Northampton General Hospital NHS Trust,
Cliftonville, Northampton, England, NN1 5BD
Tel: 01604 634700
This guidance is reasonably brief. It doesn’t cover, for example, induction, management of the third stage, or a number of other elements often treated differently in larger women. Its language is at least reasonably neutral.
Like many, is good at listing the increased risks of pregnancy for mums with high BMIs. Unfortunately, like many, it lists these increased risks without giving any indication of by how much that risk has increased.
My concern is that where hospitals do this it has the potential to make clinicians all to keen to relay these risks to mums, without giving those professionals the necessary perspective of what that increased risk actually is. Double a tiny risk is still a small risk, after all.
What you can expect:
If your BMI is between 30 and 35, you can expect the ‘here’s all the things that are more likely to go wrong with your pregnancy because you’re fat’ conversation but hopefully this should be coupled with a discussion on how to best manage those risks, including sticking to a diet with low glycaemic load (low sugar). You’ll be referred for a glucose tolerance test at 26 weeks. You’ll be weighed again at 28 weeks to assess your weight gain/loss, and again at 36 in case specialist equipment is needed. You may be recommended to take medication to reduce your likelihood of deep vein thrombosis, but only if you have additional risk factors. On admission they will want you to take Ranitidine (an antacid) every 6 hours, but the rationale behind this is not given, and nor have I seen it in other hospital’s guidance, so it’s a bit of a mystery why they’re keen on this. You’ll be given healthy eating advice postnatally, and ideally additional help to support breastfeeding.
If your BMI is between 35 and 40, you can expect the above, but you’ll be referred to a consultant obstetrician for your care, and have a discussion about your “unsuitability” for midwifery led care or home birth. You’ll be asked to complete an Antenatal Anaesthetic Questionnaire for review by a Consultant Anaesthetist.
If you are keen to use a birth pool, Northampton’s guidance is that it “is not recommended” for women with a BMI greater than 35, but it is not forbidden outright, so there may be room to discuss/negotiate this with the Supervisor of Midwives (threatening to have a home birth instead has been a successful tactic to have “waterbirth approved” written on some women’s notes!) however, they do state that the hoist available is only rated up to 150kg, so women who weigh more than this should not use the pool. Interestingly, the word used here is ‘should’ not ‘cannot’. I’m unsure if this is just me reading too much into things or if there is a potential workaround (e.g. a different hoist located elsewhere which could be brought in? Always worth exploring if a pool is important to you).
If your BMI is over 40, you can expect the above, but you’ll also be offered an appointment with a consultant anaesthetist. You’ll also be advised to take medication to reduce your risk of deep vein thrombosis for 7 days after giving birth.