This week we have been talking about pre-pregnancy obesity. We looked at the increasing rates of obesity, then talked about the physiology of obesity and how it increases risks during pregnancy. Today we will turn our attention to what midwives can do. How do we provide the best evidence-based care for obese women?
Midwives don’t seem to be very good at dealing with obesity. Some researchers asked a group of midwives to recruit women with a BMI >30 into a study on the effects of a dietary intervention. But the researchers were actually interested in what the midwives would do. During the four months of recruitment, the midwives only talked 14% of the eligible women. Why? The midwives said they had personal and professional reasons that made them reluctant to talk about obesity with the women.
I get it. You probably get it too. It’s rude. It is embarrassing for the woman. She might be offended. She might get angry. Midwives are supposed to be encouraging, but being told you are obese might undermine the woman’s confidence in her body. But to ignore her health risks is unfair to her.
To really assist a woman, I must understand that obesity will affect not only her options for delivery, but will also affect her health during pregnancy and the health of her fetus. Obesity will affect her health after pregnancy. Obesity will affect breastfeeding. Obesity will affect her child’s development. Ultimately obesity will even affect the length of her life.
She is not simply a uterus waiting to be delivered. She is a woman, learning about her health and making choices. If I take obesity seriously, I can help her make choices that will not only improve her chances of having a vaginal birth, but will improve her chances of maintaining optimum health for her and her family.
Rule Number One
Every woman is told her BMI, not just the “big” women.
Why? Because BMI is as much an estimate of her health risks as her blood pressure or iron level. She has a right to know. And if her BMI is high, she has a right to know that her risks are higher than average so she can do something about it. BMI is not a measure of beauty or value or ability or anything else we think about when we think of the word fat. It is only a measure of health risk, treat it like all the other numbers you share with her. Don’t make it a big deal, just give her the information she needs.
Rule Number Two
Every woman is told her recommended weight gain.
Why? She has a right to know that she can reduce her risks if she can stay within the recommended range. Telling her after she gains more than she should isn’t fair. Never telling her at all doesn’t let her be part of the team. Most women want to be healthy, and they are not going to be offended by your telling them all the things they can do to have as low a risk pregnancy as is possible for them.
Not all women are going to choose to stay within the recommend weight gain range, and not all of them are going to be able to. But at least give her the option and let her make an informed decision.