Obesity and pregnancy

mebump

Being fat and pregnant

In an ideal world we would all eat less and exercise more and, as I fat person, I know it’s not good to be obese but being fat and pregnant is now a cause of concern for women as well as for the NHS.

  • If you have a BMI over 30 (classed as obese but, my god, I know some fit and active people who have a BMI of about 30) you tick the obese box which means that you may need closer attention throughout your pregnancy.
  • If your BMI is over 35, your options for place of birth change – a birthing centre is no longer possible and you may have a fight on your hands for a homebirth. Chances are you will also be placed under Consultant Care, rather than just seeing your community midwife, and you will also be offered an appointment with an anaesthetist to discuss management of labour – some maternity units recommend citing an epidural earlier in labour ‘just in case’

You will be offered to be weighed at your booking appointment, to have your BP checked and to be closely screened for diabetes and pre-eclampsia during your pregnancy.

The complaints from some of my clients is that they feel, because they are overweight, they are automatically treated as a risk to be managed. Some women are handled sensitively and others are terrified with the potential risks of being fat and pregnant.

The risks can include:

  • Gestational diabetes (3x as likely than if a BMI is below 30)
  • High blood pressure
  • Pre-eclampsia (doubled if BMI is over 35)
  • Bigger baby weighing more than 8lb 14oz  if BMI is 30+ (14% risk compared to 7% in women with a BMI of 20-30)
  • Shoulder dystocia
  • Emergency c-section, which could be complicated and harder to recover from
  • Issues with anaesthetic

I am not denying at all that there could be some risks associated with being obese and pregnant but some common sense and individualised care also needs to be put into place – as I am sure it is in places but, judging by the feedback from some of my clients, it is not standard care. The risks may increase but, if my understanding of the research is correct, these risks still remain very low.

And, from a common sense perspective, I am not surprised that complications can arise in birth if overweight women are treated as a risk, made to feel that they can’t do it, given early epidurals and remain stuck on a bed.

If women develop pre-eclampsia and diabetes, then those issues can be managed to reduce the risks for both mum and baby but, if women remain in good health, then why not support, encourage and reassure them that they can birth their baby?

Here’s what you can do to take some control

If  you are overweight and planning a baby, it can be beneficial to think about your weight and lifestyle to improve your health and strength before pregnancy and to reduce the chances of being treated like a risk. And it’s got to be worth it just to give yourself more options for the birth of your baby.

 

And if you are pregnant with a high BMI, you can work to reduce the potential risks by:

  • eating well with plenty of fresh fruit and veg (more than your 5 a day), cutting down on sugars and processed foods  BUT DON’T STARVE YOURSELF. It’s about trying to eat sensibly, which could mean you don’t put on any weight and it could reduce the risk of developing diabetes and making a bigger baby. I know, I know easier said than done but it’s sound advice and we have to start somewhere. It’s also worth writing down what you eat in an average day – I was shocked at how much I snacked and when it was written down in front of me, I couldn’t deny it!

 

  • Continuing  with any exercise/walking/swimming or starting to bring some gentle exercise into your life. Through the Network you can contact Debbie at Aerobic Bumps and we also have pregnancy yoga and pilates, along with aquanatal. It’s not the time to have a regime but regular gentle exercise can help your energy levels, make you feel better and improve your strength and stamina.
  • Go to some good antenatal classes because it is so worth the investment to prepare for how you can manage your contractions, how to use positions to stay comfortable and supported, how to be assertive when you need to be and how to use your breathing to ease anxiety, to stay calm and in control.

As a fat woman I know it isn’t as easy as “eat less, move more” and I know all too well the comfort that that the couch, cake and chocolate can bring when I feel like crap BUT pregnancy can be a time of reflection and of looking at the small things that can be changed because the small changes could just make a big difference to your pregnancy, to the birth of your baby and how it is managed.

 

 Links to further support:

Babycentre – plus-size-and-pregnant

Royal College of Midwives

Some of the comments I received yesterday:

  • the only thing that worries my about my care is how medically-led the birth will be purely because of my bmi
  • I’m under a consultant because of bmi but no one has weighed me since booking appt. Feels like box ticking mostly
  • I’ve been made to feel like a second class citizen lately – only told about said policies at 34 weeks so it’s been rather a shock (I’m now 36 weeks) It appears I slipped through the net because I was having a healthy pregnancy despite having a higher than average BMI (my midwife didn’t refer me to consultant) I too have a thick skin & it’s just as well really as the way you get spoken to is quite disgraceful.
  • Women I meet who are fat (I’m fat, so I hope it’s okay to use that word, it’s how I describe myself) have usually been scared to death at their first appointment.. you will need an epidural.. you have a billion fold increase in needing a caesarean.. your baby is at risk.. How does fear help anyone to have a better outcome?!
  • it’s hard because women need to be made aware of the risks, but in a non judgemental way, with support to manage their weight. That requires time though…
  •  Every time I went to the hospital there was at least one sideways comment about the fact that I am a bit fat.
  • I suffer from PCOS and have had to go on a serious diet to lose weight in order to get pregnant. A diet which links in with insulin resistance etc linked to the hormonal imbalance of PCOS. However once pregnant the diet doesn’t work anymore – the reduction in certain foods makes me ill and feel weak. Therefore the weight piles on again in the first few months. However trying to explain this is usually met with a smirk and leaflets about eating fruit and veg.
About Janine 574 Articles
I am an antenatal teacher, doula, baby massage instructor, postnatal educator, life coach, writer, mum, wife, friend and, sometimes, just me. As an experienced and qualified practitioner, I specialise in pregnancy, birth and early parenting - my aim is to listen, inform, support and reassure when needed. I have worked with parents since 2002 and I set up Birth, Baby & Family in 2011 to provide good information, a different perspective and links to the best products and services for families. I set up the Birth, Baby & Family Centre in 2014 to provide a welcoming, friendly and supportive space for parents across Tyneside.

1 Comment

  1. From my facebook page: Janine you’re right in that there are increased risks but that they are low. Was just reading an article about research done at Liverpool University. 70% of obese women give birth naturally and had no increase in complications which compares to about 80% in non-overweight women. So yes it is a big difference nationally and something that should be focused on by the NHS but not something individual women should be unduly worried about. There are higher risks once interventions come into the picture as with any medical procedure. 33% of obese women were induced, 8% higher than non-overweight women. However, more ended up with caesarean deliveries than their lighter friends. So weight is a factor but it is not black and white, fatter=complications. I have no problem with needing more monitoring (although I didn’t get any) it is the ‘judgements’ that I and others I know got. They were not perceived, they were in your face. I don’t see why my health care providers need to judge me. And really what is the point when you’re already pregnant. Issues to do with weight always come with value judgements e.g. they are lazy or a glutton. Some people do have medical reasons others don’t but that is their business and not anyone else’s. Yes, an increase in the rate of complications may cost the NHS more but then there are plenty of things we humans choose to do that come with increased risks, and therefore cost the NHS money, such as drinking, driving a car, walking places where there are cars, eating take away, taking part in sports and eating frozen lasagna ;o) I take back the last one. Neigh chance anyone was hospitalised over that one.

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