Why hospitals need to grant pool access to bigger women

Anyone who has followed this blog for a while will know that I strongly believe hospitals need to grant pool access to women with higher BMIs.

My being denied access with my first-born is one of the reasons this blog even exists! I’d discussed it at every appointment, was promised a pool birth in the hospital (so long as the pool in the delivery suite wasn’t occupied when I needed it), taken on a tour of the pool room, but then repeatedly denied access to the pool while I was in labour until someone finally told me at 8cm dilated that I would not be allowed to use it after all. It’s also the reason I chose to have my second baby at home!

Hospitals need to grant pool access to bigger women - Big Birtha's Home Water Birth

My second labour and birth, where I did have access to a pool, confirmed everything I had suspected. The warm water was incredible at helping me manage the pain of contractions! Coupled with that, the buoyancy provided by the water meant that I could move around with ease. I was so much more comfortable and relaxed – even during contractions!

The frustrating thing is there’s no evidence to support restricting access!!

To be honest, there’s not a lot of good-quality evidence about the use of birth pools full stop. But because so few women get access to water birth there’s no data to show it’s safe for larger mums. But because there’s no data to show it’s safe, we’re denied access! Anyone see a problem here?

I’m not alone in thinking this!

It turns out that Health Care Professionals are beginning to notice this. So I’m delighted to report that the Association for Improvements in the Maternity Services asked me to write an article for their journal, complete with oodles of references for you to wave in the faces of healthcare naysayers you may meet. Enjoy!

AIMS Journal Article featuring Big Birtha

https://www.aims.org.uk/journal/item/waterbirth-high-bmi

Intended/Intending To Breastfeed?

Researchers from the universities of Manchester, Stirling, and Leeds Trinity are doing some research on the topic of breastfeeding.

They have designed a workbook intended to support bigger mums to breastfeed, and are looking for your feedback. If this sounds like something you’d be interested in…

They need participants who:

  • Are 24 or more weeks pregnant, with a Body Mass Index (BMI) of 30 or more and planning to breastfeed, or
  • Had a BMI of 30 or more at the start of their pregnancy, had a baby within the last 12 months and began and/or are currently breastfeeding.
  • Can read and understand English.

If you take part in this study, you will be asked to use the workbook and participate in an interview (which can be by phone or in person) or focus group two weeks later.

They’re planning for the interview or focus group to last approximately 1 hour and you will be given a high street voucher to say thank you for your time.

If you have any questions or comments or would like to take part in the study, please contact Stephanie Lyons (stephanie.lyons@manchester.ac.uk or 07706123929) and see the attached PDF for more information.

At last! Good news! A study on LOW RISK obese mums!

I’ve said it for quite some time. I know high BMI means a greater risk of developing complications in pregnancy, but what if those complications don’t develop? I’ve never understood why my pregnancies can’t then be considered ‘normal’? Is there such a thing as a low risk obese pregnancy?

At last a large study, from Oxford University no less, has asked this question:

The researchers 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 was 21% for ‘very obese’ but healthy women having a second or subsequent baby. For ‘normal’ weight women having their first baby it was 53% – about 2 and a half times more!! What’s reassuring too, is that this was a large study, looking at 17,230 pregnancies.

Low risk obese pregnancy - Happy pregnant mum in a park - image courtesy of Obesity Canada

Isn’t it time for more equality of access?

This 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, while women with a BMI over 35 are generally restricted to birthing only in an obstetric unit, even if they’ve had previously uncomplicated births?

This finding does highlight a possible anomaly in the guidance given to women on where to give birth

Dr Jennifer Hollowell, lead author of the study

As expected, the researchers found that the risks of complications during childbirth increase with increasing BMI even among otherwise healthy women. But the increase was surprisingly modest; only 6–12% compared with women with a ‘normal’ BMI.

My experience of low risk obese pregnancy

When I was planning the home birth of my second baby (after an easy hospital birth of my first) I met with a consultant obstetrician at 36 weeks. She wasn’t impressed and tried to convince me to birth in hospital; even when I pointed out that it was the hospital’s policy forbidding high BMI women from using the birth pool that was forcing me into a home birth.

The consultation was a waste of time for us both. She misquoted NICE and RCOG guidance (and I corrected her). She couldn’t explain why I was still deemed ‘high risk’ when no complications had arisen. My previous birth had gone without a hint of the complications you can’t predict beforehand (shoulder dystocia, post partum haemorrhage), but she would not consider my pregnancy low enough risk to permit me to use the birth pool in the hospital. So we agreed to disagree and she signed me off to the care of my lovely, supportive midwifery team.

I then met the Supervisor of Midwives, who was far more amenable. The SoM said that she thought current policies are non-sensical and discriminatory, and 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 this study validates her lived experience! (I still had to sign a document saying that I was undertaking home birth against medical advice, though).

However, without the discriminatory policies, I would never have had the inclination or determination to birth at home. Which was wonderful, and I’d do it again in a heartbeat. Every cloud, eh?