Good Move, Debenhams!

Just over a month ago, I was musing/complaining about the lack of real-size mannequins in our stores, and showing the example of a Swedish store who have been successfully using normal sized models for years.

Well, to my extreme surprise and delight, Debenhams have announced that they have an army of size 16 mannequins which they will be using in all 170 stores across the UK. http://www.theguardian.com/business/2013/nov/06/debenhams-first-department-store-size-16-models

Hurrah!
Debenhams Size 16 Mannequins

 

 

 

 

Hopefully this will be an emerging trend. A recent study involving nearly three thousand women in North America, Canada and China undertaken by researchers from the University of Cambridge found that women in Canada were three times more likely to buy clothes when the models in advertisements were their size.

So we don’t necessarily respond favourably to the stick thin coathangers on legs we’re always told ‘sell clothes’ after all!

So come on, UK retailers – let your profits expand with the waistlines of your mannequins and give us something we can relate to!

At last! Good news! A study on LOW RISK obese mums!

I’ve said it for quite some time. I know that having a high BMI puts me at greater risk of developing complications in pregnancy, but what I’ve never understood is that when I don’t go on to develop those complications, why aren’t my pregnancies considered ‘normal’?

At last a large study, from Oxford University no less, has asked this question.

The impact of maternal obesity on intrapartum outcomes in otherwise low risk women: secondary analysis of the Birthplace national prospective cohort study (13.5 KiB)

They discovered that obese mums pregnant with their second or subsequent baby, who haven’t previously had caesarian sections, and haven’t developed complications like high blood pressure, diabetes etc. are actually at lower risk of interventions or complications than ‘normal weight’ mums having their first baby!

The figure for intervention or complication at birth was 21% for very obese but otherwise healthy women having a second or subsequent baby, but 53% for women of normal weight having their first baby – about 2 and a half times more!! What’s reassuring too, is that this was a large study, looking at 17,230 pregnancies.

Which begs the question, how is it fair that first-time mums with low-risk pregnancies can plan to have their child in hospital, at home, or in a midwife-led unit; with or without a pool, depending on what is available where they are, when women with a BMI over 35 are generally restricted to birthing only in an obstetric unit and on dry land, even if they’ve had previously uncomplicated births (unless they assert their rights as I did, and insist on a home birth)?

‘This finding does highlight a possible anomaly in the guidance given to women on where to give birth.’ said Dr Jennifer Hollowell, the lead author.

As expected, the researchers did find that the risks of complications during childbirth increase with increasing BMI even among otherwise healthy women, but they found that the increase was surprisingly modest. The relative increase in risk was actually only 6–12% compared with women with a ‘normal’ BMI.

When I was planning the home birth of my second baby (after an easy hospital birth of my first) I was booked to meet with a consultant obstetrician at 36 weeks. She wasn’t terribly impressed and tried to talk me into birthing in hospital – even when I pointed out that it was the hospital’s restrictive policy on forbidding high BMI women from using the birth pool that was making me choose home birth.

After a waste of time for both of us, in which she misquoted NICE and RCOG guidance (and I corrected her), and she couldn’t explain why I was still so scarily ‘high risk’ when the majority of complications made more likely by my size had not come to pass, we agreed to disagree and she signed me off to the care of my lovely, supportive midwifery team.

I then met with the Supervisor of Midwives, who was far more sensible, said that she thought current policies are non-sensical and discriminatory, and said that as far as she was concerned, she was more interested in my previous birth history as an indicator of how this birth would go. I’m so pleased to say that this study totally supports the midwife’s experience!

On the flip side – if I hadn’t been subjected to non-sensical and discriminatory policies, I probably would never have had the courage, inclination, or determination to birth at home. Which was wonderful, and I’d do it again in a heartbeat. Every cloud, eh?

Reasons To Avoid Getting Carved Like a Pumpkin – If You Can.

As things go, we’re pretty lucky in the UK. We have excellent maternity services; free at the point of delivery (literally)! It sometimes feels ungrateful to be complaining about how we are routinely over-medicalised as bigger women when we are in such a fortunate position compared with some women in other parts of the world.

Yet in the medicalisation stakes, (or should that be medicalization?) the USA beats us hands down. Bigger mums there are routinely pushed into having caesareans without a backward glance.

Don’t get me wrong. Sometimes caesareans are necessary, really necessary, but the trouble is that in the temptation to avoid the ‘what if’ scenarios and the risk of uncertainty, can lead some medical professionals so see c-sections as a nice, reliable, predictable solution to that messy, noisy, unpredictable childbearing business.

It happens here in the UK too. Someone I know; an educated, professional woman, who had all her children by elective caesarean section, despite having no medical reason for them – just a high BMI, did so because she was advised that the most dangerous birth was an emergency c-section – and that the only way to guarantee not having an emergency c-section is to have an elective c-section instead. So that’s what she did.

Any birth experience is amazing and awe inspiring, but with my fluffy natural-birth rose-tinted spectacles on, I just can’t imagine she’d have had the same sense of euphoria, empowerment, and personal satisfaction that comes from the achievement of pushing a 7lb+ melon out of your nether regions. It helps to have great support, but when push comes to shove (literally), only you can do it. And having completed that amazing task, the feeling is AWESOME!

Being sliced and diced and handed your baby by someone in a green gown while you’re flat on your back and likely to stay that way for a few days just isn’t the same. Is it?

Or is it?

What would I know? I’ve never gone for the sunroof option. And does it matter anyway?

But the increased incidence of caesarean sections in bigger women saddens me.

Because studies have shown that the increased rate of c-section may just be a symptom of how labours are managed differently in bigger women.

Higher caesarean section rates in women with higher body mass index: are we managing labour differently? (254.3 KiB)

Because my own births were amazing, beautiful, wonderful experiences. I kid you not. After them I felt invincible, like I literally could conquer the world and achieve anything. Single handed. With just a fondue fork, if necessary.

Because despite all the fear-fodder about being overweight and the potential consequences that might bring, they turned out to be just that – fear-fodder and nothing more. After my hospital birth (my first) I wanted to walk home! Until my husband pointed out that I’d just been awake for 24 hours straight, probably ought to get some rest, and that it was probably just the hormones talking… Probably just as well that my second birth was at home.

I guess it’s personal choice at the end of the day, and my friend was glad to be able to have the choice of having a doctor deliver her babies for her. Her decision was fully informed, and while I would not have made it, it was right for her.

But I wonder how well informed we bigger women in general are of the risks of caesarean section. On some of the blogs I frequent, some women are all to keen to use their BMI status as leverage to request a c-section, despite the fact that they have no evidenced medical need for one. Why? Because they’re scared of childbirth? Have lost faith in their bodies? Have more faith in the doctors? See celebs having caesareans as the norm? See it as an easier/quicker option? Are worried about the pain of childbirth? Are unaware of the pain of a major op? I have no idea. I just want to yell loudly NOOOOOOOOOOOOOOO! But each to their own.

However, on the topic of risk, Well-Rounded Mama, which is a great US site I used to refer to when I was pregnant, has just published a great post on the complications of wound healing in bigger mums. It’s a well known risk. Yet I’m not sure how often it’s brought up by medical professionals in c-section discussions, and how aware people are of it or any of the potential complications of caesareans.

http://wellroundedmama.blogspot.co.uk/2013/08/cesarean-wound-complications-reason-to.html

All the more reason to stick to natural interventions like birth pools and massage, if you ask me, and keep the knives for carving pumpkins.