Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s Hospital, Rosie Hospital, Cambridge)

Cambridge University Hospitals NHS Foundation Trust

Hills Road , Cambridge , England , CB2 0QQ

Tel: 01223 245151

Addenbrooke’s Hospital’s maternity care is provided at Rosie Hospital and Birth Centre. Of women seen in the last year for which they have data;

440 women had a BMI 30-34.9 out of 5704 = 8%

206 women had a BMI 35-39.9 out of 5704 = 4%

  97 women had a BMI 40-49.9 out of 5704 = 2%

    7 women had a BMI 50+       out of 5704 = 0.1%

Their perspective on risk assessment is welcomed:

The primary purpose of risk assessment is to classify individual women into different categories (high and low risk) for which specific actions are recommended. It is a form of screening, although the benefits of such assessments lack evidence and harm has rarely been addressed. It is therefore important that care is individualised and based upon the unique needs of each woman.

Individualised care. Music to my ears! Unfortunately however, they still have a blanket ban on women with a BMI of 35+ using the midwife-led Rosie Birth Unit, so the nod to ‘individualised’ care does ring a little hollow.

I’m pleased to report that they have a sensible attitude to water birth in ‘high-risk’ situations, however. High BMI is not even specifically mentioned as an exclusion criteria.

there is a dearth of evidence concerning their safety in particular situations, where one or more certain high-risk factors are present. It is important that women are made aware of this lack of evidence and that any recommendation can only be made on the basis of current beliefs and limited evidence…

At all times, the wishes of the mother should be respected. There should be an open and frank discussion of the reasons for (and the possible consequences of not) receiving interventions recommended for a particular
risk factor…

It should be emphasised that women have the choice and right to opt for water-birth when high risk factors are present. Midwives have a duty to provide ongoing care, even if the woman chooses to proceed with a birth in water which is not recommended.

All in all, it’s one of the better policies I’ve read.

What you can expect:

If your BMI is between 30 and 35, you’re eligible to be booked for community based care, and should be allowed to use the Rosie Birth Unit, after a review from an obstetrician. You’ll be advised to take 5mg Folic Acid until 12 weeks of pregnancy, and 10μg vitamin D throughout. You’ll be given dietary advice and may be referred to a dietitian, and will be booked for a Glucose Tolerance Test at 28 weeks. If there are any problems with visibility at your 20 week anomaly scan, another scan should be booked at 22-23 weeks. You’ll be assessed for risk of Venous Thromboembolism (DVT).

You’ll have a ‘moving and handling’ risk assessment, (i.e. can you get yourself out of a chair, can you wash yourself). Particularly patronising when the person conducting the assessment has just seen you walk in the room and sit in a chair perfectly normally, but ho hum. You will be recommended to have an ‘active’ management of the third stage of your labour – i.e. cord clamped and cut and an injection to speed up delivery of the placenta.

They may suggest using a fetal scalp electrode to monitor the baby during labour, if abdominal monitoring is ‘unsatisfactory’. Be aware that this will require your waters to be broken artificially, you won’t be allowed to have a bath or use a birth pool, or a TENS machine, and you will be restricted in your movement.

If your BMI is between 35 and 40, you can expect the above, but you’ll be referred to a consultant for an ‘individual delivery plan’ and advised to deliver on the consultant-led delivery unit. The guidance is absolutely clear that you are excluded from using the Rosie Birth Centre, but if you want to deliver at home you should have an ‘individualised agreed plan of care’ with input from the community midwife, consultant obstetrician and a supervisor of midwives.

If you have additional risk factors for pre-eclampsia (first pregnancy, you’re over 40, have a family history of pre-eclampsia, or are pregnant with more than one baby) you’ll be advised to take 75mg aspirin daily. Even if you haven’t, your blood pressure will be monitored three-weekly between 24-32 weeks gestation, and two-weekly from 32 weeks until delivery.

If it’s your first pregnancy, you’ll be booked for additional growth scans at 30 and 36 weeks to check the baby is growing as it should and that it’s in the correct position. If you’ve had a normal weight baby before it is very unlikely that your baby isn’t growing properly, and so you will only be booked for one additional scan at 36 weeks.

If your BMI is between 40 and 45, you can expect the above, but you’ll be referred for an anaesthetic consultation, and weighed again in the third trimester to check the equipment used is suitable for your weight. When in labour they will want to ‘establish venous access’ early on. In practice this means a cannula (large needle with a plastic socket on the end) in the back of your hand. Be aware that consenting to this usually means you cannot get it wet, so no bath, birth pool etc. If you are keen to use a pool, it might be worth discussing this at your anaesthetic consultation, as the anaesthetist can look at your hand and if he or she feels there are unlikely to be any problems gaining access they can write on your notes that early access is unnecessary.

To be referred for IVF (up to 3 cycles) your BMI needs to be between 19 and 30.

Policies Current at February 2013

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