The Royal College of Obstetricians and Gynaecologists is seeking feedback from women on its new leaflet ‘Being overweight or obese during pregnancy and after birth‘.
The closing date for comments is midday on Friday 18 May.
Click on this link to access the RCOG page where you can read the draft leaflet and then feed back your thoughts via their online questionnaire. Make sure you feed back on the right one – NOT the hysteroscopy one (unless you happen to be interested in that too!)
I don’t want to prejudice your thinking, so I’m not saying what I wrote, but I will say that it’s nice to be asked our opinion at last!
Aaand… while you’re busy having your say, let me do another shameless plug for our Big Birthas Parenting Science Gang over on Facebook. We’ve been discussing the topic and what we might research for a little while, spoken to some really interesting experts to get their views; this week we’re talking to experienced midwife and waterbirth expert Dianne Garland (SRN RM ADM PGCEA MSc) of www.midwifeexpert.co.uk. We’re nearly at the point of deciding what we’re going to research – come along and get involved, you don’t have to be a scientist (I’m not!) to get involved in citizen science!
I was quite surprised to discover today that being overweight can not only affect the maternity and antenatal care you receive, but if you’re seeking a termination of pregnancy, it can cause you problems there too.
The British Pregnancy Advice Service (the UK’s leading abortion care service) have today released a briefing paper to highlight the number of women who are being forced to continue with pregnancies against their will, and sometimes against medical advice, because of delays and lack of capacity in the system.
On 46 occasions in 2016 and 2017 – or generally twice a month – BPAS was unable to secure suitable NHS hospital treatment for women by the strict legal cut-off point of 24 weeks.
In other cases, there was significant delay between the woman presenting for treatment and being able to access that treatment: one mother with cancer, whose treatment could not start until the abortion was performed, waited 45 days for an appointment. In another case, a mother with epilepsy and learning difficulties who presented at the end of first trimester was treated nearly 7 weeks later.
But where does high BMI come into this?
Three of the cases for whom BPAS could not find an appointment in time are described thus in the paper:
BMI over 40. Existing children.
Pregnancy is the result of a sexual assault.
Presented at 22 weeks.
No appointment available.
19 years old with three young children. BMI>40. Her ex-partner has recently been released on bail following a prison sentence for domestic violence.
Presented at 19 weeks. No suitable appointment available.
BMI over 40. 18 weeks pregnant. Daughter was recently violently assaulted and raped; she feels unable to cope with both a new baby and supporting her daughter through this experience. Cannot stay overnight and leave her other
children. No suitable appointment available.
Why is this?
While most abortions in the UK are performed outside the NHS by the not-for-profit sector, in stand-alone community clinics run by organisations like BPAS, women with co-morbidities must be managed within a hospital setting where there is swift access to backup care and specific clinical expertise in the event of an emergency.
BMI is included in these co-morbidities, with the cut-off being a BMI of 40, and in fact, according to BPAS’s statistics, it’s the fourth most common reason for referral for treatment.
The briefing goes on to show that many of the clinics they would refer these women into will only treat women up to a certain point in their gestation, so the later you present for treatment, the fewer options you would have in terms of a location to access the service you need. There are just 35 sites across the country offering this service to women, but if you don’t discover you’re pregnant until several weeks along, this can drastically reduce your options.
I can’t imagine coming to the very difficult decision of terminating a pregnancy and then finding you are compelled to continue with it anyway because of a lack of access to appointments.
So, where does this leave us?
One in three women will have an abortion in her lifetime, and according to government statistics, 3.6% of women have a BMI greater than 40.
So, on a rough guesstimate of the figures, it stands to reason that around 1% of the population may find themselves in exactly this situation.
If you’re considering a termination, and you have a high BMI, it looks like the sooner you approach a provider for treatment, the more likely you are to be able to access it, and access it in a location convenient to you. Perhaps in this instance it’s better to approach the provider even while you’re in the process of making up your mind, in order to buy you time to arrange a suitable appointment.
But according to this study of 4968 women in 2016,
“Offspring of obese mothers prone to childhood obesity because they develop ‘fatty liver’ in womb“
So, that sounds worryingly simple enough, an assertion which is reinforced in the first paragraph:
“CHILDREN whose mothers were obese during pregnancy are more likely to become overweight themselves because they develop a “fatty liver” in the womb, research has found.”
As usual, we’re to blame, and “research has found it”, so the article says, so it must be true. Surely?
Unless you read on.
But the trouble is, how many people doread on with articles like this? How many mums, glancing at this and feeling sick to the pit of their stomach at the potential harm they’re doing to their baby/have done to their children, breath deeply, and flick past to something lighter to brighten the mood? If you’re already pregnant/have had the baby there is little point in finding more things to stress over – being a parent is hard enough!
How many healthcare professionals, busy on a lunchbreak, notice the heading and possibly the first paragraph and move on, because there’s no need to read it – it’s clearly just going to tell the thing they already believe to be true; overweight women are harming their children through greed, laziness, and ignorance?
Not all health professionals think this way, certainly, but I’ve met enough to get the impression that it’s not a rarely-enough-held viewpoint. Newspaper articles like this don’t help matters.
The second paragraph kicks us again when we’re down.
“It has long been known that overweight and obese women are more likely to give birth to heavy babies and that these infants are at greater risk of childhood obesity.”
Actually, (and please correct me if you know of more recent studies to the contrary) I think
the link between big mum=big baby is only shown in studies which failed to adjust for mums with poorly controlled blood glucose levels (usually as a result of poorly managed gestational diabetes). Where this is accounted for, there is no established correlation between otherwise obese mums and heavier babies at birth.
The second claim, that ‘these infants are at greater risk of childhood obesity’ does have some grounding; there are plenty of studies that show a correlation between maternal obesity and childhood obesity. It’s very easy to find data on the mother’s BMI at her booking appointment – and so again, lazy researchers have been known to draw conclusions that pregnancy BMI is a factor in the obesity of a 10 year old, failing to account for the environment the child is growing up in after its birth! Funny how these studies are so rarely interested in paternal obesity as an indicator, isn’t it, since that data is so much less readily available?
Then we get onto the third paragraph and the headline starts to unravel…
“However, research published in the Journal of Physiology has revealed for the first time how fat accumulates in the liver and metabolic pathways are disturbed in foetuses developing in obese mothers with diets high in sugar and fat.”
Hang on a second! That additional information makes quite a bit of difference!! “Obese mothers with diets high in sugar and fat“. So not ALL obese mothers, but the ones with poor diets. Obviously much less catchy as a headline though, isn’t it?
Then comes not just the unravelling, but the full scale chopping up of the headline with the sword of Damocles… if you read further down to paragraph eleven.
“The study was carried out using obese pregnant monkeys.”
I’m sorry? What?! Obese. Pregnant. Monkeys??!?
They didn’t mention that in the title, now, did they? No, in fact, The Herald used the word ‘childhood’ in the title. Could have used the more factually correct ‘infant’; it even comprises fewer letters, but implying that this is research on humans makes this a more compelling read, doesn’t it?
The very first word of the article itself is ‘Children’, which we now know should read ‘Baboons’!
I can’t do this, for instance. And I’m not overly fond of bananas.>>
If you google a bit, you’ll discover that Helen McArdle didn’t even write all of the article herself. Most of it, the accurate stuff, was lifted directly from this press release from the Physiological Society. The Herald’s only input was just to add confusion and a click-bait title – and bury the essential information deeper in the text. Standard journalistic fare, sadly.
My advice, always read on if you come across a news story that makes you feel uncomfortable about being a bigger mum. More often than not, the article unravels itself as you read, and your fears prove false.
Even better, find the research the article is citing and read that, if possible, (if, in this case, you’re not squeamish about reading of the the deaths by exsanguination of not-quite-to-term baby baboons…)
This journalistic laziness is so frustrating. Research which usually took scientists months, maybe years to conduct, and several thousand words to explain, are so often twisted and misrepresented when distilled by a journalist into an attention-grabbing article. But the damage is done.
There’s a real lack of good quality research into high BMI pregnancies. There are few studies done specifically on the topic. Those that do exist are often with very small sample sizes, conflate being overweight with medical conditions, or have flawed methodology.
Yet we’re supposed to accept recommendations based on their results?
Even given the state of some of it, I definitely prefer recommendations based on evidence! All too often we’re told we should do something while pregnant because it’s ‘policy’, yet when you start unpicking the advice, it turns out to be based on nothing more than a hunch – e.g.taking an an increased dose of Folic Acid.
And then there’s the problem with finding the evidence that applies to our circumstances when it does exist. Many Big Birthas out there, myself included, have found that it’s best not to assume that your healthcare professionals are experts in whatever course of action they’re proposing, and often have no idea of the evidence base (or lack of it) to support their advice, and so we have to do the research ourselves to ensure we’re making fully informed decisions!
Well, I can announce some exciting news.
Parenting Science Gang is a user-led citizen science project funded by Wellcome, and one of the new groups for 2018 is a Big Birthas Parenting Science Gang! This is an amazing opportunity to get involved in looking at issues faced by mothers and mothers-to-be with a high BMI.
You don’t need to be a scientist – I’m not! You just need to want more information and help us find it! We will look for evidence-based answers to the questions that us bigger mums want to know, and where we find gaps, we’ll design and run our own research studies to discover and publish our own scientific results and add to the body of knowledge available.
We’ll get advice from professional scientists along the way – but the group will be in charge of the experiments.
We’ll also have regular online Q&A sessions with experts. They will help us in designing our experiments, and maybe even point us in the direction of equipment and resources.
So far we’ve already talked about weight management in pregnancy, gestational diabetes, use of blood thinners in pregnancy, fat vaginas and more! And we’ve had Q&A sessions with yours truly and Clare Murphy of the British Pregnancy Advisory Service (BPAS).
Come along and find out more, ask your questions, and maybe even help us to find the answers! You can give as little or as much time as you choose. It’s a closed Facebook group (https://www.facebook.com/groups/1955647771354577/) and there are also some meet-ups being organised across the country for people in the different Parenting Science Gangs to get together and discuss the issues in March and April.