BigBirthas PSG Research Results!

So, you’ll have been wondering what happened to the research BigBirthas was doing in collaboration with the Parenting Science Gang?

Well, we’re all done. Thank you to everyone who joined in and got involved. 161 people joined the Facebook Group in the end, we took part in dozens of Q&A sessions with experts, some of whom sounded like they enjoyed it as much as we did!

Conversations within the group revealed that many of us felt that we were given no choices during pregnancy and labour; that our high BMI led to health care professionals failing to offer choices normally available to pregnant mothers, and that often, there was no medical evidence to suggest that these choices weren’t perfectly reasonable. Many of us had had very negative experiences, even when our pregnancies themselves were uncomplicated.

This led us to decide to research the way that choice was presented to expectant mothers with a high BMI and how that affected their experiences. Were our experiences typical? Or had our negative experiences drawn us together in a way that precluded us from being aware of high-BMI women who’d had less traumatic pregnancies and births, and made us wrongly assume negative experiences were universal?

We invited volunteers to be interviewed by email, recruited from anywhere and everywhere in the UK we could think to ask, and were then overwhelmed at what an enthusiastic response we received! Almost immediately, we got 60+ responses to our request for research interviewees, and 20 filled in the full-length responses we needed to do our qualitative analysis using thematic analysis methods. Then we stopped asking for more respondents, because 20 was about the limit we could manage with a small group of first-time thematic analysts running the show!

But that is the whole point of Parenting Science Gang; letting the parents be in charge of asking the questions they want answers to, and then working out how to do it!

What did we find out?

None of our findings were a great surprise to us; they confirmed that the conversations our group had had were pretty typical. Although there were some great stories about knowledgeable health care professionals who treated mothers with dignity, we also found clear themes of unsatisfactory treatment. Several reported that they saw an immediate change of tone as soon as they were weighed:

“When I’d been weighed and measured she immediately started saying things like “Oh, there will be a problem because of your weight” but wouldn’t explain what the problem was. She wasn’t as friendly then and wouldn’t explain things to me”

Language changed, and some mothers felt lectured and patronised. There were almost constant warnings about potential problems (most of which never transpired), repeated tests for conditions (many of which never developed), with some health care professionals resorting to “persuading” mothers using guilt tactics.

“I felt that I was coerced and guilted into an additional scan by one particular midwife.”

“I felt that I didn’t have a choice, I was scared into decisions.”

“I was told ‘Well you must have known the risks when you decided to get pregnant, being the weight you are.’”

In most cases, where mothers were pregnant for the first time, they went along with the recommendations of health care professionals without question. This too echoed our experiences in the group. It was only after the birth that many of our respondents realised that they should have had a choice about the decisions made, and these decisions may have made due to an assumption of problems emerging, rather than a careful consideration of the individual mother’s situation.

“I didn’t realise you could refuse induction”

“In both labours vaginal examination was presented as a non-option.”

Some mothers felt that they had been actively ignored if they challenged recommendations. Many of our group found reading these testimonials too difficult to manage. They triggered memories of our own experiences of being ignored and in some cases basically assaulted, for want of a better word, at a time of our most intense vulnerability, so if you do read the full findings, please be aware of this.

“I was given all the interventions including an epidural that I had refused”

“First time round I agreed to one [vaginal examination] and the midwife swept me without my consent.”

Worryingly, many mothers reported finding a great discrepancy between health care professionals, in terms of knowledge and subsequent behaviour. Sometimes mothers found that their weight was blamed for everything by a few professionals, but that other heath care professionals didn’t agree.

“The first sonographer very harshly said that the reason she had trouble was because I was quite fat so it was harder to get a good picture. During other scans I was told that weight doesn’t necessarily come into it and it really does depend on the competency of the sonographer and the position of the baby/womb/placenta”

Many mothers received conflicting messages about risk and options from different health care professionals, which was both confusing and upsetting, and didn’t inspire confidence in the system to provide personalised care for their own situation and needs.

“I felt that people knew best, but when professionals are literally disagreeing about the well-being of your unborn baby, it’s a bit disheartening.”

This lack of consistency, coupled with feeling judged and unsupported by health care professionals had a great effect on mothers, many of whom reported that pregnancy had been an extremely stressful time for them.

“I found it scary and confusing during my first pregnancy.”

“I left some midwife appointments afraid that I might die in labour!”

Second Pregnancy

Not unexpectedly, mothers prepared for subsequent pregnancies with care. No one mentioned losing weight, but many mothers talked about being much better informed; reading up on guidelines and risks, and being much more confident in asserting their views and wishes, and in challenging health care professionals to explain themselves, their actions and their recommendations.

“I had the confidence (or some might say bad attitude) to say, I’m not having all of those scans – they aren’t necessary and are a waste of my time.”

Many approached their relationships with health care professionals differently second time around, either making a concerted effort to form respectful and supportive relationships from the start, seeking out professionals they had found supportive in their first pregnancies, or by actively avoiding certain individuals, and in several cases paying for independent midwives or doulas to support and advocate for them.

Sadly, in several second pregnancies, mothers also reported avoiding health care professionals wherever possible; engaging as little as possible and refusing appointments where necessary. More than once, mothers reported needing to do this for the sake of their own mental health. This is clearly a very worrying result; it cannot be positive for any mother, irrespective of their medical needs, to be making an effort to avoid the health service provided to support them, but did seem to be a common response to prior bad experiences at the hands of the health care professionals.

We know (and I have complained many times!) that many of the risks that arise from having a high-BMI in pregnancy are delivered in terms which make them sound excessively alarming. For example, where a risk changes in likelihood from 0.1% to 0.3%, it is often represented as “THREE TIMES THE RISK” in big, bold letters, which makes the difference seem very alarming, when it is actually still very low risk. These alarm bells are also usually rung when the mum is already pregnant, so NOT a safe time to diet or do anything about it, and just increases the stress and feelings of guilt. This is not helpful, and given that no respondents mentioned consciously trying to lose weight between pregnancies, clearly not serving any weight-loss motivational purpose either.

There are examples of great care out there, but until the NHS is able to universally provide larger mums with a respectful and compassionate experience of pregnancy and labour, and ensure that mothers feel in control of what happens to them at this fundamental time, then we feel that many more mothers will suffer from unnecessary and unhelpful levels of stress during pregnancy, and some will avoid health care professionals altogether, potentially putting themselves at even greater risk.

You can read our full findings here: Big Birthas’ Findings

Huge thanks to the Parenting Science Gang Team for bringing this project to fruition, for being such lovely, patient, intelligent, enthusiastic ladies, and particularly to Sophia for birthing PSG in the first place. Long may PSG continue gaining funding and doing Citizen Science into all sorts of topics, because it’s bloody ace.

Go and have a look at the Parenting Science Gang page! This link says pretty much everything I’ve said above, worded pretty similarly, but if you have a mooch around, there’s all sorts of fascinating information about the other groups and their experiments on breastmilk, baby wearing, picky eating, homeschooling and more: http://parentingsciencegang.org.uk/experiments/big-birthas-findings/

If you’re interested in joining a groups of likeminded people, the BigBirthas Facebook group is still going, https://www.facebook.com/groups/bigbirthaspsg/, feel free to come and pick our collective brains, have a chat, discuss unicorns, it’s all good. We’re just now talking about how we might want to distribute our research findings, but we also chat about all topics BigBirthas related, and anyone can post a question for the wisdom of the hivemind to respond. You’d be very welcome.

xx

Big Birtha

Time To Have Your Say!

The Royal College of Obstetricians and Gynaecologists is seeking feedback from women on its new leaflet ‘Being overweight or obese during pregnancy and after birth‘.

The closing date for comments is midday on Friday 18 May.

Click on this link to access the RCOG page where you can read the draft leaflet and then feed back your thoughts via their online questionnaire. Make sure you feed back on the right one – NOT the hysteroscopy one (unless you happen to be interested in that too!)

I don’t want to prejudice your thinking, so I’m not saying what I wrote, but I will say that it’s nice to be asked our opinion at last!

Aaand… while you’re busy having your say, let me do another shameless plug for our Big Birthas Parenting Science Gang over on Facebook. We’ve been discussing the topic and what we might research for a little while, spoken to some really interesting experts to get their views; this week we’re talking to experienced midwife and waterbirth expert Dianne Garland (SRN RM ADM PGCEA MSc) of www.midwifeexpert.co.uk. We’re nearly at the point of deciding what we’re going to research – come along and get involved, you don’t have to be a scientist (I’m not!) to get involved in citizen science!

Abortion Delays for BMI 40+?

I was quite surprised to discover today that being overweight can not only affect the maternity and antenatal care you receive, but if you’re seeking a termination of pregnancy, it can cause you problems there too.

The British Pregnancy Advice Service (the UK’s leading abortion care service) have today released a briefing paper to highlight the number of women who are being forced to continue with pregnancies against their will, and sometimes against medical advice, because of delays and lack of capacity in the system.

On 46 occasions in 2016 and 2017 – or generally twice a month – BPAS was unable to secure suitable NHS hospital treatment for women by the strict legal cut-off point of 24 weeks.

In other cases, there was significant delay between the woman presenting for treatment and being able to access that treatment: one mother with cancer, whose treatment could not start until the abortion was performed, waited 45 days for an appointment. In another case, a mother with epilepsy and learning difficulties who presented at the end of first trimester was treated nearly 7 weeks later.

But where does high BMI come into this?

Three of the cases for whom BPAS could not find an appointment in time are described thus in the paper:

BMI over 40. Existing children.
Pregnancy is the result of a sexual assault.
Presented at 22 weeks.
No appointment available.

19 years old with three young children. BMI>40. Her ex-partner has recently been released on bail following a prison sentence for domestic violence.
Presented at 19 weeks. No suitable appointment available.

BMI over 40. 18 weeks pregnant. Daughter was recently violently assaulted and raped; she feels unable to cope with both a new baby and supporting her daughter through this experience. Cannot stay overnight and leave her other
children. No suitable appointment available.

Why is this?

While most abortions in the UK are performed outside the NHS by the not-for-profit sector, in stand-alone community clinics run by organisations like BPAS, women with co-morbidities must be managed within a hospital setting where there is swift access to backup care and specific clinical expertise in the event of an emergency.

BMI is included in these co-morbidities, with the cut-off being a BMI of 40, and in fact, according to BPAS’s statistics, it’s the fourth most common reason for referral for treatment.BPAS referrals by reason

The briefing goes on to show that many of the clinics they would refer these women into will only treat women up to a certain point in their gestation, so the later you present for treatment, the fewer options you would have in terms of a location to access the service you need. There are just 35 sites across the country offering this service to women, but if you don’t discover you’re pregnant until several weeks along, this can drastically reduce your options.

NHS referral abortion sites vs gestation

I can’t imagine coming to the very difficult decision of terminating a pregnancy and then finding you are compelled to continue with it anyway because of a lack of access to appointments.

So, where does this leave us?

One in three women will have an abortion in her lifetime, and according to government statistics, 3.6% of women have a BMI greater than 40.

So, on a rough guesstimate of the figures, it stands to reason that around 1% of the population may find themselves in exactly this situation.

If you’re considering a termination, and you have a high BMI, it looks like the sooner you approach a provider for treatment, the more likely you are to be able to access it, and access it in a location convenient to you. Perhaps in this instance it’s better to approach the provider even while you’re in the process of making up your mind, in order to buy you time to arrange a suitable appointment.

But according to this study of 4968 women in 2016,

Safety of Outpatient Surgical Abortion for Obese Patients in the First and Second Trimesters (75.5 KiB)

abortion clinics needn’t be restricting access to women with high BMI at all? Is this yet another thing we should be fighting to be treated the same as any other women?

We’re damned if we do, and damned if we don’t.

Medically complex women and abortion care (425.4 KiB)

Obesity Statistics (5.7 MiB)

 

Fed Up With Lazy Journalism

Another day, another article which blames obese mums and completely misrepresents the research it purports to be reporting on.

Thanks Helen McArdle ‘Health Correspondent’ for The Herald @HMcardleHT, for yet more scaremongering claptrap.

Here’s the article:

http://www.heraldscotland.com/news/16071005.Foetuses_of_obese_women_develop__fatty_liver__in_the_womb/

Let’s begin with the headline:

Offspring of obese mothers prone to childhood obesity because they develop ‘fatty liver’ in womb

So, that sounds worryingly simple enough, an assertion which is reinforced in the first paragraph:

“CHILDREN whose mothers were obese during pregnancy are more likely to become overweight themselves because they develop a “fatty liver” in the womb, research has found.”

As usual, we’re to blame, and “research has found it”, so the article says, so it must be true. Surely?

Unless you read on.

But the trouble is, how many people do read on with articles like this? How many mums, glancing at this and feeling sick to the pit of their stomach at the potential harm they’re doing to their baby/have done to their children, breath deeply, and flick past to something lighter to brighten the mood? If you’re already pregnant/have had the baby there is little point in finding more things to stress over – being a parent is hard enough!

How many healthcare professionals, busy on a lunchbreak, notice the heading and possibly the first paragraph and move on, because there’s no need to read it – it’s clearly just going to tell the thing they already believe to be true; overweight women are harming their children through greed, laziness, and ignorance?

Not all health professionals think this way, certainly, but I’ve met enough to get the impression that it’s not a rarely-enough-held viewpoint. Newspaper articles like this don’t help matters.

The second paragraph kicks us again when we’re down.

“It has long been known that overweight and obese women are more likely to give birth to heavy babies and that these infants are at greater risk of childhood obesity.”

Actually, (and please correct me if you know of more recent studies to the contrary) I think
the link between big mum=big baby is only shown in studies which failed to adjust for mums with poorly controlled blood glucose levels (usually as a result of poorly managed gestational diabetes). Where this is accounted for, there is no established correlation between otherwise obese mums and heavier babies at birth.

The second claim, that ‘these infants are at greater risk of childhood obesity’ does have some grounding; there are plenty of studies that show a correlation between maternal obesity and childhood obesity. It’s very easy to find data on the mother’s BMI at her booking appointment – and so again, lazy researchers have been known to draw conclusions that pregnancy BMI is a factor in the obesity of a 10 year old, failing to account for the environment the child is growing up in after its birth! Funny how these studies are so rarely interested in paternal obesity as an indicator, isn’t it, since that data is so much less readily available?

Then we get onto the third paragraph and the headline starts to unravel…

“However, research published in the Journal of Physiology has revealed for the first time how fat accumulates in the liver and metabolic pathways are disturbed in foetuses developing in obese mothers with diets high in sugar and fat.”

Hang on a second! That additional information makes quite a bit of difference!! “Obese mothers with diets high in sugar and fat“. So not ALL obese mothers, but the ones with poor diets. Obviously much less catchy as a headline though, isn’t it?

Then comes not just the unravelling, but the full scale chopping up of the headline with the sword of Damocles… if you read further down to paragraph eleven.

“The study was carried out using obese pregnant monkeys.”

I’m sorry? What?! Obese. Pregnant. Monkeys??!?

They didn’t mention that in the title, now, did they? No, in fact, The Herald used the word ‘childhood’ in the title. Could have used the more factually correct ‘infant’; it even comprises fewer letters, but implying that this is research on humans makes this a more compelling read, doesn’t it?

Baboon hanging from its tail above water

The very first word of the article itself is ‘Children’, which we now know should read ‘Baboons’!

While I concede that humans share 91% of their DNA with baboons, there’s definitely enough of a difference between us for that distinction to be quite important.

I can’t do this, for instance. And I’m not overly fond of bananas.>>

If you google a bit, you’ll discover that Helen McArdle didn’t even write all of the article herself. Most of it, the accurate stuff, was lifted directly from this press release from the Physiological Society. The Herald’s only input was just to add confusion and a click-bait title – and bury the essential information deeper in the text. Standard journalistic fare, sadly.

My advice, always read on if you come across a news story that makes you feel uncomfortable about being a bigger mum. More often than not, the article unravels itself as you read, and your fears prove false.

Even better, find the research the article is citing and read that, if possible, (if, in this case, you’re not squeamish about reading of the the deaths by exsanguination of not-quite-to-term baby baboons…)

Primate fetal hepatic responses to maternal obesity: epigenetic signalling pathways and lipid accumulation (72.7 KiB)

This journalistic laziness is so frustrating. Research which usually took scientists months, maybe years to conduct, and several thousand words to explain, are so often twisted and misrepresented when distilled by a journalist into an attention-grabbing article. But the damage is done.

This is all I have to say about that…

A baboon's bottom
If you’d like to get involved in some citizen-led science about high-BMI pregnancy in conjunction with Parenting Science Gang, funded by the Wellcome Trust, then do join our Facebook group here: https://www.facebook.com/groups/1955647771354577/

x

Big Birtha