Policies & Research

On this page you will find links to all the references I have used while writing for this site.

I had initially intended to submit freedom of information (FOI) requests to all the hospital trusts in the UK, and post them here. Unfortunately, that turned out to be an impossibility given the huge number of hospital trusts in the UK, the fact that policies are periodically rewritten, and the amount of free time I have to work on this site!

But that doesn’t mean you shouldn’t find out this important information!

So, if you are pregnant and want to know as much as possible about your likely treatment (a very sensible plan) then it’s a pretty simple process:

Find the email address to send your query to. This should be easy to find on their website, but if not, use the search function and search for ‘freedom of information request’ or ‘FOI request’

Then submit your questions – here’s what I sent, but you might want to alter it a little:

FOI Request

I would like to know with regard to your fertility, maternity, childbirth and post-natal services:

1. Do you have a policy for the management of obese women? If so, what is the BMI cut off (or other criteria) where this policy comes into use?
2. Please attach a copy of the above policy.
3. Please could you attach any other policies/guidelines/protocols relating to fertility, maternity, childbirth and post-natal which address the management of obese women. This could include (but not be limited to):
  • Inclusion/exclusion criteria for use of midwife led unit, hospital birthing pool, home birth, IVF etc.
  • Glucose Tolerance Testing and Gestational Diabetes,
  • Clexane prophylaxis
  • Pre-Birth Anaesthetist referral
  • Additional growth scans
Digital copies/pdfs preferred.


Then you wait for the response. The authority must reply to you within 20 working days.

Anyone has a right to request information from a public authority. For your request to be dealt with according to the Freedom of Information Act, you must:

  • contact the relevant authority directly;
  • make the request in writing, for example in a letter or an email.
  • give your real name; and
  • give an address to which the authority can reply. This can be a postal or email address.

You do not have to:

  • mention the Freedom of Information Act
  • say why you want the information.

A public authority can charge you for the costs of sending the information, such as photocopying and postage. These are known as ‘disbursements’. But they would always let you know the cost of this beforehand, and obviously, cannot charge this for emailed documents.

By law they must release the information unless there is good reason not to, for example, if it is in the interests of public safety and security (unlikely in the case of hospital birthing procedures!) or they do not record that information.

See the Information Commissioner’s Office page for more info on Freedom of Information requests.

Individual Hospital Policies (A-Z)

Policies are listed alphabetically by the name of the Trust. The name(s) of the hospitals covered by that Trust are listed (in brackets) after the Trust name. The date indicates when I received the policy.

Airedale NHS Foundation Trust (Airedale General Hospital, Keighley) (Feb 2013)
Full marks to Airedale for a sensitively worded policy which is sensible, respectful, realistic and supportive of bigger women.

Barnet and Chase Farm Hospitals NHS Trust (Barnet Hospital, Barnet, Chase Farm Hospital, Enfield) (Feb 2013)

Barnsley Hospital NHS Foundation Trust (Barnsley District General Hospital, Barnsley) (Feb 2013)

Bedford Hospital NHS Trust (Bedford Hospital, Bedford) (Feb 2013)

Interestingly, their policy applies to women with a BMI of 30 or more, or who weigh 100kg or more.

Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s Hospital, Rosie Hospital, Cambridge) (Feb 2013)
All in all, it’s one of the better policies I’ve read.

Countess of Chester Hospital NHS Foundation Trust (Countess of Chester, Chester) (Feb 2013)
A very BMI focused policy. However, after returning for more information about pool use, I’ve been told that access is on a case-by-case basis, so it sounds as though you can argue your corner if you would like to use a pool in their facility.

The are sadly under the misapprehension that BMI ‘must be under 35 for home delivery’ which is absolutely not the case. Choosing to birth at home is every woman’s right, protected in law.

Heart of England NHS Foundation Trust (Heartlands Hospital, Birmingham, Good Hope Hospital, Sutton Coldfield, Solihull Hospital, Solihull) (Feb 2013)
Its intentions seem good. The trouble is I can’t find much evidence of the care being individualised, BMI seems to rule over all considerations. I can report, however, that BMI is not mentioned as a specific exclusion in the waterbirth policy.

Leeds Teaching Hospitals NHS Trust (Leeds General Infirmary, St James’ University Hospital, Leeds) (Feb 2013)
While the content of this guidance is fairly standard, the wording leaves a lot to be desired.

It quite clearly indicates how this Trust believes the “Obese Pregnant Woman” is a thing to be “managed”, and the tone of the language is divisive and confrontational. Big Birtha would be very interested to hear from anyone with first hand experience if the treatment received is equally so.

Mid Cheshire Hospitals NHS Foundation Trust (Leighton Hospital, Crewe) (Feb 2013)

Mid Essex Hospitals Trust (Broomfield Hospital, Chelmsford) (Feb 2013)
relating to home births or births in midwife led units – all decisions are risk based according to each individual woman and her particular health, not because of a line on a chart.” Music to my ears…

Northampton General Hospital NHS Trust (Northampton General Hospital)
(Feb 2013)

Princess Alexandra Hospital NHS Trust (Princess Alexandra Hospital, Harlow, Essex) (Feb 2013)

University Hospitals Bristol (Bristol Royal Infirmary, Bristol) (Feb 2013)

Bristol Royal Infirmary’s policies and procedures seem fairly standard ‘judge a woman by her BMI and not a lot else’ fodder. But the language used is at least considered – ‘offer glucose tolerance test‘, ‘consider dietician referral’ etc. which is better than some.

University Hospitals of Leicester NHS Trust (Leicester General Hospital, Leicester; Leicester Royal Infirmary, Leicester; Glenfield Hospital, Leicester) (Feb 2013)

University Hospitals of Morecambe Bay NHS Foundation Trust (Royal Lancaster Infirmary, Lancaster; Furness General Hospital, Barrow-in-Furness; Westmorland General Hospital, Kendal) (Feb 2013)

Western Health & Social Care Trust (Altnagelvin Area Hospital, Londonderry; South West Acute Hospital, Enniskillen; Tyrone County Hospital, Omagh) (Feb 2013)

Worcestershire Acute Hospitals NHS Trust (Alexandra Hospital, Redditch, Kidderminster Hospital, Worcestershire Royal Hospital) (Feb 2013)

Wirral University Teaching Hospital NHS Foundation Trust (Arrowe Park Hospital) (Feb 2013)

York Teaching Hospital NHS Foundation Trust (York Hospital, Scarborough General Hospital, Bridlington & District Hospital) (Feb 2013)


Official Guidelines:

Anaesthesia for the Obese PatientThe Society for Obesity and Bariatric Anaesthesia431.7 KiB
BETTER BIRTHS Improving outcomes of maternity services in EnglandNHS England3.6 MiB
Diabetes in PregnancyNICE2.5 MiB
Diabetes in PregnancyNICE275.8 KiB
Green-top Guideline No. 42: Shoulder DystociaRCOG705.5 KiB
Immersion in Water During Labour and BirthRCOG257.3 KiB
Improving the nutrition of pregnant and breastfeeding mothers and children in low-income householdsNICE544.3 KiB
Intrapartum care: Care of healthy women and their babies during childbirthNICE407.6 KiB
Joint statement No.2 : Home BirthRoyal College of Obstetricians and Gynaecologists/Royal College of Midwives83.2 KiB
Management of Women with Obesity in PregnancyRCOG1.0 MiB
Obesity: guidance on the prevention, identification, assessment and managementNICE1.5 MiB
Routine antenatal care for the healthy pregnant womanNICE7.0 MiB
Weight management before, during and after pregnancyNICE257.2 KiB

Research Studies:

A systematic review of maternal obesity and breastfeeding intention, initiation and durationL Amir, S Donath293.7 KiB
A systematic review of the ultrasound estimation of fetal weightN. J. Dudley87.2 KiB
Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance.Sarwer DB, Wadden TA, Foster GD.87.3 KiB
Association between maternal sleep practices and late stillbirth – findings from a stillbirth case-control studyAEP Heazell, M Li, J Budd, JMD Thompson, T Stacey, RS Cronin, B Martin, D Roberts, EA Mitchell, LME McCowan9.5 KiB
Association between maternal sleep practices and risk of late stillbirth: a case-control studyTomasina Stacey, John M D Thompson, Ed A Mitchell, Alec J Ekeroma, Jane M Zuccollo, Lesley M E McCowan117.6 KiB
Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births SurveyJordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G.929.0 B
Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of deliveryDresner M, Brocklesby J, Bamber J.12.8 KiB
Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeedingRowe-Murray HJ, Fisher JR.88.8 KiB
Breast-feeding and its relation to smoking and mode of deliveryLeung GM, Lam TH, Ho LM87.6 KiB
Effect of Body Mass Index on pregnancy outcomesSohinee Bhattacharya,Doris M Campbell, William A Liston, and Siladitya Bhattacharya259.3 KiB
Effect of maternal obesity on the ultrasound detection of anomalous fetuses.Dashe JS, McIntire DD, Twickler DM.84.9 KiB
Factors predicting severe childhood obesity in kindergartenersG Flores and H Lin383.9 KiB
Factors promoting or inhibiting normal birthSamantha J. Prosser, Adrian G. Barnett and Yvette D. Miller607.8 KiB
Fetal macrosomia - a continuing obstetric challengeHeiskanen N, Raatikainen K, Heinonen S86.3 KiB
Fooled By FoodNutrition Action Canada52.9 KiB
Gestational weight gain and adiposity, fat distribution, metabolic profile, and blood pressure in offspring: the IDEFICS project.Dello Russo M, Ahrens W, De Vriendt T, Marild S, Molnar D, Moreno LA, Reeske A, Veidebaum T, Kourides YA, Barba G, Siani A80.7 KiB
Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control studyLesley M. E. McCowan , John M. D. Thompson, Robin S. Cronin, Minglan Li, Tomasina Stacey, Peter R. Stone, Beverley A. Lawton, Alec J. Ekeroma, Edwin A. Mitchell168.4 KiB
Higher caesarean section rates in women with higher body mass index: are we managing labour differently?Abenhaim HA, Benjamin A.254.3 KiB
Immersion in water in labour and birth (Review)Cochrane Review741.1 KiB
Influence of head-out water immersion on plasma renin activity, aldosterone, vasopressin and blood pressure in late pregnancy toxaemia.Kokot F, Ulman J, Cekański A.82.8 KiB
Linear association between maternal BMI and risk of caesarean sectionG Barau, P-Y Robillard, TC Hulsey, F Dedecker, A Laffite, P Gerardin, E Kauffmanna531.0 B
Management of large-for-gestational-age pregnancy in non-diabetic womenAye SS, MillerV, Saxena S, Farhan M12.8 KiB
Maternal Morbid Obesity and the Risk of Adverse Pregnancy OutcomeCedergren MI183.6 KiB
Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in LondonSebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S.216.5 KiB
Maternal obesity in the UK: findings from a national projectCMACE4.5 MiB
Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women.Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM.255.6 KiB
Medically complex women and abortion careBPAS425.4 KiB
Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women.Arthur PG, Smith M, Hartmann PE.87.4 KiB
Obesity affects spontaneous pregnancy chances in subfertile, ovulatory womenJ.W. van der Steeg, P. Steures, M.J.C. Eijkemans, J.D.F. Habbema, P.G.A. Hompes, J.M. Burggraaff, G.J.E. Oosterhuis, P.M.M. Bossuyt, F. van der Veen and B.W.J. Mol6.3 KiB
Obesity StatisticsCarl Baker5.7 MiB
Obesity, obstetric complications and cesarean delivery rate--a population-based screening study.Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, Saade G, Eddleman K, Carter SM, Craigo SD, Carr SR, D'Alton ME; FASTER Research Consortium.89.1 KiB
Outcome of pregnancy in a woman with an increased BMIUsha Kiran TS, Hemmadi S, Bethel J, Evans J.12.5 KiB
Pain management for women in labour: an overview of systematic reviewsJones et al 20120.0 B
Pregnancy outcome following bariatric surgeryR Khan, B Dawlatly, O Chappatte12.1 KiB
Prepregnancy body mass index in non-diabetic women with and without shoulder dystocia.Neumann G, Agger AO, Rasmussen K.81.6 KiB
Prepregnancy Obesity Predicts Poor Vitamin D Status in Mothers and Their NeonatesL Bodnar, J Catov, J Roberts, H Simhan588.9 KiB
Primate fetal hepatic responses to maternal obesity: epigenetic signalling pathways and lipid accumulationSobha Puppala, Cun Li, Jeremy P. Glenn, Romil Saxena, Samer Gawrieh, Amy Quinn, Jennifer Palarczyk, Edward J. Dick Jr, Peter W. Nathanielsz, Laura A. Cox72.7 KiB
Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study.Donath SM, Amir LH; ALSPAC Study Team.89.0 KiB
Risk of neural tube defect-affected pregnancies among obese women.Shaw GM, Velie EM, Schaffer D.88.2 KiB
Safety of Outpatient Surgical Abortion for Obese Patients in the First and Second TrimestersBenson LS1, Micks EA, Ingalls C, Prager SW.75.5 KiB
Sleep Position, Fetal Growth Restriction, and Late-Pregnancy Stillbirth: The Sydney Stillbirth StudyGordon, Adrienne FRACP, PhD; Raynes-Greenow, Camille MPH, PhD; Bond, Diana RN; Morris, Jonathan FRANZCOG, PhD; Rawlinson, William FRACP, PhD; Jeffery, Heather FRACP, PhD362.9 KiB
Statistics on Obesity, Physical Activity and Diet 2013NHS Information Centre1.5 MiB
The Association of Maternal Obesity and Diabetes With Autism and Other Developmental DisabilitiesMengying Li, M. Daniele Fallin, Anne Riley, Rebecca Landa, Sheila O. Walker, Michael Silverstein, Deanna Caruso, Colleen Pearson, Shannon Kiang, Jamie Lyn Dahm, Xiumei Hong, Guoying Wang, Mei-Cheng Wang, Barry Zuckerman, Xiaobin Wang94.7 KiB
The National Diet & Nutrition SurveyOffice for National Statistics1.0 MiB
Transition from overweight to obesity worsens pregnancy outcomeRaatikainen K, Heiskanen N, Heinonen S.12.4 KiB
Weight Gain During Pregnancy: Reexamining the GuidelinesRasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J716.1 KiB


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