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• • • swellings pain tenderness and redness, particularly at the back of your leg, below the knee. Please report any of the above symptoms to your midwife or doctor immediately. Ultrasound scanning We offer all women two scans during their pregnancy, one to date the pregnancy between 11-14 weeks and one to check baby’s major organs and physical characteristics at around 20 weeks. If you have a high BMI, particularly with a lot of fatty tissue around your abdomen, it can sometimes be difficult to see all of baby clearly. This limits the potential to pick up problems with the baby and reduces the ability to see how well the baby is growing. How does my BMI affect labour? Women who have a high BMI may experience more difficulties in labour. However, many women have no problems. We know that women who have a high BMI are at increased risk of having: • Pregnancy induced • A longer labour • A caesarean section (raised BMI increases chance of unsuccessful vaginal birth) • A larger baby and difficulty delivering the baby’s shoulders • A baby that experiences breathing difficulties after birth • Heavy bleeding after the baby is born • Problems with having epidurals and drips inserted • Difficulty recording the baby’s heartbeat • Slower healing and increased risk of infection If your BMI is over 35 we advise that you give birth on the main delivery suite, so doctors and midwives can respond quickly if any problems occur. Delivery Suite also keeps specialised equipment for women who are heavier. Post natal care Raised BMI is associated with reduced breast feeding rates. We offer breast feeding workshops antenatally and support postnatally. Please discuss this with your community midwife. Continue to eat healthily but do not restrict your calorie intake or ‘crash diet’ if breast feeding. Try to continue activity after discussion with your community midwife or GP. Epidurals and pain relief A Raised BMI Your Pregnancy and Labour If you have a BMI of over 40 one of our anaesthetists will usually ask to see you or contact you by telephone. The anaesthetist will assess and discuss your options for pain relief in labour. Having an increased BMI can make it more difficult for an epidural to be inserted. It is safer to have an epidural than a general anaesthetic if a person has a high BMI. Useful websites www.rcog.org.uk www.breastfeeding.nhs.uk www.nhs.uk/livewell/pregnancy Acknowledgement to Sarah Barlow (midwife) for extracts taken from the Southampton University NHS Trust leaflet entitled Pregnancy and Body Mass Index (BMI) References CMACE/RCOG Joint Guideline (2010) Management of Women with Obesity in Pregnancy. London: Centre for Maternal and Child Enquiries, Royal College of Obstetricians and Gynaecologists NICE Guidelines no 27 (2010) Dietary Interventions and Physical Activity Interventions for weight management before, during and after pregnancy. London: National Institute for Health and Clinical Excellence. PIL10825/K Evans/Mar14/review Mar16 Maternity A raised BMI - Your pregnancy and labour Activity Am I at risk of diabetes? Your BMI is your weight to height ratio, and is a useful way of knowing if a person is overweight or obese. We measure and record your BMI in your ‘Pregnancy notes’ as early as possible in the pregnancy, usually at your booking appointment. We record your weight again at about 36 weeks. If you have an uncomplicated pregnancy exercise is safe for both you and your unborn baby. Pregnancy can be a time for making changes and exercise is known to reduce tiredness, varicose veins and leg swelling. Having a raised BMI can increase your risk of diabetes. The higher your BMI, the greater chance you have of developing diabetes. We offer women with a BMI of 30 and over a screening test for diabetes (glucose tolerance test). • • • • A person of ideal weight has a BMI of between 18.6 - 24.9 An overweight person has a BMI of 25 - 29.9 An obese person has a BMI of 30 - 34.9 A morbidly obese person has a BMI over 35 How can a raised BMI affect pregnancy? Research shows that a BMI of 30 or more at the start of pregnancy can increase the risk of complications during pregnancy, labour and after you have given birth. We will offer you blood tests later on in pregnancy to screen for diabetes. At your booking appointment: • • If you have a BMI of 30-35 you will be offered an appointment to see an obstetric doctor between 30-32 weeks If you have a BMI of over 35, you will be offered an appointment to see an obstetric doctor between 14-20 weeks Eating healthily It is really important that you try not to gain more weight than is recommended. Aim to put on no more than 9kgs (19.8lbs) during the pregnancy. Putting on no weight will not make the baby small, the growing baby will take all it needs from your body stores. It is important that you have a low fat, low sugar and high fibre diet. Try to eat five portions of fruit or vegetables a day and drink plenty of water. The community midwife can arrange for you to meet with a dietician. We encourage you to exercise as part of a healthy lifestyle. If you did not exercise regularly before pregnancy it is acceptable to start now. Try to build activity into your daily life. For example, gradually build up from a 15 minute brisk walk or swim three to five times a week (up to 30 minutes). Please see useful website links overleaf for further information about exercising in pregnancy. Please speak to your doctor or midwife if you are unsure about exercising in pregnancy. Additional supplements - folic acid/vitamin D All women are at increased risk of vitamin D deficiency in pregnancy and you are advised to take a pregnancy multi-vitamin daily during pregnancy and while breastfeeding for the vitamin D (10 micrograms supplementation). It is also recommended that you take a higher dose of Folic Acid (5mgs). Ideally, you should start taking a folic acid supplement before conception, but even if you didn’t do so, it is worth starting as soon as you find out you are pregnant and continuing to take folic acid until you are 13 weeks pregnant. You will need to see your GP for a prescription of folic acid 5mgs. Checking the position of your baby It is sometimes difficult for midwives and doctors to find out which way your baby is lying and how big the baby is when you have a high BMI. It may also be more difficult to monitor the baby’s heartbeat, which can cause difficulties whilst you are in labour. Am I at risk of high blood pressure? Women with a higher BMI are at increased risk of developing high blood pressure. Your midwife or doctor will assess your wellbeing and blood pressure at each antenatal visit and more frequently if required. High blood pressure puts you at risk of developing a more serious condition called pre-eclampsia. One sign of pre-eclampsia can be protein in the urine, so remember to provide a sample of urine at each check-up. Am I at risk of urinary infections (UTI)? Some women with a high BMI are more prone to UTI’s. This could be related to the fact that many of these women also have diabetes, which increases the risk of UTIs. All women are asked to provide a sterile catch of urine at their booking appointment with the midwife; this sample is screened for infection. Your midwife will refer you to your doctor if a UTI is identified at any stage of the pregnancy. Am I at risk of blood clots (thrombosis)? A raised BMI is linked to an increased risk of a thrombosis. This is especially relevant if you have had a blood clot in the past or your mother, father, brother, sister or any other children had one before the age of 50. Your midwife will refer you to an obstetrician if they have concerns about this. The symptoms of a deep vein thrombosis in the leg include: