Bump or bulge? Battling obesity in pregnancy

Kim Watts, Midwife Lecturer, Academic Division of Midwifery, PGEC, City Hospital, Nottingham Editorial Board Bump or bulge? Battling obesity in pregnancy We are well into the year now and at the point where the new year’s resolutions have tailed off. For some people the vows to eat healthier and go to the gym have instead become promises to give up chocolate or wine for Lent and exercise can wait until the weather’s better. Following a healthy eating programme is a way of life, not a diet to be discarded when bored of it. Obesity is a serious problem in the UK with 24% of adults classified as obese in 2007 (Information Centre, 2008). For obese pregnant women the risk factors are higher for a number of complications, such as pre-eclampsia, pre-term labour, and postpartum haemorrhage. Some of the risks to the baby include intrauterine death, hypoglycaemia and high birth weight. In fact 30% of mothers who have a stillbirth or neonatal death are obese (CEMACH, 2007). A recent study has reported that obese women having their first baby are, surprisingly, also at greater risk of having a smaller baby and caesarean section (Rajasingam et al, 2009). At a time when attempts are being made to reduce the caesarean section rates, obesity prevalence needs to be addressed. Caesarean sections and complications during delivery mean a longer stay in hospital and increased costs to the NHS. Add to this the need for special equipment, such as blood pressure cuffs and operating tables, and the numbers are going to mount. There is currently a government drive to tackle obesity and to ensure people eat more healthily which includes the issue of guidelines (not for pregnancy), setting up obesity clinics and advertising to the general public. Common advice given to women, probably from family and friends, is that pregnancy is not the time to lose weight. And it is not only women’s weight before becoming pregnant that is of concern; how much is safe to gain during pregnancy? The phrase ‘eating for two’ is often heard but is far from the truth. What are midwives supposed to do when there are no guidelines available as yet on which to base their practice? Richens (2008) suggests that one way to open the discussion on healthy eating and weight is to routinely weigh women as part of their antenatal care. Given that there are more obese women having babies now than 15 years ago, this sounds like a good idea. The British Journal of Midwifery is devoting its annual, two-day conference to this hot topic aiming to cover the effects of obesity on a number of aspects of midwifery practice: from fertility and antenatal booking issues, to medical complications, intrapartum care, as well as breastfeeding with a raised BMI. We are also hosting our Midwifery Practice awards (see page 143), a prestigious event designed to honour those hard-working, innovative and inspiring midwives who make a difference to women’s lives and their colleagues. If you know a midwife, or a team, who inspires you and who you feel deserves recognition, then please nominate them for one of our special awards. BJM