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Bristol Royal Infirmary’s policies and procedures seem fairly standard ‘judge a woman by her BMI and not a lot else’ fodder. But the language used is at least considered – ‘offer glucose tolerance test‘, ‘consider dietician referral’ etc. which is better than some.
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 and an offer of a glucose tolerance test at 24-28 weeks, but you will be booked under the care of the midwifery team.
If your BMI is between 35 and 40, you can expect the above, but you’ll be booked under consultant care, likely be offered a dietician referral, and be told that you ‘should’ give birth in the obstetric unit and not consider home or water birth. However, it sounds like if you are insistent on a water birth, an individual risk assessment should take place (presumably the same applies for a home birth since the choice is not theirs to make). They couldn’t make an example water birth individual risk assessment available, as they stated that they could not easily identify a relevant patient.
You may be referred for extra scans to check your baby’s growth at 32 and 36 weeks, and a referral to see an anaesthetist if you have other medical problem which could affect your risk if you needed an anaesthetic. They’ll want to weigh you again at 36 weeks to check their equipment can tolerate your weight. You won’t be given the leaflet ‘Managing your weight in pregnancy’, because it’s no longer in use at the Trust, apparently.
If your BMI is over 40, you can expect the above, but a likely recommendation that you take clexane if you have other risk factors for deep vein thrombosis, an automatic referral to see anaesthetist, and a presumably fairly patronising assessment of your ‘manual handling needs’ (i.e. can you get yourself out of a chair, can you wash yourself).
But don’t even think of asking for IVF if your BMI is over 30.
Policies correct as of February 2013
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