Obesity and Pregnancy

Many midwives find discussing weight and BMI with women can still cause issues with judgement and stigma relating to unhealthy lifestyles and diet. Weight and height are documented at first booking appointment to calculate BMI, from which women are categorised and care plans made. This can cause issues as many women feel they are still stigmatised for being overweight in the media, they would not be expecting it from health care professionals - especially those in place that are not specialists in diet. However obesity is a risk factor in pregnancy and is becoming increasing apparent in maternity services.

World Health Organisation note that worldwide obesity has nearly tripled since 1975 and in 2016, more than 1.9 billion adults, 18 years and older, were overweight. Most of the world's population live in countries where overweight and obesity kills more people than underweight (WHO 2017).

As mentioned addressing obesity in pregnancy begins with the calculation of the expectant mothers BMI. 
BMI or body mass index was created in 1830s to calculate healthy weight. It has come under much criticism as the weight in kg/height formula tends not to take into account body fat %, or muscle %. It sometimes also can be skewed from a woman's height. People now are also eating different foods, introduction of more non-healthy cheap foods into the market has affected the national weight average and body shapes have changed since 1830s. It is still used however in medicine to determine a 'healthy weight'.

BMI reporting of 30+ is classed as obese, with BMI of 35+ being classed as morbidly obese. The term "obese" itself tends to come with stigma and judgement as this can be difficult in addressing when talking to women.

The best option is to use compassionate care (which all midwives should practice) and discuss the subject without trying to sugar coat the topic. One way to approach would be to discuss the health risks associated with the woman's weight at booking. 

Healthy eating and foods to avoid can often lead to conversation about current eating habits and in turn weight gain/BMI. In my trust the women are allocated to a 'red pathway' when presenting with a high BMI and are explained concerns surrounding options to place of birth, anaesthetic and gestational diabetes. By presenting these risks at booking or in first appointments, midwives can help woman to continue her pregnancy eating healthily for both herself and the baby.

One thing that should be avoided is prompting the woman to think about dieting. the RCM are partners with Slimming World, the only national weight management group which have specialist plans for pregnant and breastfeeding women. However this also has it's critics. Focus should be on health whereas company's such as Slimming World often use body image and being 'slimmer' in advertising their services, presenting a distorted version of body image to women who are going through substantial body changes during pregnancy. A body image in which they should embrace.

Healthy lifestyle management again needs to be addressed holistically, looking at lifestyle, family and socioeconomic status.

By using skills in communication midwives are in a great position to promote health education surrounding obesity and risks in pregnancy and should make advantage of this, through building trusting relationship and not dancing around the subject. This is especially needing in planning birth environment and preferences in regards to pain relief, positions in labour, place of birth and even small issues such as ease of access to veins. This has all been noted as factors which may affect the birth experience of women with high BMI's. 

How have you managed in addressing this antenatally or during birth planning?

Ruth x

twitter: @ruth_stmw