Tuesday, May 29, 2012

Plea for Help in the U.K.


This comment was left on a recent post on this blog.  It is a plea for help from a pregnant women in the U.K.

I am only going to address one aspect of her concerns, the one I find most disturbing; I hope others will step up and address some of the rest of her concerns.
Please please please, can someone help me. I am 10 weeks pregnant and currently have a BMI of 35.  
Firstly, I have suffered with severe sickness since 5 weeks and doctor said it was ok as I 'could do with losing some weight' and refused to give me medications, and now I have had my first midwife appointment today and was told that more than 50 percent of maternal deaths in pregnancy and childbirth are obese mothers and that I will have to have special monitoring and won't be allowed to have a natural birth at the birth centre and will have to be under consultant care and be constantly monitored throughout labour (meaning no water birth, no moving around, no getting into positive positions to birth).  
I am so scared and disappointed, I feel like I am an unfit mother already and feel that the drs think I do not care about the health of my unborn baby. Now I know that this will not go down well with some people but I am considering a termination so that I can lose more weight before carrying a child (I have currently lost 70 pounds). 
I came across this blog and I am aware that you are based in the US and I am in the UK so some things are different...for instance I can't actually choose a provider and am stuck with who I have :(...but please, any advice would be so appreciated. Both myself and my partner are concerned and do not know what to do. 
There are so many things to cover here, it's hard to know where to start.  Please comfort and reassure this woman that she CAN do this.  She needs to hear from many people, not just me.  Please leave some encouraging comments at the end of this post.*

In the meantime, here is my response.  First, dear Reader, please don't terminate this pregnancy over these scare tactics or your fears.  Chances are that everything will be okay.  Many MANY women with a BMI well over 35 have had healthy pregnancies and babies.  My BMI is 48, far over yours, and I had 4 healthy pregnancies and babies, and am none the worse for wear for it. I know so many women your size and far larger who have had healthy happy babies.  You can read some of their birth stories here and here.

No, no one can promise you with 100% certainty that you and this baby will be fine, but the odds are certainly in your favor, "obese" or not. Most obese women have healthy babies; some do have complications like GD or high blood pressure, but even then, most of the time, these conditions are able to be treated and everyone is still fine.  So don't panic over the scare tactics they are giving you.

To be fair, the doctors and midwives are trying to do what they think is their job, to apprise you of possible risks associated with "obesity" and pregnancy, but the problem is that they have gone so far overboard in stating these that they are frightening women unduly, making them think that almost no women of size have healthy pregnancies or babies, when in fact, most do.

In some cases, care providers lay on the scare tactics so strongly that they bully women into weight loss surgery, risky diets, over-intervention, and even terminating the pregnancy.  That is NOT good health care, that's medical bullying. And for God's sake, this poor woman has already lost 70 lbs., but despite the fact that she followed typical medical advice to lower her BMI before pregnancy, she is still being punished and scared half to death.  Where is the justice in that?

Yes, there are some risks associated with pregnancy in obese women, but NO, the answer is not in scaring women into terminating an established pregnancy until they reach a "normal" BMI.

Shame on these providers for laying the scare tactics on so strongly that someone would even consider terminating a pregnancy simply because of their weight.

Yes, among those rare women who have died during pregnancy or birth, obese women are overrepresented somewhat.  That does NOT mean that 50% of obese women who are pregnant die during pregnancy─that's a misunderstanding of what the care providers were trying to say. Death is an extremely rare occurrence for childbearing women in the developed world, and although very high BMI women are somewhat overrepresented in that group, the actual numerical risk of it happening to any one obese woman is quite low.

And the reason why fat women do die during pregnancy or birth boils down to three main causes, some of which is preventable:
  • Complications from general anesthesia during a cesarean
  • Complications from hypertensive disorders (high blood pressure and resulting disorders) in pregnancy
  • Blood clots (usually in conjunction with cesareans)
So to lower the risk for these problems, consider the following:
  • Don't let them push you into a cesarean you don't need. If a cesarean is required at some point, make sure they are prepared to use an epidural or spinal block instead of general anesthesia. Have an anesthesia consult ahead of time to be sure they have the equipment needed on hand if it were needed
  • Make sure you are monitoring your blood pressure carefully (you can get a home BP monitor if your readings are questionable at all), make sure they use the correct-sized BP cuff so that that readings are accurate, and get regular exercise and have great nutrition to lower your risk for developing gestational diabetes or blood pressure issues 
  • Regular exercise also lowers the risk for a blood clot during pregnancy; for certain people, low-dose aspirin therapy (only under the supervision of a care provider) is sometimes advised. If you have a cesarean, discuss with your provider the use (and proper dosage) of blood thinners, and be sure to move your legs around and walk as early as you can tolerate after the surgery. There are also special wraps and cuffs that can help reduce your chances of a blood clot after a cesarean; make sure to request these if you have a cesarean, and note any increase in shortness-of-breath to your providers
If this woman were in the U.S., I'd tell her to change care providers ASAP because it's difficult to overcome a really deep-set provider bias about obesity in just a few months, and it often influences the care a high-BMI mother receives.  However, I'm not sure what your options are for alternatives in the U.K.

There are, of course, private midwives that you could hire from outside the NHS system, and it seems to me like this would be well worth the money to do if you can manage it.  I bet we could find a private midwife who would take you on as a client and who would work with you to find a way to make it financially feasible.  I know there have been women of size who have had great out-of-hospital births in the U.K. with private midwives.

But if that's absolutely not an option, then you will have to work within the system, and the way to do that is to push back against the care providers who are giving you a hard time.  I'm hoping some of my U.K. readers will pop in and leave some suggestions about how to do that.

At the very least, one of the best things you can do is to find a Pregnancy Buddy, an advocate familiar with size-friendly care practices, who will come with you to appointments and help you speak up for quality care and question fat-phobic practices.  A doula who really "gets" weight stigma and has a Health At Every Size approach could be a great help for you in advocating for more size-friendly care.

Best wishes to you, and I sincerely hope you will not let your fears (and the scare tactics of the providers) keep you from enjoying this pregnancy and this baby.  Be as healthy as you can in your habits without obsessing over them, find a Pregnancy Buddy or Size-Friendly Doula to help you speak up for yourself, and don't be afraid to push back against the bias of your providers and even report them to their superiors if necessary.

Pregnancy is one of the best times to learn how to advocate for yourself, your baby, and your needs (whatever size you are), and you deserve to have loving, respectful care, regardless of your BMI or whether you lose enough weight to fit into their narrow definition of "normal".  Start demanding that care now, and don't settle for second-best.  You and your baby deserve no less.


*Please keep your comments civil and kind and aimed towards helping this woman's specific situation or about commenting on weight-biased scare tactics, rather than about pushing a particular point of view on abortion. This is not a forum for abortion debates, and I will be vetting comments before I publish them.  Please stay kind and helpful in your words.  Thank you.

24 comments:

Allyn said...

I, unfortunately, cannot comment too much on the specifics of the UK system, but I can offer some thoughts. My friend had her child in the UK nearly ten years ago and hated the NHS system in terms of maternity care, so she ended up using a private midwife. The midwife worked with her on a payment plan and my friend thought it was fabulous.

I am sorry you are having negative appointments, but I would also second the writer's suggestion to switch practices (while I know this has some hangups in the UK that we do not have in the US, I still think that there is some flexibility depending on the facilities in your area).

I will close and say a loud HOW LAME to scare tactics used by doctors, who are supposed to be helping people, not scaring them away.

I wish you the best of luck and certainly hope that you have a loving, happy pregnancy or that the outcome you choose is the best for you and your growing family.

pipsknits said...

I was considered "morbidly obese" when I became pregnant with my daughter. Maybe I was lucky, because my doctor never made a single comment on my weight, other than checking to make sure I was gaining, or at least not losing, as the baby grew. I didn't have any complications, and my doctor didn't recommend any special monitoring or treatment. (At least, not until my doctor went on vacation, and his substitute was all ignorant about my weight and wound up inducing me a month early... But that's beside the point.)

I have a healthy 8-year-old now, who has never had any major health issues, and I would do it all over again, no matter what size I was at.

Don't let the doctors scare you into making decisions you don't want to. Their 50% claim is a load of bull. You only need extra monitoring or special treatment if you actually show symptoms of issues. Being fat is NOT a health diagnosis, and does NOT make you an unfit mother. In fact, you being worried proves just the opposite - you're going to be a great mother, no matter your weight. :)

BettySue said...

I am about the same size as the questioner. I have had 9 healthy, strong babies ranging from 8lb to 10.8 lb, two breech! I had GD with #8, but with diet was able to prevent it with #9. Now, I wasn't this big with my first two, but I was still "overweight." This is the normal size for my body and Obviously it is possible to have healthy babies here.

Janie said...

Hugs mom - I don't even know exactly what my BMI is but I'd say 50? or even over. And I had a peaceful waterbirth at home.

Fight for the right to be treated right!!!

Moose said...

I have never had a pregnancy but I read your blog because of the weight-based issues it raises.

I am completely horrified at what this poor woman is going through. This is malpractice, sure and simple.

It is also a classic example of why doctors are generally not scientists.

The first scientific failure here is one of pool selection. Every time I hear (or hear of) a doctor saying, "In my practice I've seen (absurd conclusion here)" I want to bang my (or their) head against the wall.

I most often see it in medical blogs. Long story short, they see the trees but not the forest -- A classic example is the position that since every fat diabetic they see in their ER is out of control, that does not mean that all fat diabetics have no diabetes control. They fail to take into account socio-economic and related factors.

There are no real studies done on the patients of just one practice.

The 2nd scientific failure is statistical anomalies. Just because Dr FooBar see something different, and maybe your buddy Dr BingBazz does, too, does not mean anything. This, again, is why studies use a wide spectrum of people.

The 3rd scientific failure is the hard data failure -- When a Dr tells me "I find that XYZ", I ask to see hard evidence of this by real published papers. Sadly, just because it's published in a peer-reviewed journal doesn't make it drew a valid and concrete conclusion.

The biggest of these failures is the *data-mining* study, sometimes called meta-analysis. They examine one or more previously done studies for "new information." Famously, the Framingham Nurses Study has been data-mined to death to discover all sorts of conclusions, many of which have since been found to be fluff and nonsense.

Why? Because the original study wasn't looking for those conclusions, so it didn't take into account the possible variables for the other things the data-mining went looking for. These data-mining studies are useful for getting a leg up to get the funding to do real research, but they are not drawing hard conclusions.

Lastly, the simplest and saddest failure is one I learned in Grade 9 science: Correlation Is Not Causation. Made up example: "Of 1000 fat women who gave birth last month, 100 of them died. Therefore, being fat gives a 10% risk of dying."

Let's make it more clear: Of all of the people who died last week, at least 75% of them had at least one cup of coffee a day. Therefore coffee causes death.

That's not science, that's random guessing.

So I'm sure I'm lecturing to the teacher here, and I won't be surprised if you refuse to post this because of that or because I do run on :-).

But my point is this: Medical people pull statistics out of their butt every day with ZERO hard evidence to back it up. I personally find it helps to stand up to the medical bullies when you know that they're just making things up to try to scare you.

I had a doctor try to bully me into getting weight loss surgery because "it's safe now." I said, "there's no proof of that." She insisted there was. I said there wasn't. She pulled out a study I knew of, which looked at 3 yr survival rates. I told her to find me the 10 yr survival rates and to come back when they existed and were positive. (BTW, they still don't exist, any study about "long term" survival of WLS has a scant handful of patients who lived to 10 yrs, which they abuse to call it "long term". The vast majority of people in the study are 2-3 yrs post-surgery.)

kproufou said...

I don't think I have anything useful to add to the discussion, but this woman has my complete sympathy. I can certainly understand why she thinks she has few options.

I'm in the US and I don't really understand the UK health system all that well, so please pardon me if I don't have my facts right. Am I correct that you are unable to change doctors due to where you live? Aren't doctors assigned based on your location? If that's the case, is there anyway you can temporarily relocate somewhere else, to your parents or a friends? It is also my understanding that the health services in the UK is trying to cut it's spending during the financial crisis the the current scapegoat is fat people and as such they are getting excusably poor treatment at the hands of providers.

There is no reason in the world a doctor should treat you the way you've been treated.

I will keep you in my thoughts and that there are people (like me) who are on your side no matter what your decision.

Anonymous said...

My starting BMI was 40/41, and I am currently 29 weeks pregnant with healthy twins! I was also warned about possible risks (although not nearly so horribly as you), and have had perfectly normal blood pressure and glucose readings throughout my whole pregnancy. In fact, my doctor often describes my pregnancy as "textbook." If you want to have kids, PLEASE don't terminate! I only say this because I know first hand that fertility is NOT guaranteed. You are pregnant NOW and have every chance to deliver a happy, healthy baby! Good luck!

Nicole said...

You can do this!!! I have had two healthy, happy pregnancies resulting in two beautiful, healthy babies. And I was much fatter than you are (by BMI)! I had very mild gestational diabetes during the last four weeks of my first pregnancy, which was controlled with diet and exercise. I did not get GD with my second pregnancy. I had a vaginal birth both times; my firstborn was even breech and I managed a vaginal birth.

I know it is hard to stand up against this kind of ridiculous prejudice, but you can do it. You are worth it, and so is your baby.

Sending strength and good vibes all the way from Montana USA.

Team MJ said...

Oh I am so sad to hear that you are having such a horrible experience with your pregnancy because of doctors and health care staff! Shame on them! If your body wasn't healthy enough to carry a baby then you would have never gotten pregnant! You will be a wonderful mother and don't need to listen to what these doctors are saying. Keep your chin up you can do this! I am a bigger girl and just delivered a healthy baby girl. As long as you feel baby's movements often at the end of your pregnancy, stay away from smoking and alcohol and take your pre-natal vitamins you'll do great :) Good luck in your pregnancy!

penguinlady said...

My heart breaks, too. All I can add is solidarity - I was pregnant with twins at a BMI of 40. I had some minor complications (blood pressure), but everything turned out just fine in the end and they are perfect kiddos now. Hang in there, advocate for yourself and it will turn out okay.

JeninCanada said...

I have nothing to add, really, except a need to shout at my computer, echoing the FIGHT FOR YOUR RIGHTS and know your options comments. There is absolutely no reason you can't have the birth you want to have. You have my complete support, all the way from Canada.

Aimee said...

I don't have any advice about UK medical care, but wanted to lend my voice in support. I am a big woman! I was big when I was pregnant and everything was fine. I had no problems and delivered my daughter naturally. You *can* do it!

Kelley said...

I conceived my 2nd child with a BMI of 37. I've ever been told I was high risk. My 1st child was conceived with a tiny bit lower bmi (33) and my OB gave me the title Easiest Pregnant Woman Ever. Both pregnancies were great. I never had edema, my BP has always been good, no GD.

My 1st was an easy uncomplicated vaginal delivery and I'm hoping for a home birth for my 2nd soon.

I write this to say that your provider is seriously negligent. I have been cared for in my pregnancies by medical personnel from Australia, France, Thailand, Finland and the US. (long story!). None have EVER used that kind of scare mongering. It's plain wrong not to mention cruel. I know the NHS isn't easy but there has to be a way to get another care provider if the one you've seen is being grossly negligent. And yours are.

Lots of love from far away.

Tanz33 said...

I'm from New Zealand so we have a similar health system to the NHS.

First let me say that I have had two (naturally conceived) twin pregnancies with a BMI of 50. Yes, *50*. When I first got pregnant I was worried about what could happen (i'd heard the same scare tactics you've been told) so I asked my GP. His exact words were "you have a slightly greater chance of developing GD or high blood pressure but there is no reason why you shouldn't have a perfectly normal pregnancy". The midwife I had the first time around said the same thing; and all the OB's (bar one) have been of the same opinion (btw I saw specialists because I was carrying multiples, not because of my weight; if they had been single babies I would have had a midwife like everyone else, and would not have been considered 'high risk' because of my weight). Perhaps this might be something to state the next time someone gives you this weight-hate BS: that in NZ fat women are expected to carry and deliver normally *unless* problems develop. We have a midwife-led system and a pretty good one, I think. Also remind them that Pacific Island women tend to be very heavy (even heavier than me, often) and they birth fine too without high death rates and/or high risk of complications.

Good luck to you. It can be hard to fight them (negative medical people) but the odds are overwhelmingly on the side of everything going smoothly. Gentle exercise, eating enough (when/if you can, I sympathize about the morning sickness), resting when you need to and looking after yourself mentally will get you through. If I were you I would demand some medication for the morning sickness (I assume you've tried the more 'natural' therapies such as ginger) and some respect from those who are looking after you.

I hope it all goes well for you :) Best wishes from another fat mum!

Karla said...

I am 26 weeks pregnant with my first child. At 32 years old, I have a BMI of approximately 42. I started this pregnancy at 302lbs and currently weigh around 312lbs. When I weighed in at my first OB appointment I thought “This is my BEFORE weight?!”, but I didn’t let that detract from the excitement my husband I share at the prospect of being parents. My doctors seem to be more focused on helping me understand and manage the risks associated with my weight and pregnancy, rather than condemning my weight. They only offer comments when I ask and make a point not exacerbate my fears. I have struggled to manage my own worries and fears on the topic, but I’m finally beginning to accept that everything will most likely be just fine. I hope in time, she will find the same peace.
I too thought it might be better to wait until I lost some weight before starting a family. Yet, when I considered the likelihood of losing a significant amount of weight and the time it would take to do so, I decided to take my chances and get on with it. While I’m not old by any means, I didn’t want to risk getting too far into the ‘advanced maternal age’ category with future pregnancies as we plan to have more than one kiddo. Additionally, I felt that waiting would go against all the energy I’ve put into dealing with my internal weight demons. Long ago I decided that if I could not lose the weight, then it damn sure wouldn’t prevent me from enjoying life. I will sit on the beach in a bathing suit and enjoy the splendors of this Earth, I will wear fashionable clothes, I will have a successful career, I will enjoy sex and not be ashamed of my body, I will marry a wonderful man who loves me the way I am, I will be as healthy as I possibly can be at any weight. Get the picture? I do not let my weight determine l what I am capable of and I believe I will have a healthy baby. If I can, why would she be any different?
If I were in her shoes, I’d try to lead my health care providers towards an ‘understand and manage the risks’ philosophy. As an example, I have a history of borderline high blood pressure. Before trying to conceive I even took medication, not because my numbers were off the charts, but because my family history is such that both my family doctor and I felt that it was better to treat the disease sooner rather than later. Once my husband and I started trying for a baby, I stopped taking the medication (under my doctor’s supervision) and bought a home use blood pressure monitor. My numbers weren’t too bad without treatment and I continue to check my blood pressure regularly. I take my monitor with me to OB appointments so we can see if I’m trending too far upwards and decide a course of treatment before it gets out of hand. Note: wrist style monitors are particularly useful for fat chicks because cuff size is less relevant than in the upper arm styles.
Also, I advise she get educated on the reality of the risks for obese women during pregnancy. Being armed with good information is the first step in battling ignorance, even with so called health care professionals. Don’t be afraid to challenge them! This is your baby and body we are talking about not theirs. You have to be an advocate for your care. In addition to the support and information she can get online at blogs such as this one, I recommend a couple of books that I have found particularly helpful. They are: “Big, Beautiful and Pregnant” by Cornelia van der Zeil M.D. and Jacqueline Tourville and “Your Plus Sized Pregnancy: The Ultimate Guide for the Full-Figured Expectant Mom” by Brette McWhorter Sember and Dr. Bruce D. Rodgers. I seem to prefer the format and content of “Big, Beautiful and Pregnant” myself.
In closing, I’d like to add that a 70lbs weight loss is huge! She has already done a great deal to reduce risks associated with obesity and pregnancy. Bravo, may we all be so lucky to enjoy such success in the future. I’ve heard that breastfeeding does wonders to help shed excess pounds gained during pregnancy.

Bethany B said...

Dear mama,

Please don't be afraid. I have a BMI of 51 and I've had 7 beautiful babies. I've never had doctors treat me the way that you are describing. I'm so sorry, and I know its hard to face people who think they have authority over us. Please consider finding another doc. If you can't do that, then read, read, read and speak out against these issues to your doctor. You are not that big. You just aren't. I know many, many women who are your size and larger who have healthy, uneventful, and plesant pregnancies.

You can do this. :)

Sharon Muza, New Moon Birth said...

Dear mama! You need to find another doctor or midwife. I hope that is possible in the UK, but the fear tactics are not based on fact. Many, many women who are plus sized have healthy pregnancies, rocking labors and birth healthy babies with no problem. Deal with issues IF They come up! I believe in you! 100 percent! Find a supportive health care provider who believes in you and BELIEVE IN YOURSELF!

Tilly Cat & Pip-Squeak said...

Well, I AM in the UK, and although I don't know too much about how you could go about changing your doctor I can tell you that 7 years ago, with your exact same bmi, I gave birth to my first child at home, in the water. And THAT was at the suggestion of my nhs midwife. (I happen to live in an area that is very pro-homebirth -Torbay.) I then had another great waterbirth with my second child. This time around, with a BMI of 52 some noises were made, but in a very respectful manner -I was going to have a waterbirth at home again, but this time I *did* develop complications and my baby was induced at 37+5 weeks (Induction went well, by the way, I had her vaginally and avoided a c/section at least, and the medical reason for it was valid.)

The bottom line is this: In the UK, if you go to hospital, it's their rules. BUT you have the right to a homebirth, they can advise you strongly to avoid it but in the end it's your decision. And they HAVE to send someone to attend it.

That said, if you go that route you are risking getting an unsupportive midwife who will just make some excuse to transfer you to hospital. I agree that you should contact independent midwives to see if anyone can help you -I bet anything there will be some who will be so disgusted by your treatment they'll want to find a way to help. Alternatively, a homebirth with a doula can be an option -they are much cheaper than independent midwives.

Find the studies showing the actual risks to obese women -a ood one is the Weiss study: http://www.ncbi.nlm.nih.gov/pubmed/15118648

It is a large study of more than 16,000 women in multiple hospital centers, and it found that 9.5% of "morbidly obese" women experienced Gestational Diabetes during their study. The number certainly is higher than the 2.3% with a BMI less than 30(…) (9 out of 10 of morbidly obese women will NOT develop GD.) It also found only 6.3% of "morbidly obese" women developed pre-eclampsia....higher than the 2.1% of non-obese women.
These are the two more common complications during pregnancy for obese women, an as you can see they are not THAT common.

Get as many statistics as you can... You'll find your consultant will often not know the actual numbers (mine didn't.) Then write to the Supervisor of Midwives (her details will be on the front page of your pregnancy notes) and tell her about your research, tell her you understand the risks and are happy to take them, and you intend to have an active normal birth, unless an actual problem arises. Tell her you are prepared to stay home if that is the only way, but are willing to work with the hospital if they can offer you a satisfactory alternative (if that's what you want.) My friend got them to agree to let her use the pool with this approach and she was a grand multipara, pregnant with twins and had a history of post partum haemorrhage ;)

See this UK site for help and inspiration:
http://www.homebirth.org.uk/youcant.htm

Good luck, you can do it!

onesillyme said...

If the timing or other circumstance of this pregnancy is bad for you, abortion is absolutely your right and your decision. Please don't decide based on weight-based scare tactics, though.

My personal experience is not a scientific study, but perhaps the story will help. I had twins at age 27. Not sure what my BMI was (and I refuse to calculate it now because I think it's meaningless on an individual basis).

I got pregnant at about 210 lbs and was advised not to gain weight because of obesity. I improved my diet (more fruits/veggies, less packaged/junk food) and ended up not gaining until my 5th month. After that I gained about 40 lbs, a lot of which was fluid in addition to babies. (I'm told your blood volume DOUBLES!) I had pre-existing high blood pressure which was managed with different medications depending on stage of pregnancy. Two weeks before my due date I had a c-section (both babies breech, blood pressure no longer in control, and I was exhausted carrying them). All of these things could have happened regardless of weight, and did not happen my next pregnancy. Result was 2 healthy girls at 5lb 11oz and 6lb 7oz. They are now 23. I was back to pre-pregnancy weight within 2 weeks.

Between this pregnancy and the next I had 4th month miscarriage. It was very sad but had nothing to do with my weight and within a month I was pregnant again. (Timing not ideal, but that's how it worked out.)

When I was 33 I had my 3rd daughter. 250 lbs when became pregnant and absolutely no complications except that my cervix would not dialate (possibly due to a previous surgery) and I had another c-section. 9lbs 4 oz and she's graduating simultaneously from high school and community college in 2 weeks! We treated my existing medical problems as usual during pregnancy (hypertension and asthma) and I had zero signs of gestational diabetes, pre eclampsia, etc.).

Some obese moms have complications during pregnancy, just like some thin moms do. Most of them can be managed well. Sometimes there are bad outcomes, but that's true of anything in life. If you do take the leap of faith and this is a wanted baby, the experience will enrich you in ways you can't imagine.

Mama Mary said...

I am about the same BMI as your letter writer. I've had 3 healthy children, but only one natural birth. My first was an emergency c-section due to pre-eclampsia. Totally understand why that surgery was needed. Second baby was also delivered c-section...not out of necessity, but out of scare tactics and the doctor wanting to go home. (For some reason he thought my baby was going to be large...maybe because I'm large?? HA- baby was 7 lbs!) SO, for the third I decided that I needed to educate myself and get a health care worker who would support me. I drove 2 hours away for midwife appointments (no midwives in my area) and read a TON of material to educate myself. I read all kinds of accounts online of women who had gone through natural childbirth, either at home or at the hospital. I ended up giving birth in the same hospital that I'd had my second c-section in...attended by the same doctor who had given me that c-section. I was totally prepared with my stock question, (the question I'd ask if they suggested any kind of intervention) "What will happen if we wait a half an hour?" If they wouldn't tell me for sure that the baby was in danger or that I was in specific danger then I was going to wait. Fortunately my baby came so quickly I never had to ask that question. He was born just under 30 minutes after I arrived at the hospital. Fast and furious, totally healthy and I had no problems either. You can be large and still healthy-regardless of what the medical profession thinks!

K A said...

I am an American who has moved to the UK and am learning the system myself. I have a high BMI, pre-pregnancy it was 51. Not quite sure what it is now because my weight has fluctuated up and down my entire pregnancy (baby is growing perfectly though)

Switching over from an amazing OB/GYN and Nurse practitioner/midwife has been very rough dealing with the NHS. We ended up going the route of hiring a private midwife who was plus size friendly, but using the NHS for all of my tests instead of paying more/extra since those are my right to have. We also went ahead and did the NHS "booking" appointment in case there is any need to transfer to the hospital in an emergency situation.

So far, I love my private midwife. She has let me know the risks, but doesn't harp on my weight or weight management because I am doing it on my own. I did my research to know what to expect. Just to keep myself aware, we purchased glucose and protein urine monitoring strips for at home tests so we could hopefully catch PE or GD if they were to happen (27 weeks and still healthy no complications or anything!)

The NHS midwife that I saw was not the best person though. She seemed very uneducated and really just wanted to rush me out as soon as she could so she could start her weekend. She didn't explain anything to me at all, and all of a sudden I get phone calls to come in for extra appointments due to my BMI. I had requested a vitamin D check and was told no (even though I had been tested in early pregnancy and it was low, I wanted another check to make sure we were doing alright at this point) I went ahead and cancelled all the extra appointments (my high BMI is genetic, not due to lack or exercise or poor eating, I don't have any pre-existing risk factors, great blood pressure, normal glucose levels, fabulous cholesterol levels, and no family history) and asked again for my blood test and she granted it to me since it was the least she could do since I had denied all the other appointments.

With NHS, if you have an issue, file a complaint. Talk to the head midwife at the hospital. If you can, transfer to another group. I had a choice of two hospitals I could get booked at in the case of emergency. I suppose that depends on where you are living, I know more rural areas don't have as many options. Also, possibly ringing the community midwives instead of the hospital midwives might be another option.

It has been a fight, and as an American, I am not used to being treated this way, but I have discovered that because I took the time to educate myself regarding my plus size pregnancy that I can argue with NHS in such a way that they are working with me when I need. I would still recommend looking into a private midwife, or even a doula if needed. There are so many out there and they are really there to help YOU and not make the system happy.

Anna said...

Hey!

I am uk based too. Started off with bmi of 42 but certainly higher now as i have gained more weight during pregnancy largely as my PCOS is now uncontrolled and secondly as ive indulged in a fair few nice treats!

I am 37 + 2 now with a steady bp of 120/70 and no GD. Even I was shocked with the GD ! I got sent off to the consultant and the first one was a real witch, she basically told me I will get GD I will have high BP I will have complications I will ahve either a huge baby or a tiny baby and I quite probably could die....not even during labour but before hand due to being so obese! I even had to fill in this form of if i could wash myself, take myself to the loo etc?!!

Yes I am large but certainly not THAT large! I am quite capable of looking after myself, working full time, cleaning cooking etc!

I had to have growth scans every 4 weeks and they are all fine. I have since seen different consultants (you know how the nhs is you get who your given) and they have been fine and always happy with things.

its horrid to be treated so badly and i would put a complaint in but remember not everyone is mean. i have been to the labour ward several times with 'concerns' ranging from movement worry to watery d/c etc and the midwives there are fantastic. they have never commented on my size and if i ever mention anything, eg sorry you have to lift tummy a bit for the doppler, they are fine with it.

hang in there xxx

Anonymous said...

This is so indicative of why weight-positive health professionals are CRUCIAL to pregnancy. My size-positive mid-wife has been great about not making my weight an issue unnecessarily.

There's so much misinformation and scare tactics out there, it's a shame. I'm active with HAES and fat acceptance and I still felt extreme fear at the beginning of my pregnancy that my weight would harm my baby. Thankfully, my midwife calmed my fears and let me progress stress free.

I have a BMI of 52 and I'm currently 29 weeks pregnant. I do not have any complications. Two glucose tests came back healthy, I have a great BP and I've gained a total of 2 lbs so far.

According to the books and blogs, I wasn't supposed to be able to feel my baby move until 20-22 weeks because of my weight. I felt my baby move at 16 weeks.

They also suggested that I'd have trouble seeing my baby in an ultrasound or hearing the heartbeat through a doppler. I had two beautiful, clean ultrasounds and I've heard the heartbeat at every appointment.

Perfect pregnancies won't happen for every woman, regardless of size but we need more positive stories out there for fat women to know that they can have healthy pregnancies. Complications or challenges are not inevitable simply because of size.

Big Birtha said...

Wow. Just wow.

I'm in the UK, have had 2 babies with a BMI of 45+ and 44 respectively (me, not the babies!)

The last one was born in June 2012 (just after this blog post) at home.

I used to use this site then (which is excellent btw), but had to do additional research to get things from a UK perspective, and have now started a support and info website to cater for UK well-rounded mamas because the NHS is extremely negative and discriminatory when it comes to bigger pregnant women.

The site is in the very infant stages (and I am a webbuilding novice!), but I had to link to this article in my blog - I hope that is OK.

Posts like this totally support my belief that there is a NEED for a UK site. I find the lady's comments and thoughts just so sad. It's not like a BMI of 35 is that big!!?

I'm only sorry that bowrungsbaby is not contactable to offer her some local support, although she may have just had the baby by now (fingers crossed).

I hope she and her partner gained some valuable insight from the helpful comments here and went on to challenge some of the health professionals' negativity.

xx