The big issue in this programme was that of obesity. The RCOG now describes obesity as the most common complication and risk factor in obstetric practice. They identify 3 classes of obesity all of which require obstetric attention commenting that the prevalence of obesity doubled during the 1990s and I can only assume has continued to increase since then.
Official Guidelines
The list of complications to mother and baby associated with obesity are many and serious. From the RCOG guidelines on caring for obese women in pregnancy, they include: miscarriage, fetal congenital anomaly, thromboembolism, gestational diabetes, pre-eclampsia, dysfunctional labour, postpartum haemorrhage, wound infections, dystocia, still birth, neonatal death. There is a higher caesarean section rate and lower breastfeeding rate with an increased risk of maternal death. “In addition, babies born to mothers with obesity are up to 1.5 times more likely to be admitted to a neonatal intensive care unit than babies born to mothers with a healthy weight”
Epidurals are also harder to administer to obese women and the effect of anaesthesia is different to a woman with a normal weight and so pain relief during labour is a complex issue, not least because with the increased rate of caesarean-section, anaesthesia is more likely than not going to be required.
The hospital (all obese women are advised to birth in an obstetric unit) will also require specialist equipment to cope with the manual handling issues as well as specially trained, or highly experienced consultants.
The bad news
Obese women and their babies often need special care which may or may not be forthcoming with due attention to the mental wellbeing. Whilst key guidelines will be met I would not be confident that the feelings and fears of obese women would always be handled with the sensitivity that they may need entering a stage in their life that they probably know deep down they are not physically well prepared for.
There is a government push to educate pregnant women about the numerous dangers of smoking, drinking, unhealthy lifestyles etc but very often by the time women are pregnant it is too late to change the habits of a lifetime not to mention the complications from making them feel guilty and unhealthy at a time in their lives when they could already be feeling vulnerable to their failings and the views of those around them.
The good news
The good news is that any attempts to improve diet and health during pregnancy will be beneficial to the baby in the long term. The metabolism – and many other physical and emotional traits – are set in utero which is why eating healthily in pregnancy is so important. There are steps that can be taken to improve pregnancy and birth outcomes and HypnoBirthing could undoubtedly be part of a package of care. With the ability to birth calmly and comfortably, thus reducing the need for pain relief and keeping women mobile (reducing issues of pressure sores) whilst maintaining a good blood pressure to keep the baby calm, the outcomes would be better using this method than normal labouring conditions.
One born every minute
Carole shows all the fears and lack of preparation expected from watching the other women ‘cared for’ by this hospital. Staff talk around her and over her in the operating theatre where she is clearly terrified though trying to retain a sense of calm friendliness. From her interview during pregnancy it is clear that the doctors have scared her by listing all the complications of obesity and whilst I am all for informed choice, I do not think this philosophy extends to scaring women who can do little about their circumstances, particularly if no additional healthcare support is going to be made available. She copes with brave fortitude and is, obviously, delighted when her child is born safely but do not underestimate the complications she may face postnatally from her scar.