Midwife appointments - weight and BP - advice/reassurance needed please

[AxisofEvil]

I'm pregnant with twins and have my booking in appointment on Monday. Its my first pregnancy and I have a couple of things I'm worried about. They're pretty minor on the scale of things but they're worrying me so any advice/reassurance would be lovely.

1. Weight. I'm quite overweight and I know this. I'd lost weight whilst TTC but I'm still technically obese (although am not that big as I'm pretty muscular). I can understand the midwife wanting to know what I weigh and I don't have (too much of) an issue with telling her from weighing myself before I go but I have quite bad ishoos from childhood about being made to go on scales in front of other people. Is this something she is likely to try and insist I do? Now clearly she can't physically force me onto the scales but I've had people be difficult/rude with this before (nurse when registering at doctors). As well as the humiliation of trying to deal with this at the time (its v hard to talk about without getting upset, even writing this is hard) I'm worried that my eating issues will get worse and I'll end up binging and/or controlling my food in an unhealthy way. BTW I've managed to keep my food issues off my medical records and I have zero desire for that to change.

1. BP. My blood pressure is fine when at home but I've had an issue of "white coat-itis" for years ie my blood pressure goes up quite a bit when measured by medical professionals. I now own two blood pressure monitors - the second bought in case the 1st was giving unduly low readings! My GP has been fine with this - was high when he saw me, I measured at home at his request, he was happy with the results. But is the midwife likely to take the same approach? To be clear I'm certainly not going to want to ignore issues with high BP and if it goes up I'll certainly be making sure they know it but I want to avoid my treatment being dictated by the raised readings. Needless to say the concerns about no 1 aren't exactly going to help me feel relaxed at the appointment!

COngratulations on your pregnancy. She'll probably want to weigh you, or at least know your weight, at booking to work out your BMI, but IME (two pregnancies) nobody ever wanted to know my weight after that...
I would hope she'd be sympathetic to the white coat hypertension, and should be happy to take the same line as GP re home monitoring - all you can do is talk to her about it.
Hope the appointment goes well.

The weighing thing seems to vary from place to place. I'm overweight and wasn't weighed during my booking in. She asked if I knew my weight and/or BMI which I did so they might be happy with that.

BP should be fine if you explain what you've said here. If they have any concerns about your BP then they could always send you home with a 24 monitor which would give truer readings. I think the key thing is to be upfront about it and tell them that you are more than willing to be guided and monitored in these things but that you need to do them in your own way.

It's a small, practical thing, but make sure they use the big blood pressure cuff - the normal one just goes around my arm, but gives pretty dramatically different results than when they use the properly sized large cuff.

Insist on it - you don't want to be labelled as high blood pressure when it's just that they don't know how to properly use their equipment.

I've seen 4 different midwives (and one student) and it was 50/50 whether they thought of using the big cuff without me asking.

Hi

1. From what I remember they weigh you at booking in but dont keep weighing you at subsequent appointments. (Like they used to) So it is only the one weigh in now. Much better than it used to be so please be rassured you won't be under constant scrutiny. She might be happy with the weight you tell her. Its worth a try. There are lots of nice understanding midwives out there x

Congrats on twins!!

I've never been obese but I do have PCOS and the consultant told me losing 10% of my body weight could have a big effect on regulating my period/helping me manage my symptoms etc. Between that and getting married last year, I went from 12st 4lb to 10st 7lb which I was delighted with. After the honeymoon, I did put some of it back on and I had intended to start back to weight watchers in january this year, but by then I was 6 weeks pregnant and had to say goodbye to the prospect of being slim in 2010 ;)

I have been weighed at all my appointments and they always do it with your shoes on . Just tell the midwife you'd rather not know what the scales say, they'll let you know if they think there is something to be particularly concerned about - like if you put on or lose a huge amount between two appointments.

Good luck with it all!!

I agree that talking to your midwife about your worries is the way forward. They deal with ladies with all sorts of issues all the time e.g. needle phobias etc so I am sure this will be nothing new. If they understand how much it troubles you then I'm sure they will want to find a solution that works for both of you especially if you make it clear you aren't trying to avoid telling her negative/high etc results.

Congratulations on your pregnancy and good luck with the appointments. xx

I agree that talking to your midwife about your worries is the way forward. They deal with ladies with all sorts of issues all the time e.g. needle phobias etc so I am sure this will be nothing new. If they understand how much it troubles you then I'm sure they will want to find a solution that works for both of you especially if you make it clear you aren't trying to avoid telling her negative/high etc results.

Congratulations on your pregnancy and good luck with the appointments. xx

Axis I am so with you on this one. I am also technically obese and have white coat syndrome (but am the healthiest member of my large family). The medical profession can be real buggers about this, it's their constant 'step on the scales please' then excruciating lecture afterwards that actually exacerbates the problem, IMO. I am not stupid, I know I am big, I also know how to lose weight.

In my 1st pg I was actually in Slovenia and was weighed for every check-up. I came to the UK for the last month and was not weighed once. I also had a BP monitor at home (I like the fact that you have 2!!) and I would take my BP twice a day every day and record it for the drs. I didn't bother with this in the UK, as the midwife came to my house, and that reduced my anxiety a lot.

Sorry for waffle, basically I want to say that you have the right to not be weighed/weigh yourself/ etc etc and it is NOT a major factor in pg and you can take control and charge of your care. In my experience the midwives were all very understanding and supportive and I never felt bad because of my weight.

I really hope that your pg goes well and you can enjoy it to the full.

Thanks ladies for being so kind, it helps a lot to know you don't all think I'm a loopster! I'm a tough nut on most issues but I'm still quite messed up about food/weight in some respects if I'm being honest.

debka - I totally agree with you. Its like "you're overweight and " when I'm quite aware of the situation, what health risks that poses and why it would be good to lose weight. In all other respects have a very healthy lifestyle but its like none of that counts for anything at all.

chunkypickle - hadn't thought about the larger cuff, thanks for that, will have to measure my arm!

LittleMissSnowShine - to be honest its not knowing my weight that is the issue, it is the being weighed by others. The though of the midwife wanting to weigh me at each appointment makes me feel sick if I'm frank, whether or not I can see the scales. I really hope they won't want to know on an ongoing basis.

There is also the complication of twins - specialist books I've read stress the importance of gaining weight particularly in 1st/2nd trimester to ensure they have a good birth weight (looks like they are ID so higher risk for early delivery etc anyway) but generic advice (with one extra line for multiples) seems to find this less important.

So, I think what I'll do is

• on weight, if asked to step on scales say I'm happy to share the figure but I'm not willing to be weighed in the surgery - and just deal with any fallout hopefully without welling up

• on BP say I'm happy for her to take it but warn in advance of whitecoatitis and if it is high show her readings from home.

How does that sound to you? I don't want to get off to a bad start with the midwife if I don't have to.

Axis please don't worry.....
IME most medical people are aware of the potential of white-coat-itis to raise blood pressure and will even ask if you're feeling anxious f they pick up a high reading.
I'm also v urg about being weighed. They did it once at booking in, tried to get me to have a gestational diabetes test (which I refused -- they'd actually calculated my BMI wrong :s).... but it hasn't been mentioned again and I think it only would if I was looking like I'd gained loads of weight.
At the start of this pregnancy I was pretty much needle phobic and petrified of getting my bits out in public(!).... an internal scan and being jabbed about seven times to get my blood cured me of both!

It sounds like a plan.

I got weighed at my booking in apt but I'm not stressed about my weight even though I'm very overweight - I gained the weight because of medical issues and drugs I was on and managed to lose over a stone before getting pregnant, so I haven't any guilt about the weight if that makes sense. I was a bit worried they were going to say my BMI was risky, but the midwife said that they only start to get concerned if your BMI is over 35. And even then it just means more check-ups and medical support in case of problems - it's still important to put on weight, though they might offer a dietician apt to check you're eating as healthy as pos.

Btw, your bp tends to drop when you get pregnant so it may not be as high as you might expect. Also, later on they're then looking for whether it rises compared to your booking in appointment. So it may not be an issue. I get white-coat syndrome too and mine was fine for once.

Hopefully you'll have an understanding MW, Axis. Most people seem to, although unfortunately my community MW could def do with a little tuning up in the tact dept

Just as long as you understand it's your body and you know the things that trigger stress and upset for you better than anyone else can, so be very clear about what you don't want to do and they can hardly force you into it.

Let us know how you get on!!

I closed my eyes when I stood on the scales and told them not to tell me. The midwife said it was fine because it was in kilograms which is foreign anyway and doesn't mean anything. She was quite lovely actually and didn't tell me off for being a bit of a lardarse.

Congratulations on your pregnancy. I was weighed at booking and found to have a BMI of 30, not a word was said about it I am quite tall and do not look 'obese' iykwim. Was weighed last week at 30 week check up as re-booking at different hospital due to move and have only put on 1.5 lbs, nothing was said about this either so no-one seems concerned either way. With regards BP it is only the top number which is affected by stress/white coat syndrome the diastolic does not change with environmental factors and is taken into account during pregnancy, usually a rise of + 20 from your usual reading would give cause for monitoring

Hello. from my experience, the only time they might want to weigh you is if you have screening for downs syndrome. Interpretation of the bloods they take is affected by weight and so they need to have an exact weight for you.
Good luck and congratulations

I got weighed at my booking appointment. Was expecting to get a lecture as I know I'm overweight. So when my BMI came out as 31, I was feeling brave and asked if it was a problem. MW just said 'I'm in no position to judge you' (she was a larger lady herself.)
Haven't been weighed since.

Good luck on Monday.

Thanks everyone.