I’ve said it for quite some time. I know high BMI means a greater risk of developing complications in pregnancy, but what if those complications don’t develop? I’ve never understood why my pregnancies can’t then be considered ‘normal’? Is there such a thing as a low risk obese pregnancy?
At last a large study, from Oxford University no less, has asked this question:
The researchers discovered that obese mums pregnant with their second or subsequent baby, who haven’t previously had caesarian sections, and haven’t developed complications like high blood pressure, diabetes etc. are actually at lower risk of interventions or complications than ‘normal weight’ mums having their first baby!
The figure for intervention or complication was 21% for ‘very obese’ but healthy women having a second or subsequent baby. For ‘normal’ weight women having their first baby it was 53% – about 2 and a half times more!! What’s reassuring too, is that this was a large study, looking at 17,230 pregnancies.
Isn’t it time for more equality of access?
This begs the question, how is it fair that first-time mums with low-risk pregnancies can plan to have their child in hospital, at home, or in a midwife-led unit, while women with a BMI over 35 are generally restricted to birthing only in an obstetric unit, even if they’ve had previously uncomplicated births?
This finding does highlight a possible anomaly in the guidance given to women on where to give birthDr Jennifer Hollowell, lead author of the study
As expected, the researchers found that the risks of complications during childbirth increase with increasing BMI even among otherwise healthy women. But the increase was surprisingly modest; only 6–12% compared with women with a ‘normal’ BMI.
My experience of low risk obese pregnancy
When I was planning the home birth of my second baby (after an easy hospital birth of my first) I met with a consultant obstetrician at 36 weeks. She wasn’t impressed and tried to convince me to birth in hospital; even when I pointed out that it was the hospital’s policy forbidding high BMI women from using the birth pool that was forcing me into a home birth.
The consultation was a waste of time for us both. She misquoted NICE and RCOG guidance (and I corrected her). She couldn’t explain why I was still deemed ‘high risk’ when no complications had arisen. My previous birth had gone without a hint of the complications you can’t predict beforehand (shoulder dystocia, post partum haemorrhage), but she would not consider my pregnancy low enough risk to permit me to use the birth pool in the hospital. So we agreed to disagree and she signed me off to the care of my lovely, supportive midwifery team.
I then met the Supervisor of Midwives, who was far more amenable. The SoM said that she thought current policies are non-sensical and discriminatory, and that as far as she was concerned, she was more interested in my previous birth history as an indicator of how this birth would go. I’m so pleased this study validates her lived experience! (I still had to sign a document saying that I was undertaking home birth against medical advice, though).
However, without the discriminatory policies, I would never have had the inclination or determination to birth at home. Which was wonderful, and I’d do it again in a heartbeat. Every cloud, eh?