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?