Countess of Chester Hospital NHS Foundation Trust (Countess of Chester, Chester)

The Countess of Chester Hospital,
Liverpool Road, Chester. CH2 1UL

Tel: 01244 365 000

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.

Unfortunately, the Countess of Chester 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.

While the hospital may advise against it, they may not forbid it. Many women with a BMI over 35 (Big Birtha included) have successfully and happily birthed at home.

If your BMI is between 30 and 35, you can expect to be given a moderately scaremongering leaflet entitled ‘Information for Pregnancies with increased BMI’, which tells you all the increased risks but not by how much the risk is increased (so you have lots of nice things to worry about but no idea about how much to actually worry about them), the ‘here’s all the things that are more likely to go wrong with your pregnancy because you’re fat’ conversation, checked that you’re taking 5mg folic acid, be offered a dietician referral, be booked for a glucose tolerance test at 28 weeks, assessed for risk of high blood pressure and prescribed aspirin if you’re deemed a risk, and you will be booked into ‘Shared Care’, which seems to be a euphemism for Consultant Care.

If your BMI is between 35 and 40, you can expect the above, be told that you ‘should’ give birth in the hospital and not consider home birth, and be referred for extra scans to check your baby’s growth at 28 and 34 weeks.

If your BMI is between 40 and 50, you can expect the above, but also be given an appointment with an anaesthetist, and a presumably fairly patronising assessment of your ‘manual handling needs’ (i.e. can you get yourself out of a chair, can you wash yourself). You’ll be considered a moderate risk for deep vein thrombosis (DVT) and be advised to take medication for 7 days after delivery.

If your BMI is 50 or over, you can expect the above, but they may also suggest that you consider elective caesarean section!? Not sure where or why they dreamt this up, but it’s not from any RCOG or NICE Guidance. Women with a BMI of 50+ are perfectly capable of birthing babies naturally and don’t need to have their abilities and confidence undermined. Fine if there is a valid medical reason, but being fat is not.

I have received no policy for IVF referral, but the covering email states that a woman’s BMI needs to be under 30 to be considered (amongst other criteria).

Policies correct as of February 2013:

NameAuthorSize
NameAuthorSize
Information For Pregnancies With Increased BMICountess of Chester Hospital NHS Foundation Trust18.3 KiB
ObesityCountess of Chester Hospital NHS Foundation Trust559.5 KiB
Venous Thromboembolism ObstetricsCountess of Chester Hospital NHS Foundation Trust456.5 KiB

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3 thoughts on “Countess of Chester Hospital NHS Foundation Trust (Countess of Chester, Chester)

  1. I do like the title ‘plus-size-positive clinician’! (Happily I am spared doing any manual handling assessments.) I think that this web site must offer very useful support for higher BMI mums who can feel very stigmatised. I made the comment to one whom I saw that it was my impression that they all tended to be very uncomplaining, and she agreed by saying rather poignantly that ‘us big girls just don’t want to be noticed’. I always realised that most women with raised BMI don’t like it that way, but she did give me a new perspective.

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  2. I comment as the anaesthetist to whom all women with a BMI of 40 or greater are referred for an antenatal appointment. The driver for this is less clinical need than the requirements of the CNST (Clinical Negligence Scheme for Trusts)who make this one of their criteria for level 3 status. I would be very disappointed were I to be perceived as patronising because I see my role as essentially to provide reassurance. There is nothing that a mother with a high BMI can do about it mid-pregnancy and there is no justification for creating alarm by discussing theoretical risks for which there is little good evidence. I do tell them that practical procedures such as epidurals and spinals may be more difficult to perform (‘may’, not ‘will’), but that otherwise they will be treated from the anaesthetic point of view just like any other prospective mother.

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    • Dr Bricker, thank you so much for taking the time to comment. And thank you for being a plus-size-positive clinician. There are some of you out there!

      I hope you approve of the website. I think bigger women are not blind (or deaf) to the extra risks and complications we face, but it’s not unreasonable to ask that the information is communicated sensitively and fairly (which it sounds like you do). I have to confess that I have been on the receiving end of less sensitive and balanced (and factual) interactions, hence the creation of BigBirthas to present the facts and statistics from an alternative angle.

      I totally agree with your point about how a high BMI mother can do little about her BMI mid-pregnancy and there’s little point in scaring her half to death. Practical advice going forward good. Scaremongering and recrimination bad. I hear far too many stories of heavy-handed professionals making women feel wretched for little or no benefit. I have met such professionals. The use of language is powerful and too often underrated. As you point out, it’s ‘may’ rather than ‘will’, ‘we advise’ rather than ‘you need to’ etc; the distinction is so important, and so overlooked by some.

      If you are the unfortunate person who has to conduct the ‘manual handling risk assessment’ then I do apologise if you manage to deliver it in a way that is not patronising. My experience thus far (not in Countess of Chester) is that they are demeaning and insulting, given that both times I have been subjected to a long list of questions like ‘can you wash yourself?’ ‘yes’, ‘can you get out of a bed by yourself?’ ‘yes’, ‘can you go to the toilet without assistance?’ ‘yes’ and so on and on and on, when the person has clearly just watched me walk into the room, sit down, discussed various aspects of my care and aspirations for my birth etc. While I appreciate that you don’t know unless you ask, undoubtedly my assessments could be conducted in a more inclusive and efficient way, and so apologies again if you do deliver it another way.

      In fact, my experiences with anaesthetic referrals has been universally good, even though beforehand it felt like a bit of a waste of time for all concerned, all anaesthetists I have spoken to have been, like you, reassuring, positive, and practical, and the meeting was ultimately useful.

      I am interested to hear that the driver for referral is negligence based rather than clinical! I guess that is to be expected given NICE and RCOG guidance on the topic, and the vast NHS legal bill. I’m afraid to say that this is not the only aspect of treatment of high BMI pregnant women that is driven by fear of negligence litigation rather than clinical need…

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