subject: Pregnant And Obese: Are The Maternity Services Adequate? [print this page] The UK public is getting heavierThe UK public is getting heavier. March statistics show that 1:4 of the population is now clinically obese. This has meant a steep increase in obesity related health disorders including type II diabetes, hypertension, high cholesterol and joint problems. As a result, many patients have considered bariatric surgery to treat their obesity. Celebrities such as Sharon Osbourne and Fern Britton have alerted the public to the successes of obesity surgery procedure such as laparoscopic adjustable gastric banding and roux-en y gastric bypass surgery
This clearly has implications for providers of health services but is especially important within the area of maternity care, since the implications of poor outcomes affect mother, child and the extended family. 1:5 pregnant women are now clinically obese. Recent research by The Centre for Maternal and Child Enquiries has shown that half of all maternity units were short of basic equipment such as extra wide operating tables and beds. As a result, they have teamed up with The Royal College of Obstetricians & Gynaecologists to produce guidelines to advise maternity units of how best to improve the services and meet the special needs of pregnant women who are obese.
The UK remains one of the safest nations in which to give birth and has a better maternal and perinatal mortality rate than the USA. This is almost certainly associated with the NHS/socialised medicine offering care to all regardless of ability to pay. Regardless of social status, the vast majority of UK women utilise NHS services and many private hospitals depend upon NHS services for obstetric emergencies and specialist neonatal care.
Obesity is associated with an increase in pregnancy and labour complications such as gestational diabetes, hypertension, miscarriage, stillbirth and birth injuries. It is also clear that obesity can make diagnosis technically difficult as ultrasound waves struggle to move through fat meaning that images may be less clear.
Annette, 35, underwent a keyhole gastric bypass with bariatric surgeon Guy Slater:
I had two miserable pregnancies both resulting in emergency caesareans. In the second one it was difficult to monitor the baby in labour as the fat made it hard to pick up his heartbeat. I had to have an emergency caesarean which was awful. The theatre table was a bit narrow and I was terrified of falling off. The pregnancy was awful too as my diabetes meant the baby got very big. I hated having the growth scans since the scanners struggle to get good pictures and I felt really guilty.
After my gastric bypass I tried pregnancy once again. It couldnt have been more different. I was more comfortable, less breathless and everything was so much easier. I had a normal sized baby and was thrilled to give birth naturally. I cant thank Mr Slater enough for advising that bariatric surgery and the gastric bypass was the right option for me.
Toni Russo is a bariatric nurse consultant for Streamline Surgical who has worked as a midwife in fetal medicine. She says:
Simply telling women to lose weight is unhelpful and does not help with the current pregnancy. Many of our patients have bariatric surgery and procedures such as the gastric bypass or gastric band as they want to have children. They have had fertility problems, miscarriages or a previous bad experience giving birth. In an ideal world, all women would be fit and well prior to conception and follow the RCOGs advice to lead healthier lives before becoming pregnant. However, we dont live in an ideal world. Pregnancy is a difficult time for many women. It is imperative that they are not made to feel guilty for being overweight, they are offered the correct equipment and treated with dignity.
Obesity will not disappear in the near future and it is likely that more women will choose bariatric surgery and procedures such as gastric bypass surgery and gastric band surgery to help them to address their weight problem. It is also likely that many women will still be obese and the maternity services offered need to cater for these women.
by: Daniel Harris
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