Skipton Road, Steeton, Keighley, England, BD20 6TD
Tel: 01535 652 511
Full marks to Airedale for a sensitively worded policy which is sensible, respectful, realistic and supportive of bigger women.
The policy states clearly; “any decision by an individual patient to refuse treatment in line with best practice must be respected“.
It also states that a conversation about the potential complications associated with obesity “should be given in a clear but sensitive way to empower the woman to engage with the services available“.
What you can expect:
If your BMI is between 30 and 35, you can expect to be advised to take 5mg folic acid and 10μg vitamin D daily. You’ll be monitored for risk of DVT (deep vein thrombosis) and considered for medication if you have two additional risk factors for DVT, and be provided with some attractive stockings to wear while in labour and after the birth. You also should get a glucose tolerance test at 28 weeks, with the potential for another if there are any concerns. The guidance is quite clear that obesity alone does not indicate a need for induction of labour. They recommend an active third stage of labour (i.e. giving you medication to make your body expel the placenta more quickly) due to the increased risk of haemorrhage.
If your BMI is between 35 and 40, you can expect the above, but you’ll be classed as high risk, booked under consultant care, and be advised to deliver in hospital. You’ll be given dietary advice and ‘reassured that there is no benefit from further weight gain’ and told you can lose weight on a supervised programme, so long as you do it gradually. They’re clear that there are no evidenced based UK guidelines on recommended weight gain in pregnancy, but do reference a US guideline;
They will want to weigh you again in your third trimester to check they are using the correct equipment for your weight, and may refer you for a consultation with an anaesthetist if they believe your physique suggests a greater challenge for natural delivery.
Their policy on use of water in labour and birth excludes women with a BMI over 35 from using a pool, but does state that if you continue to request one, they will refer you to the Senior Midwife / Supervisor of Midwives / Obstetrician (doesn’t say you’ll get one, but sounds like you can argue your case…)
Home birth is not recommended by the trust for women with a BMI of 35 or greater, but their home birth policy does at least recognise the possibility, and advises a consultation with a consultant obstetrician if obesity is the only risk factor. If you decide to go ahead, the Supervisor of Midwives will support your midwife to provide your care, but you will still be advised that your home birth is against medical advice, and this will be recorded in your notes.
If your BMI is over 40, you can expect the above, along with an automatic referral for consultation with an anaesthetist, and a risk assessment around 35 weeks to plan for any specialised equipment needed for the birth. During labour they will not want you to eat, and only drink clear fluids, in case of the need for anaesthetic – they will also want to prescribe ranitidine (an antacid medication) for the same reason. They do recommend you stay mobile.