Looking For A Bargain?

I’ve always got one eye open for a cheeky bargain. And when I’m updating the links for this site I often spot great deals, so I thought I might as well share them with you!

Hop along to Big Birtha’s Bargains – I’ll post links to any reduced price plus-size maternity wear (or regular items that could be suitable as maternity wear) I find, please feel free to post any good deals you spot.

Even if you wouldn’t fit into that gorgeous bargain of a size 22 babydoll dress, some other Big Birtha out there might be looking for just that!

Weight Management In Pregnancy – Nursing Practice

New article on weight management in pregnancy in Nursing Practice magazine:

It highlights some interesting points:

  • UK data suggests that between 40-65% of women gain too much weight in pregnancy.
  • International research suggests that women who gain too much weight in pregnancy irrespective of pre-pregnancy BMI, have an increased risk of pre-eclampsia, caesarean section, and delivering larger babies.

So while we know that being overweight before pregnancy confers slightly higher risks, it is interesting to note that for any pregnant woman, controlling weight gain is important.

  • A large UK trial recently found that limiting weight gain in pregnant women with obesity did not result in a lower risk for gestational diabetes, indicating that there is no strong evidence for what constitutes appropriate healthy or safe weight gain in pregnancy.

This is very interesting, because I have had concerns ever since the Royal College of Midwives started receiving income from Slimming World as a ‘partner’ and then the next thing I knew, larger pregnant women left, right, and centre were being packed off to Slimming World, despite the advice, from the Royal College of Obstetricians and Gynaecologists always having been to not try to lose weight while pregnant.

Now the argument for sending people to Slimming World is that by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount, which is not harmful. And I can hardly complain, I lost weight in both of my pregnancies through a variety of factors – more exercise (I LOVED aquanatal), consciously trying to eat more healthily, but predominantly because I felt sick as a dog for the first trimester and felt constantly full for the third!

My issue is – is sending pregnant women who are expressly advised not to try to lose weight to an organisation called Slimming World sending the right message? Given that the setting of Slimming World meetings and the entire focus for most of the rest of the participants in attendance is all about losing weight, is that the right environment for someone who is expressly not supposed to be trying to lose weight because it could be harmful to them and their fetus? Ho hum.

  • Midwives often report feeling anxious or worried about discussing weight with pregnant women.

This is probably true for many midwives. And may actually be the cause of some of the tactlessness we encounter. If we already anticipate resistance before we discuss something (think of a dispute you’ve had to raise with a friend or significant other) often our anxiety about raising what we perceive will be a difficult topic clouds the way we deliver the message, and so we start off on a bad foot before we’ve even got anywhere. Phrasing difficult questions or topics sensitively and non-judgementally is an incredibly important and underestimated skill.

  • NICE recommends that all women should be weighed at the start of pregnancy, but weighing should only continue throughout pregnancy if there is a clinical reason to do so; women should not be weighed repeatedly during pregnancy as a matter of routine.

So feel free to mention this if you’re seemingly getting on the scales every five minutes.

  • As there are no UK guidelines regarding pregnancy weight gain, healthcare professionals are advised to focus on supporting women to eat healthily and keep active. This advice is the same for all women regardless of their weight category.

So if you’re feeling like you’re being nagged, remember, you may not be. The same advice is supposed to be given to all pregnant ladies.

  • Moderate physical activity in 15 minute bouts three times a week is advised before increasing this activity to 30 minutes every day of the week. Women who have kept active regularly before pregnancy should be advised that they can continue this activity. If women struggle to keep active in pregnancy, they should be advised to avoid being sedentary, i.e. avoid sitting for prolonged periods of time.

This is another bugbear of mine, so glad there is an implication that questions should be asked about pre-pregnancy activity levels. It drives me bananas when women are automatically told they need to ‘get more exercise’ before the healthcare professional has actually ascertained what exercise level they are already at!

I know of fitness instructors who do a ton of exercise but are still overweight and even officially obese. Obesity does not necessarily mean inactivity. I got told to ‘slow down!?’ in a surprised manner when I galloped up the stairs ahead of my midwife once, and there were remarks at how sprightly I was at getting in and out of the birth pool too…

  • This support needs to be delivered in a sensitive manner taking the woman’s circumstances into account.

Hurrah for them making this point! So don’t forget to remind your healthcare professionals of this if you feel they’re overstepping the line at any time.

Big Birtha x

For the full text, click here:

www.nursinginpractice.com/article/weight-management-pregnancy

Shoulder dystocia page now online!

Shoulder dystocia is a popular reason given for restricting the choices in how and where we give birth as bigger women.

But is this fair?

The potential consequences aren’t great, and as bigger mums we’re told that we have a 3 or 4 times greater risk. But a look at the evidence, as usual, is not that clear cut.

More information here.

BBC News – Delay pregnancy after obesity surgery, women warned

Interesting news for anyone considering weight loss surgery before trying get pregnant.

Even though you’ll have lost the weight, you still won’t escape the ‘high risk’ bracket, and will likely receive much of the same treatment that you would if you were still big. Furthermore it seems that a number of things could go wrong, a significantly increased risk of miscarriage being one of them, if you get pregnant within 18 months of the surgery (31% of pregnancies occurring within 18 months of surgery, as opposed to 18% of pregnancies occurring 18months+ after surgery).

BBC News – Delay pregnancy after obesity surgery, women warned.

Comes from this study:

Pregnancy outcome following bariatric surgery (12.1 KiB)

Which looks at different research, some of which compared pregnancies after different types of weight loss surgeries against each other, some against those of obese patients who haven’t undergone surgery, and some against ‘healthy weight’ women.

The text (and sub-text) is quite interesting:

“Case–control studies demonstrate increased fertility following bariatric surgery, although these studies lack complete data and statistical significance due to small sample sizes.”

It would be interesting to see whether this is due to the positive effect of weight loss on Poly Cystic Ovary Syndrome in particular, which is known to affect fertility the heavier you are, or whether in general it improved fertility for larger women.

“Post-LAGB [Laparoscopic adjustable gastric banding] pregnancies are not without complications. Band slippage and migration can result in severe vomiting. Band leakage is reported in 24% of cases.”

Sounds tempting.

“Mild nutritional deficiencies are frequent after bariatric surgery”.

 

“Significant malabsorption in the mother can affect the energy content of breast milk and may affect the postnatal growth of the baby”.

The solution given for this is to supplement breast milk with formula. But mixed feeding with both bottle and breast is a significant indicator for stopping breastfeeding sooner.

“Aside from nutritional deficiencies, case reports have documented risks of intestinal hernia (most commonly reported), intestinal obstruction, perforation and death in pregnant women post-RYGB [Roux-en-Y gastric bypass].”

Hmm. Again, tempting.

If you are considering gastric surgery because you were concerned about having a caesarean or induced labour:

“Overall, bariatric surgery does not appear to reduce the risk of CD [caesarean delivery].”

 

“Another study showed higher labour induction rates as compared with non-obese comparison groups.”

There may also be reasons not to consider certain types of bariatric surgery if planning to get pregnant. One study reported:

“higher congenital malformation rates following BPD [Biliopancreatic diversion].” and

 

“Miscarriage rates following BPD [Biliopancreatic diversion] may be higher.”

Finally,

“There is no strong evidence that adverse neonatal outcome rates are higher following  LAGB and gastric bypass procedures as compared with obese groups”.

So reading between the lines, there is evidence that outcomes for babies aren’t as good following surgery, just not strong evidence?

But my personal favourite is:

“maternal and fetal outcomes are acceptable with LAGB and gastric bypass”.

Acceptable? What does that mean?

On the positive side:

“Most studies report a reduced incidence of GDM [gestational diabetes mellitus] in
patients following bariatric surgery.”

 

“Studies comparing pre- and postbariatric surgery pregnancies consistently show that the incidence of PIH [pregnancy induced hypertension or high blood pressure] and pre-eclampsia is lower following surgically induced weight loss than the risks in obese women.”

The study concludes:

“In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women”.

Hmm. I’m struggling to be convinced. 21% of post-surgery pregnancies reported problems according to one study. Though I can’t find a comparable statistic for obese women who have not had weight loss surgery, that doesn’t seem like great odds. Presumably the reduction in serious complications like pre-eclampsia are significant enough for the authors to reach this conclusion.

As always, it’s for you to make up your own mind, but at least here’s some information for you to get started.