Time To Have Your Say!

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!

Abortion Delays for BMI 40+?

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.BPAS referrals by reason

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.

NHS referral abortion sites vs gestation

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,

Safety of Outpatient Surgical Abortion for Obese Patients in the First and Second Trimesters (75.5 KiB)

abortion clinics needn’t be restricting access to women with high BMI at all? Is this yet another thing we should be fighting to be treated the same as any other women?

We’re damned if we do, and damned if we don’t.

Medically complex women and abortion care (425.4 KiB)

Obesity Statistics (5.7 MiB)

 

Now For The Science Bit…

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?

Pregnant Woman in front of windowEven 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.

We’d love to have you on board!

 

How Risk Is Presented In Pregnancy

Today, Big Birtha was honoured to participate in a discussion about how risks are presented to women in pregnancy, organised by the British Pregnancy Advocacy Service (BPAS).

The room was filled with intelligent, interesting and influential women, from many different backgrounds, but who all share the passion that the way things are at the moment needs to change, and what can we do to bring about this change?

After years of running this blog, and feeling pretty isolated at times, it was so lovely to be in a room of like-minded people who agree that actually;

It’s not OK to make women feel failures that they are providing a ‘suboptimal’ host for their baby for whatever reason; be that because they dare to be overweight, or over 35 years of age, or have a medical issue controlled by medication, or want to enjoy the occasional glass of wine, or because they haven’t been taking folic acid and other dietary supplements religiously since reaching childbearing age just-in-case…

It’s not OK that statistics are often presented in the most alarming fashion possible – where relative risks are focused upon as routine because it’s a sure-fire way to make very small discrepancies look much more significant and scare the bejeezus out of us.

It’s not OK to unduly worry women and make them feel guilty about their situation, when that additional stress serves no purpose, can actually be detrimental, and is often at a point where the woman is not in a position to do anything about it.

It’s not OK that during a time when a woman is most apprehensive and in need of support and reassurance that she can be made to feel like she’s a bad/selfish/negligent mother who is undoubtedly doing harm to her unborn child, when she’s probably doing the best she can right now, probably has a perfectly healthy baby gestating inside her, and needs to be able to build rapport with and trust her care givers, not feel wretched every time she has contact with them.

It’s not OK that studies tend to focus exclusively on the behaviours/circumstances of the mother when drawing conclusions (usually negative!) about maternal actions and the consequences on their children (and sometimes their children’s children!), completely ignoring paternal and other societal influences role to play.

It’s not OK that when the media reports on scientific studies and research that the results are often presented with implied blame on the mother, usually from the most sensationalist angle, and that studies with poor methodology but the most sensationalist claims get more attention than those that are more balanced and better planned.

It’s not OK that women aren’t trusted to be able to look at the evidence (or sometimes lack of it!) for themselves in order to reach their own decisions about what’s best for them, their fetus, and their family, and instead are regularly presented with an oversimplified version of the available research, or worse still, a blanket ‘this is policy’ with no justification whatsoever.

It’s not OK that women routinely don’t feel supported in their ‘high-risk’ pregnancies, but that they’re a problem or ticking time bomb to be ‘managed’.

The fight for a more balanced, consultative, and respectful treatment of women in pregnancy is far from over, but this meeting really felt like the start of something positive.

If you want to see more of what BPAS have been doing on this topic, they’ve written some great press releases here:

www.bpas.org/about-our-charity/press-office/press-releases/