Dr Bricker, thank you so much for taking the time …

burger and chips

Comment on Countess of Chester Hospital NHS Foundation Trust (Countess of Chester, Chester) by Big_Birtha.

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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