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| Big Mother - How Obesity REALLY affects birth. |
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Having watched and listened to women attending antenatal classes for over fifteen years now, I've noticed for a long time the correlation between obesity and difficult labours. Yet I've long wondered about the similarity to the "older" mother : the obese woman can be so surrounded with doubt as to her ability to give birth that it becomes a self fulfilling prophecy of doom. Added to this, obese women can be made to feel so completely ill at ease with their own bodies that they are inhibited about displaying their bodies, feel exposed to comment and censure from their carers and are unlikely to strip naked, exude oxytocin and birth in amazonian triumph. One of the saddest moments in my antenatal teaching career was listening to a plump, but not clinically obese, woman telling me her birth story. She had been labouring well at home and then went to hospital as planned. She had hoped for a water birth and, as she was already 6cm at admission, was soon stepping into the lovely pool at her local unit. As she did so, her midwife asked her whether she'd been drinking a lot of milk during this pregnancy. She felt this was an overt comment on her size and guess what happened to her labour? She never dilated another millimetre and the birth ended up in failure to progress caesarean, postnatal depression and misery. I do wish I could have persuaded this lady to complain. But she had perfectly absorbed the "failure to progress" as her own body's failure, the label on her size, accepted as just her dues for committing the social sin of being mildly overweight. Just this week there has been research showing that fertility can be impaired in eating disordered women and it has long been recognised that for an anorexic, pregnancy is a desperately difficult time. Also that pregnancy can be the trigger for eating disorders or can make an existing disorder worse. Being "allowed" to gain weight, have a tummy - the removal of the societal pressure to be a sexually attractive "babe" can remove some self imposed restrictions on eating. For others the terror of being out of control, feeling compelled to "eat for two" can have disastrous effects on existing coping methods. If the woman you are seeing is already obese she may have a compulsive eating disorder of which she is already bitterly ashamed. It may already be a huge ordeal to present her bump for palpation, muttering about how you can't feel the head through the layers of fat will send her home to raid her cupboard and stuff back down all those feelings the whole appointment has aroused in her. In short she is in need of just as much sensitive care as the anorexic, she is however exceedingly unlikely to receive it. Obesity is the new smoking and it is often viewed in a worse light. At least smokers are acknowledged to have an addiction, if you are overweight you are merely sinful, indolent, greedy. It is still perfectly socially acceptable to make fat jokes with impunity whereas most comedians nowadays hesitate before making pejorative comments about someone's sex, race, sexuality, mental capacity or colour. In my more "to terms" moments I can call myself Reubanesque, voluptuous or traditionally built. Yet every morning I listen to the Radio One DJ Chris Moyles, no skinny minny himself, refer to fat women as "lard-arsed". Before even considering being upright and forward leaning to birth my babies, my first thought would be who would be looking at my bottom while I did so and what comments they would be making to themselves. Midwifery is still, in the main, a female profession and many midwives will themselves be overweight yet many will not themselves be at ease with their own size and may have many personal conflicting feelings about approaching the subject with a woman for whom they are caring. Advising a woman not to put on too much weight when you are traditionally built yourself can lead to some interesting conversations. And women don't take kindly to being lectured by those who clearly do not have a weight problem themselves. So for the midwife who is overweight herself she may feel she does not have the authority, if she is not overweight she may be perceived as judgmental. Actually the perception of being judged by a younger, skinnier midwife isn't misplaced -I've just had the misfortune to read the Community Midwife's comment on her Facebook page about a client with a "mahoosive apron and gigantic BMI" and how disgusting it felt to palpate her sweaty abdomen. Gee, thanks for that, I'd feel really inspired to attend my midwifery appointments if I were pregnant now. It is possible to support smokers to give up smoking without impairing their view of their own body and the effect on the pregnancy is immediate. Yet an obese woman still has to eat and by the very act of telling her what impact obesity can have on pregnancy, birth and breastfeeding, are health professionals actually setting her up for failure? Trial by BMI is, in any case, a very crude and ineffectual method for decisions on place and mode of birth. Caesarean is a much riskier mode of birth for an obese woman with increased risk of postpartum morbidity and death. Yet by routinely refusing women access to midwifery led units and birth pools are their carers not putting them on that very path to surgery? Is this not iatrogenesis in action? As always what the system needs and what the woman needs might differ. As an autonomous practitioner ,a midwife might feel that a particular mother to be is intrinsically well, is motivated to manage her weight, has stable blood pressure and no signs of diabetes. What the protocol will say is refer to consultant, decline admission to stand alone maternity unit and strongly dissuade from a home water birth. As well as telling her what her weight might do to her pregnancy and birth will anyone also honestly tell her what attitudes she is likely to encounter and how that might further impact her self esteem? Will she be told that she is likely to end up flat on her back with a belt monitor and an epidural heading fast down the route marked "emergency caesarean"? Or will your average midwife continue to intone "Well I'm afraid your BMI means that you have to be seen by a consultant" and usher her off before she sneaks a quick bag of maltesers and breathes a sigh of thanks that she had her babies before she got to that size? |
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| Last Updated ( Friday, 05 August 2011 ) |
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