definitely doesn't mean that your birth will be mediacalised if you don't want it to be though.

Where I live they seem to refer to the consultant for every minor deviation from the "norm." However all the consultant seems to do is to see the patient, then refer back to midwives if happy with midwife-led care. I wouldn't worry about it: go and see consultant, discuss preferred mode of delivery and listen to any concerns that the consultant may have and go from there.

I had gestational diabetes and it was the policy of my hospital that all babies born to mothers with GD would be whipped away immediately to SCBU for monitoring, against the NICE guidelines. I discussed this with my consultant, midwives etc and told them that I wished my baby to stay with me unless there was a clinical need. They were all happy with this apart from a few rogue MWs so I got a letter from the Head of Midwifery for my notes to be on the safe side.

You need to know what you want, what the risks are, what the professionals say, and then have your plan. But be prepared to go with the flow too.

sigh

I'm afraid midwives and consultants can be a total PITA about high BMI pregnancies, so prepare yourself.

My BMI was 37 when preggers with DD, and I was booked in for a home water birth, so there's no reason why you cannot have a hospital home birth. I was sent for a telling off by the consultant for having the temerity to have a home birth with a high BMI. He actually wasn't that bothered as my pregnancy was absolutely normal by all other measurements, it was the midwives who had a bee in their bonnets about it. Basically said, "We advise that you have a hospital birth with a high BMI." I said "I understand, but I want a homebirth anyway." and that was that!

You don't have to have GTT, I think it's a bad idea to have one unless your bloods indicate you have a high glucose level. This is because it flags up on your notes and makes everyone very jumpy, and that will lessen your chances of as natural a birth as possible. I'm pretty sure it would prevent you from going to a midwife led unit, if previous threads are to be believed.

Were you induced because your son was back to back? Is that the only reason? Cos that's a BS reason.

marking thread for later, i have experience of this but no time to go into details

short version - bmi of 35 at booking in, got the birth i wanted (well not quite but nothing to do with bmi or hcp's reaction to bmi)

Firstly thank you for all your replies!

I was induced with my son because he was 12 overdue but was led to believe that he was overdue because he was back to back and never engaged. I had a sweep but nothing happened and I although I didn't want to be induced I was told that my placenta could fail at any time and he was going to be a huge baby, I felt I needed to trust what I was being told.

I really don't want to fight but I also don't want another labour basically tied to a bed. Was told several times I could be up and about whilst being monitored but as soon as I got up they lost his heart beat (which was a steady 130 through my whole labour so really no problems).

I don't want to put my baby at risk and I know it's a long way off but I feel already I have been pushed into a corner. I have always had low blood pressure and it wasn't a problem in my last pregnancy and I walk pushing single or double pushchairs for about an hour everyday so I am not unfit at all.

The midwife said I will be fine as it's all in my thighs! Which it is but you are still put into a little box of high risk :-(

Do you know what I have found works really well? Smile and nod and do all the things that you don't mind, so for me that was the GTT/seeing the consultant/agreeing to a hospital birth/growth scan etc. But then absolutely dig right in about the stuff that you do mind about. So, they will not be inducing me, I will NOT be on my back (monitor or not), I have no intention of going anywhere near the hospital until I feel I am close to pushing, etc.

My BMI is 39, this is my second baby, I had an easy pregnancy/labour for DS and am having a very similar pregnancy for this baby.

Have a think about the stuff that you really care about and do not budge (unless they clearly explain the medical need for it) then you can be flexible on the other stuff and they will still have you down as a nice easy type.

Consultant led doesn't have to mean induced. And induced doesn't have to mean lying flat on your back. When I was induced I was still able to have a warm bath in the early stages and encouraged to walk about as much as possible.

I know it doesn't have to mean being induced but I am worried it means more intervention generally. I was induced with my son and was monitored very regularly which did mean lying on my back as they couldn't read his heartbeat when I got up, I was able to walk inbetween monitoring but the contractions I had while I was being monitored were much harder to cope with.

"although I didn't want to be induced I was told that my placenta could fail at any time and he was going to be a huge baby, I felt I needed to trust what I was being told."

Had they checked the placenta? When you go really overdue you can have daily monitoring of the placenta instead of induction. That way they aren't just guessing that as you are overdue the placenta will probably fail, they're actually measuring whether or not induction is really necessary.

Was your son a huge baby?

I was scanned at 36 weeks and told I was expecting a whopper on the 99th centile, 4 weeks later DD was born (sponataneously, not induced) and weighed in on the 50th centile exactly. That's a 49% difference from estimation to reality in the space of 4 measly weeks.

Late measurements are notoriously unrealiable, and unfortunately I think most HCPs think big momma = big baby, it can bias their treatment, even their "measurements".

I would not recommend just giving in on anything, but that's me. I know some people prefer to take the easier route. My previous experience showed me that there's a lot of prejudice against bigger mums in the healthcare profession. But I refuse to let people push me about when it's my body and my baby, you know?

No they didn't check the placenta at all and after he was born, the midwife who was getting blood from it to check is blood type as I'm rhesus negative said it was in very good condition.
He was 8lb 12 so not massive, I think that because my husband and stepson had been big babies the midwife assumed this one would be. I was also told on many occasions that I didn't have a lot of water and it was all baby.
It's horrible to feel that you are being selfish and not thinking of your baby and that's really what persuaded me. I know more this time and will not just give in without more explaination but I also don't want people who are not happy with me delivering my baby!

cinnamongreyhound "It's horrible to feel that you are being selfish and not thinking of your baby..."

Fuck, that pisses me off.

I had a growth scan yesterday because my fundal height is measuring quite big. Baby is supposed to be around 9lbs 2 ounces if he continues on the curve to term. The ultrasound operator delivered this news like it was supposed to be terrifying. I just snorted and said that was fine. My last baby was 8lbs 5ounce so not that much difference IMO. I don't think she was very impressed with my reaction, apparently there was supposed to be wailing and gnashing of teeth and agreement to see a consultant?

I am not overweight this pregnancy and from the stories I hear on here I think, Thank God.

For my last pregnancy I weight almost 135kgs and it was much easier than this one.

it has been proven that people with raised bmi - whether 35 or 55 are at risk of all sorts of complications and adverse outcomes. For this reason your HCP's want to provide you with extra care and monitoring (by which I mean growth scans and gtt, extra mw appointments) so that if it does look like you're developing a problem something can be done about it promptly to ensure the best outcomes for you and baby. Bmi of 35 is not a reason for continuous monitoring in labour or induction per se however something may come up which means intervention is necessary. These things aren't done without reason or because people get spooked. if u don't understand whu they want to do something ask for an explanation, they shouldn't mind. Hth x

I had a similar birth where they broke my waters and I ended up getting all sorts of interventions and not having the birth I wanted (I wasn't overdue but they couldn't get a good monitor reading so put a scalp monitor on DS)

My BMI is currently 36 - I'm in the process of seeing what I can do despite being one point over their 'high risk' cutoff. I'm considering a home birth, but like you I just want to have a more relaxing, intervention free birth without all the drugs that made my first few days with DS so detached.

I'll let you know what happens with my midwives/ consultants but IME with the first, the extra appointments etc were nothing to do with the birth circumstances - I just took them cos it wasn't worth the argument otherwise!

Liz- I agree with this analysis of obesity + childbearing research

Also recommend this

and this

my bmi is about 31 and I have been told to to have the diabetes test etc. I am consultant led anyway because of previous preeclampsia. I have been induced the last twice but never had to have any other interventions and have been allowed to move around etc. You can move around while on the monitors you dont have to stay lying on your back.

Liz79 Women with a "normal" BMI are also at enormous risk of pregnancy-related complications. Your post is incredibly patronising.

Perhaps it should be re-worded to say something like "Pregnancy in women may cause complications."

sorry it's taken me so long to come back to this

my bmi was 35 at booking in

i was booked in for a gtt and an extra scan at 34 weeks

tbh i accepted these, i like scans and was happy to have extra, and i was unconcerned about the gtt and was happy to go through with it just to keep them quiet - although i understand and fully support anyone else's decision to refuse any antenatal tests

the only thing that upset me was that i was refused a waterbirth at booking in as my bmi was 35.2 and the cutoff point was 35 (arggh)

however

i said in my birth plan that i wanted to labour in water

the pool was free when i was on the labour ward so in i went

in the end though i had to have my waters broken and my labour augmented however i was on my feet all the way through and only lay down to push

i had a long labour but a quick second stage and my midwives were all utterly fabulous and completely unconcerned about my weight

a doctor that i saw at 34 weeks couldn't understand why i had been referred as the pregnancy was progressing so normally

OP, you are only 10 weeks now so probably won't have a bump. as your bump grows, as long as your mw can feel the position and approx size of the baby you have nothign to worry about. the doc i saw at 34 weeks said that they only scan obese women if they can't feel the position of the baby - so as long as you don't put too much extra weight on around your stomach/bump then all should be well

yes, there is a slightly increased risk of some complications during pregnancy if you are obese, however many people seem to think that you will definitely end up with problems if you are obese and that is utter bollocks

i have two children, a completely uncomplicated pregnancy and birth with dd1, slightly more difficult pregnancy and complicated birth with dd2 but the differences weren't down to my weight

congratulations and good luck

I have an "high" BMI. I'm just over 16 weeks and just in the last few days have I got a "babybump" - i.e., not gas! My blood pressure is low (130/65) and there is no expectation for it to rise. I'm a healthy person who is heavy - and not overly "fat".

cinnamongreyhound it sounds like your 1st labour was just like mine. Second time round, just like you my BMI was around 35. I did not have a GTT as at no point was there any glucose in my urine. My fundal height always measured big (apporx 5 weeks bigger) and I agreed to one extra scan and providing it was a big baby with no other complications I would have no further interventions. It was "just" a big baby who I delivered without intervention following a 2.5hour labour and a physiological 3rd stage. You can ask for what you want, you just need to have more confidence in doing so, there is no reason that you cannot have a healthy pregnancy and birth. A high BMI is a risk, just as a low BMI, smoking or high blood pressure is, it is not a definate. Good luck

skihorse, women with a raised BMI are at increased risk. Whilst pregnancy is a normal life event for just about every women, there are those who will suffer complications, even those who are initially low-risk and would appear unlikely to develop problems.Thats why we have antenatal care and every woman has her blood pressure, urine and fundal height etc monitored regularly. Women who have risk factors identified are monitored more closely, regardless of what those risk factors are

Liz79 I understand the concept of "increased risk" - you might also be interested to know of how much of an increased risk? No, doesn't surprise me.

Increased risk does NOT mean a blanket approach which is what you implied.

Thank you all so much for your responses you have put my mind at rest at least until I have my next appointment and can ask more questions .
I am a childminder and want to take as little time off as possible so was looking forward to an easier time with this one. You have given me hope Greenbeanie and Tigerfeet! It was suggested my son would be 10lb but was actually 8lb 12 so I really don't put a lot of faith in fundal height measurements to be honest.
The most annyoing thing is I am only 4Kg's more than at this stage in previous pregnancy, much fitter as I walk a lot more and my blood pressure has always been on the low side :-(

Sorry I do not have the exact figures at the forefront of my mind, presumably as cinnamons BMI is borderline, her risk will not be that much greater. The line has to be drawn somewhere for who gets extra care and that is where it has been drawn. To not offer extended care in the presence of a risk factor would be negligent.

I have decided not to attend mine, I also feel annoyed that I was not really offered, more told. Also at 10 weeks already told that I won't be allowed to have mine at home. I will not be going anyway near that hospital that's for sure, I feel like they are already trying to take over. I can see if I keep accepting what they say I will end up with my worst nightmare of a birthing plan.