The consequences of obesity in pregnancy
As the subject of obesity hits the headlines (again), Of Saffron & Cyrus looks at how tipping the scales in pregnancy can lead to mums feeling anxious, distressed and uneasy.
One in five pregnant women is either overweight or obese, according to the NHS Choices website, while a UK report on maternal obesity reveals it’s ‘one of the biggest challenges to maternity services’.
Recent findings have linked obesity in pregnancy to an increased risk of gestational diabetes, having a C-section, preeclampsia, sleep apnea, pregnancy loss, macrosomia, preterm birth, stillbirth and birth defects – and that’s just for starters. Other studies suggest there are also links to a risk of autism and neurodevelopment and psychiatric disorders in children of obese parents.
I always thought I’d lose sleep over stretch-marks, swollen ankles and nausea when I became pregnant, but being over 40 opened up a new cavern of things to worry about.
When I first started considering a pregnancy, I was a size 14/16 and I was drinking vile green wheatgrass juice and going to the gym daily. I loved combat. While this did help me lose some weight, I was still, technically, overweight with a Body Mass Index (BMI) of 28. My weight had always caused me a great deal of anxiety over the years. I’d longed to have zero body fat and a fab figure, but I wasn’t born that way. I just looked gaunt and unhealthy whenever I lost a few pounds.
I arrived at my 14-week hospital check-up feeling excited and looking forward to the journey ahead of me. I’d been swimming daily before work and I felt good, but it soon became clear that I had pre-pregnancy weight issues. My excitement turned to anxiety after the midwife revealed I’d tipped the scales with a Body Mass Index (BMI) of 31. I was OBESE.
She asked about my diet and I was truthful, sharing all the well-balanced diet information I’d consumed in my Pregnancy Book. My diet wasn’t THAT bad, but having a Persian husband (blame him indoors), we did eat A LOT of rice.
The appointment felt like I’d been called into the headteacher’s office for a ticking off. The information I received was reeled off like one of those tedious leaflets stuck to the noticeboard in the GP’s waiting room. It felt like a no-win situation now I was pregnant.
After my appointment I went home and just pushed things around on my plate during dinner. I couldn’t eat anything. I was upset and the anxiety of it all, combined with the unknown was a real strain. The midwife wasn’t offensive and did tread sensitively on the subject of obesity, although I guess some bits were lost in the sub-editing. Here’s the unedited version (below) which I received in the post:
One of the most useful pieces of advice I was given was to take aspirin. While I did protest the principle of taking something I’d been told was harmful in pregnancy, I followed her advice. She explained that it helped to slash the risk of preeclampsia.
During my pregnancy I’d gone to all the antenatal classes available to me. The fact they were held in the idyllic surroundings of the midwifery-led Birthing Centre put me at ease. This was where I wanted to have my baby. Nowhere else.
After viewing the private rooms complete with low-level lighting, birthing pools, comfy sofas and TVs, I knew this was the perfect place to have a baby. It was more like a spa retreat than somewhere you might give birth. One of the rooms was even featured on the glossy front cover of my Pregnancy Book. It just looked so serene. It was a far cry from the cold and clinical delivery suite where all manner of equipment was on display, including forceps.
My heart sank as I read in the Pregnancy Book that my BMI had to be lower than 35 to use the Birthing Centre. I was so anxious about this that I stepped on the scales EVERY SINGLE DAY. Sometimes more than once. I made a note of everything I ate and I was so obsessed with my pregnancy weight-gain, that I’d compare myself with other pregnant mums at antenatal classes.
The midwives were always very reassuring and told me not to worry. They said I’d still be able to use the Birthing Centre and pool IF everything else was normal at the end of the pregnancy. All I needed was a letter from my consultant saying I was fit and well and that she was happy for me to do so.
I was so relieved…until I met with my consultant. She was small and skinny and had a special interest in obesity.
At 35 weeks my baby was in head down position (CHECK), my blood pressure had been stable at around 112/63 (CHECK). There were no signs of preeclampsia or gestational diabetes or any other issues (CHECK). I was also told that my placenta was working well during my scan. (CHECK). The one thing that suddenly wasn’t was my BMI. It was 35.3 (95.3kg).
The consultant refused to write a letter based on the fact I was not eligible to use the Birthing Centre as a BMI of more than 35 was contraindicated in water birth. She went on to suggest I could either elect to have a caesarean or I could be induced around 40 weeks to avoid stillbirth. We had not even spoken about this before – since I’d only met her once.
I felt like I was being given a raw deal. I had endured the cold and clinical nature of a ward the year before during my miscarriage. I didn’t want to be on another ward that reminded me of this. I understood that if there were complications that I’d end up there – but it was a worst-case scenario.
I found water extremely beneficial to ease pain so to be told that I could have an elective caesarean – but not a bath seemed absolute bonkers! As the tears rolled down my cheeks, she went to get herself a chaperone before asking me if perhaps it would be better birthing at home. “Perhaps hire a birthing pool or stay in you own bath,” she said.
I snapped back “Surely that puts me and my baby in more danger being high-risk? Although I realise it wouldn’t be the Trust’s fault if something went wrong. I’m NOT prepared to risk a home birth.”
I’d been calm and collected all the way through my pregnancy until that point. I had nine days left at work and suddenly I couldn’t concentrate on anything until I got the issue sorted out. I was afraid and not sure where to turn. I needed answers.
Given that I’d found my consultation both challenging and upsetting, I put everything in writing. After an emotional email to the Head of Midwifery, Women’s Services, I was assured that she would investigate the matter and report back to me.
She came back to me the same day and invited me to meet with one of the Supervisor of Midwives and a Consultant Obstetrician to discuss ‘factors which did affect my care’.
I wrote back:
It’s the first time in my pregnancy that I have been made to feel overweight and old and I’ve been left bitterly upset after my appointment with the consultant. I do not feel she was in any way sympathetic to my needs and I felt I had to apologise for my tears to her.
I’ve never felt so let down in my life at the moment. I hope this matter can be resolved without any more undue stress.
Another email later:
‘Irrespective of where you choose to have your baby, the risks we have identified need to be discussed and addressed in preparation for labour and birth. Whilst I can appreciate this may have been upsetting for you, the doctors and midwives involved in your care have a professional duty to do so’.
After a sleepless night and having not eaten a thing, I put on my Mrs Angry face and marched back to the hospital for some carthartic ranting. Perhaps they’d made a mistake, it was an oversight or just a general cock-up. I was very hot under the collar and not in the mood for reasonable persuasion. I didn’t know how best to go about complaining – and in hindsight, I’d say DON’T complain.
I met with a harassed Consultant Obstetrician and Supervisor of Midwives and I felt like I was about to be ticked off again. I wasn’t complaining solely to get anyone into trouble, I just wanted a natural birth in the most idyllic setting possible.
I spoke, politely about my concerns. Of course, he justified and explained everything and it eliminated any real point to me being there. I’d ascertained the reality and was convinced I wouldn’t be allowed into the Birthing Centre when it came to it. I was extremely distressed.
In the end, I was offered an induction on my due date. I was too afraid not to accept it given the risk of stillbirth. I was shown to a two-bed room on the delivery suite where I started to be induced. There was another patient in the bed next to me which wasn’t ideal.
It was cold, clinical, dirty and depressing and the curtain was partially hanging off its rail. The nearest toilet was also across a corridor in the bay opposite. I became increasingly agitated and complained bitterly to the midwife about my wish to be in the Birthing Centre. My hormones were in overdrive. The fact was it did no good. I was stuck where I was and there was no way they were letting me go.
Once the contractions started, I gave in. I was uncomfortable, exhausted and in pain. It was at this point I was told that I MUST go on a pitocin drip. I was transferred to another room, given an epidural and the rest is history.
Despite all the horrible consequences of being OBESE, I didn’t suffer from the majority of the things I’d been warned about. Cyrus was born – 8lb 4oz. He was not a BIG baby, he was just perfect.
My final note: My job as a mum-to-be was to create a perfect environment for my baby to grow in, yet he was born in an environment I consider to be less than ideal. This was all down to my BMI being too high. Make of that what you will.