On this page you will find links to all the references I have used while writing for this site.
I had initially intended to submit freedom of information (FOI) requests to all the hospital trusts in the UK, and post them here. Unfortunately, that turned out to be an impossibility given the huge number of hospital trusts in the UK, the fact that policies are periodically rewritten, and the amount of free time I have to work on this site!
But that doesn’t mean you shouldn’t find out this important information!
So, if you are pregnant and want to know as much as possible about your likely treatment (a very sensible plan) then it’s a pretty simple process:
Find the email address to send your query to. This should be easy to find on their website, but if not, use the search function and search for ‘freedom of information request’ or ‘FOI request’
Then submit your questions – here’s what I sent, but you might want to alter it a little:
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 obese 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 obese 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 scansDigital copies/pdfs preferred.
Then you wait for the 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. This can be a postal or email address.
You do not have to:
- mention the Freedom of Information Act
- say why you want the information.
A public authority can charge you for the costs of sending the information, such as photocopying and postage. These are known as ‘disbursements’. But they would always let you know the cost of this beforehand, and obviously, cannot charge this for emailed documents.
By law they must release the information unless there is good reason not to, for example, if it is in the interests of public safety and security (unlikely in the case of hospital birthing procedures!) or they do not record that information.
See the Information Commissioner’s Office page for more info on Freedom of Information requests.
Individual Hospital Policies (A-Z)
Policies are listed alphabetically by the name of the Trust. The name(s) of the hospitals covered by that Trust are listed (in brackets) after the Trust name. The date indicates when I received the policy.
Airedale NHS Foundation Trust (Airedale General Hospital, Keighley) (Feb 2013)
Full marks to Airedale for a sensitively worded policy which is sensible, respectful, realistic and supportive of bigger women.
Interestingly, their policy applies to women with a BMI of 30 or more, or who weigh 100kg or more.
Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s Hospital, Rosie Hospital, Cambridge) (Feb 2013)
All in all, it’s one of the better policies I’ve read.
Countess of Chester Hospital NHS Foundation Trust (Countess of Chester, Chester) (Feb 2013)
A very BMI focused policy. However, after returning for more information about pool use, I’ve been told that access is on a case-by-case basis, so it sounds as though you can argue your corner if you would like to use a pool in their facility.
The are sadly under the misapprehension that BMI ‘must be under 35 for home delivery’ which is absolutely not the case. Choosing to birth at home is every woman’s right, protected in law.
Heart of England NHS Foundation Trust (Heartlands Hospital, Birmingham, Good Hope Hospital, Sutton Coldfield, Solihull Hospital, Solihull) (Feb 2013)
Its intentions seem good. The trouble is I can’t find much evidence of the care being individualised, BMI seems to rule over all considerations. I can report, however, that BMI is not mentioned as a specific exclusion in the waterbirth policy.
Leeds Teaching Hospitals NHS Trust (Leeds General Infirmary, St James’ University Hospital, Leeds) (Feb 2013)
While the content of this guidance is fairly standard, the wording leaves a lot to be desired.
It quite clearly indicates how this Trust believes the “Obese Pregnant Woman” is a thing to be “managed”, and the tone of the language is divisive and confrontational. Big Birtha would be very interested to hear from anyone with first hand experience if the treatment received is equally so.
Mid Essex Hospitals Trust (Broomfield Hospital, Chelmsford) (Feb 2013)
“relating to home births or births in midwife led units – all decisions are risk based according to each individual woman and her particular health, not because of a line on a chart.” Music to my ears…
Bristol Royal Infirmary’s policies and procedures seem fairly standard ‘judge a woman by her BMI and not a lot else’ fodder. But the language used is at least considered – ‘offer glucose tolerance test‘, ‘consider dietician referral’ etc. which is better than some.
|Anaesthesia for the Obese Patient||The Society for Obesity and Bariatric Anaesthesia||431.7 KiB|
|BETTER BIRTHS Improving outcomes of maternity services in England||NHS England||3.6 MiB|
|Diabetes in Pregnancy||NICE||2.5 MiB|
|Diabetes in Pregnancy||NICE||275.8 KiB|
|Green-top Guideline No. 42: Shoulder Dystocia||RCOG||705.5 KiB|
|Immersion in Water During Labour and Birth||RCOG||257.3 KiB|
|Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households||NICE||544.3 KiB|
|Intrapartum care: Care of healthy women and their babies during childbirth||NICE||407.6 KiB|
|Joint statement No.2 : Home Birth||Royal College of Obstetricians and Gynaecologists/Royal College of Midwives||83.2 KiB|
|Management of Women with Obesity in Pregnancy||RCOG||1.0 MiB|
|Obesity: guidance on the prevention, identification, assessment and management||NICE||1.5 MiB|
|Routine antenatal care for the healthy pregnant woman||NICE||7.0 MiB|
|Weight management before, during and after pregnancy||NICE||257.2 KiB|