How To Submit an FOI Request for Maternity BMI Policies

If you’re pregnant or trying to conceive, you might want to know how to submit an FOI request (Freedom of Information) to your local maternity providers. It’s worth finding out as much as possible about your likely treatment beforehand, and it’s pretty simple to do.

How to Submit an FOI Request

  1. Find out which NHS Trusts cover your local area

    Quickest way to do this is to use the postcode location service on the NHS website. This will list all the local services, sorted by distance. https://www.nhs.uk/service-search/Maternity-services/LocationSearch/1802

  2. Check out the Trust websites you’re interested in.

    Mostly clicking through to the individual pages will display the website at the top under the name, if not, just Google it.

  3. Find the page on Freedom of Information requests.

    There always is one. Easiest way is to type “FOI” into the search box, usually found somewhere near the top. Somewhere on that page will list the email address you need to send queries to.

  4. Send your questions/request for relevant policies to the FOI email address.

    If you don’t want to write your own, feel free to use/adapt mine:

    “I would like to know with regard to your fertility, maternity, childbirth and post-natal services:
    1. Do you have a policy for the management of larger women? If so, what is the BMI cut off (or other criteria) where this policy comes into use?
    2. Please attach a copy of the above policy.
    3. Please could you attach any other policies/guidelines/protocols relating to fertility, maternity, childbirth and post-natal which address the management of higher BMI women. This could include (but not be limited to):

    Inclusion/exclusion criteria for use of midwife led unit, hospital birthing pool, home birth, IVF etc.
    Glucose Tolerance Testing and Gestational Diabetes,
    Clexane prophylaxis
    Pre-Birth Anaesthetist referral
    Additional growth scans

    Digital copies/pdfs preferred.

    Kind regards”

  5. Wait for a response

    The authority must reply to you within 20 working days.

    Anyone has a right to request information from a public authority. For your request to be dealt with according to the Freedom of Information Act, you must:

    Contact the relevant authority directly
    Make the request in writing, for example in a letter or an email
    Give your real name; and
    Give an address to which the authority can reply (postal or email)

    You do not have to:
    Mention the Freedom of Information Act
    Say why you want the information

    They can charge you for the costs of sending the information, such as photocopying and postage if you request a copy by mail, but not if you request copies by email. They must let you know any cost beforehand.

    By law they must provide the information unless there is good reason not to; e.g. if in the interests of public safety or security to withhold the information or they do not record that information. See the Information Commissioner’s Office page for more info.

  6. Send the documents to Big Birthas for inclusion on the website!

    If you do get copies of your local policies, please contact me via the form on http://bigbirthas.co.uk/about-big-birtha/contact-big-birtha/ to let me know, and I’ll email back (stops me being inundated with spam!). Then you can send me the documents so I can add them/update them here for the benefit of all.

#FatFertilityMatters Q&A with Nicola Salmon

Are you affected by fertility issues?

Sick to the back teeth of hearing “have you thought about losing weight?”

Want to talk about it, or listen to someone else talk with experience of the issue?

Then join us on Monday April 15th at 9pm.

Nicola Salmon, author of ‘The Fat Girl’s Guide To Getting Pregnant’ and the originator of the #FatFertilityMatters hashtag is going to be with us for an hour to answer your questions on all things fertility related!

To get involved you’ll need to join the Facebook group set up specially (do it now, before you forget!)
https://m.facebook.com/groups/366477067323511

Find out more about Nicola and #FatFertilityMatters at nicolasalmon.co.uk

See you there!

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)