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/

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Big Birtha

Important New Info About Sleeping On Your Side

Tommy’s, the charity who fund research into miscarriage, stillbirth, and premature birth,
have just released some interesting new information about sleep position during pregnancy, following the publication of a large new research study.

In the third trimester, the advice is to go sleep on your side.
Research has shown that this is safer for your baby, whether at night or for daytime naps.

https://www.tommys.org/pregnancy-information/sleep-side-pregnancy-campaign

While the numbers we’re talking about are very small (fewer than 1 in 200 UK pregnancies results in stillbirth), and the researchers are not sure of the reasons sleep position may have a part to play, it does seem like this small difference in the last three months of pregnancy is significant, and is what’s known as a ‘modifiable risk factor’ – something we can do something about.

I’ve posted more information, with links to the relevant studies and a video here: Sleep Position During Pregancy

How Risk Is Presented In Pregnancy

Today, Big Birtha was honoured to participate in a discussion about how risks are presented to women in pregnancy, organised by the British Pregnancy Advocacy Service (BPAS).

The room was filled with intelligent, interesting and influential women, from many different backgrounds, but who all share the passion that the way things are at the moment needs to change, and what can we do to bring about this change?

After years of running this blog, and feeling pretty isolated at times, it was so lovely to be in a room of like-minded people who agree that actually;

It’s not OK to make women feel failures that they are providing a ‘suboptimal’ host for their baby for whatever reason; be that because they dare to be overweight, or over 35 years of age, or have a medical issue controlled by medication, or want to enjoy the occasional glass of wine, or because they haven’t been taking folic acid and other dietary supplements religiously since reaching childbearing age just-in-case…

It’s not OK that statistics are often presented in the most alarming fashion possible – where relative risks are focused upon as routine because it’s a sure-fire way to make very small discrepancies look much more significant and scare the bejeezus out of us.

It’s not OK to unduly worry women and make them feel guilty about their situation, when that additional stress serves no purpose, can actually be detrimental, and is often at a point where the woman is not in a position to do anything about it.

It’s not OK that during a time when a woman is most apprehensive and in need of support and reassurance that she can be made to feel like she’s a bad/selfish/negligent mother who is undoubtedly doing harm to her unborn child, when she’s probably doing the best she can right now, probably has a perfectly healthy baby gestating inside her, and needs to be able to build rapport with and trust her care givers, not feel wretched every time she has contact with them.

It’s not OK that studies tend to focus exclusively on the behaviours/circumstances of the mother when drawing conclusions (usually negative!) about maternal actions and the consequences on their children (and sometimes their children’s children!), completely ignoring paternal and other societal influences role to play.

It’s not OK that when the media reports on scientific studies and research that the results are often presented with implied blame on the mother, usually from the most sensationalist angle, and that studies with poor methodology but the most sensationalist claims get more attention than those that are more balanced and better planned.

It’s not OK that women aren’t trusted to be able to look at the evidence (or sometimes lack of it!) for themselves in order to reach their own decisions about what’s best for them, their fetus, and their family, and instead are regularly presented with an oversimplified version of the available research, or worse still, a blanket ‘this is policy’ with no justification whatsoever.

It’s not OK that women routinely don’t feel supported in their ‘high-risk’ pregnancies, but that they’re a problem or ticking time bomb to be ‘managed’.

The fight for a more balanced, consultative, and respectful treatment of women in pregnancy is far from over, but this meeting really felt like the start of something positive.

If you want to see more of what BPAS have been doing on this topic, they’ve written some great press releases here:

www.bpas.org/about-our-charity/press-office/press-releases/