Download A Raised BMI

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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).
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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:
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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: