Hospital Bans overweight Pregnant Women

Charlie - posted on 11/17/2009 ( 23 moms have responded )

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Pregnancy is the one time overweight women can get a break from society. Unless they’re planning to have their baby at one particular English hospital.



The Weston General Hospital has announced it will turn away obese women who want to give birth there – for fear that their weight is going to kill them.



Hold on there, isn’t that the point of giving birth in a hospital with medical practitioners at hand?



A spokesman for the hospital told UK newspaper the Daily Mail: “Our foremost concern is for the safety of mothers who deliver here and their babies. ‘Mothers with a high BMI are at increased risk in labour of bleeding, needing an instrumental delivery or complications, such as the baby’s shoulder becoming trapped behind the pubic bone.”



Again, the reason these women would opt for a hospital birth instead of going it alone. To be fair, the hospital announces any woman who goes into distress will be moved to St. Michael’s, the hospital where the obese women are currently being directed from the beginning.



But the hospital also promises “You will be given the freedom, choice and confidence in your ability to give birth naturally in a relaxed and safe environment.” Where’s the freedom of choice for women with a bit of girth? A high BMI doesn’t mean she doesn’t want a midwife and a “relaxed and safe” environment.



Should the women get a choice? What do you think?

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Mary - posted on 11/18/2009

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I am sure that many of you are going to take what you think is the moral high ground on this one, but as an L&D nurse, I have to agree with this policy. I am going on the assumption that Weston is a community hospital that does not have the capacity to care for high risk births. Please understand that no one is trying to be hurtful or mean here...the ultimate truth is that obesity IS a risk factor for pregnancy, labor and delivery. As someone who works in a hospital that does care for high risk patients of all types, I can assure you these women ARE very challenging to care for, and require additional equipment and personnel that most small community hospitals do not have.

Can a morbidly obese women deliver vaginally with a midwife?? Well, sometimes, but the odds are not in her favor. We do it, but we have, in house, 24/7, an OB house doc and anesthesia. We also have a perinatologist and back-up anesthesia on-call, as well as a level III NICU, and (usually) adequate nursing staff. Morbidly obese women are a freakin NIGHTMARE to monitor unless they have internals (which are, at best, tricky to place). They are also extremely challenging to give any type of anesthesia to, be it regional or general. AND, they almost always have additional health problems that go hand-in-hand with obesity, such as hypertension & diabetes (be it gestational or pre-existing). What often happens when these women labor is that they will dialate, but the baby head does not descend (we call it fat dystocia). Trust me, we give it our very best shot to help them deliver vaginally, because they are NOT an easy c-section...you would be horrified at what we need to do to retract that panis just to get to where the incision needs to be...it is difficult to get that baby out, and they have enormous problems with healing post-op. Anesthesia prays that they can get a spinal in, because they have horrendous airways...I could go on and on.

Please understand that I am in no way being mean or disriminatory...it is a simple fact that obesity DOES complicate labor and birth, and requires much more care and precautions than the average women to ensure the health and safety of momma and baby. They SHOULD only be cared for at a facility that is capable of doing so.

Sarah - posted on 11/18/2009

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Ok, so this hospital is in the town that i live in!!!!!

I STRONGLY believe they are RIGHT in sending obese mothers to St Michaels.

Weston General is only equipped to cope with a completely normal straightforward birth. They cannot even use forceps there. The only pain relief they can offer is gas and air or the injection of whatever that drug is (i forget the name).
Weston General just doesn't have the equipment or staff to handle things if they go wrong.
If, for example, you had other factors that COULD lead to a problematic birth, you would also be sent automatically to St Michaels. IE. high blood pressure, breech baby etc etc.

I started off in Weston General when giving birth to my eldest and got rushed to St Michaels......with my youngest i went straight to St Michaels and good job i did as she was breech, NOT something they could cope with at Weston.

It's not about making obese women feel bad.....it's about letting them give birth in the SAFEST place. This would be a completely different debate if they had let an obese woman give birth at Weston, knowing they can't cope with the possible complications and something terrible had happened to mother or baby.

St Michaels in my experiences has been FAR superior than Weston General while i was giving birth.

The fact of the matter is, that until someone makes the decision to give Weston General the equipment and staff to cope with problematic births.....the SAFEST option for these women is to go to St Michaels.

Mary - posted on 11/18/2009

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Quoting Laura:

I guess my thoughts are this...any pregnancy can have complications. My daughter had her chord wrapped around her neck, my son was in the process of his first bowel movement during labour, my brother's son needed to spend the first 24 hours of his life in an incubator. Many of the women on COM have expressed thoughts on the difficulty of a labour gone wrong, even without the added complication of being morbidly obese.

If this hospital is unequipped to deal with "difficult" deliveries and births, should they be performing ANY?



I think, from reading this, and a few other posts, some of you may not fully understand what the OB community (including midwives) classify as a high risk patient.  A large number of babies are born both vaginally and surgically with the cord wrapped around their neck (or arm, leg, or body).  The majortiy of the time, this is not a big deal...they may be a little stunned at birth, but typically respond to minor stimulation and a brief amount of O2 therapy.  This is usually something which is resolved within the 1st  few moments of life, and does not require additional personnel or equipment than that which is standard to have available at all births.  These are resuscitative measures which the L&D nurse should be able to perform unasissted.  Meconium (that 1st bowel movement) is also a very common occurence, and again, does not typically require any more staff or euipment than that which is the established standard of care/precautions for all deliveries, with or without risk factors.  As for forceps (Diana's post)...they are a relatively inexpensive set of instruments.  The key is having a practicioner who is skilled at knowing how & when to use them.  Sadly, with the increase in litigation, this is a dying art in the world of OB.  There is less liklihood of a law suit if the practioner just does a C/S.  Most new docs completing their OB residency these days cannot (and should not) use forceps.



 



The reason that women who are morbidly obese need to deliver in a place that routinely does high risk births is the multitude of skilled practicioners and equipment required to care for them even if nothing goes awry (some of which I touched upon in my previous posts).   No, you cannot always predict when the most horrendous of complications will occur, but it would be foolish to start out at a place which is up front about not having everything that could be needed to ensure the health and safety of both you & your baby.

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Charlie - posted on 11/19/2009

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I personally dont think its discriminatory , i think it sounds to bet the safest option and am glad to have had Sarah's insight to this story . Thanks

Sarah - posted on 11/19/2009

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Quoting Diana:

Well, what I was commenting on was Sarah saying that they can't even use forceps there. Whether it's because they don't have them or don't know how to use them, I still think it's sad.

I'm just, upon further information from Sarah about the hospital in question, thinking that not only is this hospital correct in sending these women to another hospital, but also thinking that a hospital that doesn't have the capability to handle complications should directly re-route all labor and delivery patients.

I mean, knowing what I now know about the hospital's capabilities, I would choose to go straight to the other hospital unless I were opting for a home birth.


I'm not sure about the numbers and figures and such, but i'm sure that 1000's of babies have been safely delivered at Weston General. My experience with them wasn't great, which is why i opted to go straight to St Michaels for my second birth. However, i know many many people who have delivered at Weston and thought it was great!



I don't think they would be able to re-direct ALL patients to St Michaels as that is also a relatively small hospital really. They also struggle with staff and bed issues. They always encourage mothers to go back to Weston General to recover as they don't have the space and staff.



I still think that Weston could do with some more funding to enable them to deal with some complications, but i think as it stands, the majority of people have a good experience however it pans out.



As Cathy said, this story as been twisted into an obesity issue when it really isn't, it's more about whether there is a need for more funding at the labour unit at Weston.

Erin - posted on 11/18/2009

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Sending these obese women to a better-equipped hospital is not at all about being discrimminatory. It's about ensuring the safety of mother and baby. To me, it's in the same category as doctors refusing to perform elective surgeries on morbidly obese people. I work as a medical receptionist for a GP surgery and we have had numerous patients told they must lose weight before having their knee or hip replacement, or even gastric banding (just as examples). It is not because the doctor is being an asshole, it is because they are too high a risk to put under a GA!!! It's because their recovery and rehabilitation would be compromised.

Attempting to deliver the babies of morbidly obese (and therefore high risk) mothers in an under-staffed, under-equipped local hospital would be irresponsible. As Sarah said, if they were ONLY turning away obese mothers, while they continued to treat other high risk cases, THEN it would seem a little suspicious.

[deleted account]

This story has been twisted by the Daily Mail, it's a tabloid and sells papers by embellishing on the truth.

The NHS can't afford to fully staff and install all the necessary equipment for every minor hospital in the UK, not when there is a major hospital within a reasonable distance that can offer that service. Every woman has a right to have a baby in a major well equipped hospital yet many women choose the minor hospitals close to home or even homebirths when they are low risk.
Our midwives are well trained and they can detect any complications in the early stages of labour and have no hesitation transferring someone if all is not right. Most pregnancies in low risk labours go off without a hitch. It's totally unreasonable to expect hospitals to quit offering a service to low risk patients which they are generally equipped to deal with because high risk patients are being asked to go to a hospital that can properly handle any complications that may arise. That's the simple truth of it.

As I said the Daily Mail always like to take a sensationalist angle!

[deleted account]

Well, what I was commenting on was Sarah saying that they can't even use forceps there. Whether it's because they don't have them or don't know how to use them, I still think it's sad.

I'm just, upon further information from Sarah about the hospital in question, thinking that not only is this hospital correct in sending these women to another hospital, but also thinking that a hospital that doesn't have the capability to handle complications should directly re-route all labor and delivery patients.

I mean, knowing what I now know about the hospital's capabilities, I would choose to go straight to the other hospital unless I were opting for a home birth.

[deleted account]

I'm beginning to think, from the descriptions of the hospital, that they should send ALL women to the other hospital.

Sara, that's ridiculous. It sounds like I'm in about the same boat as you-I could stand to lose about 40 or 50 pounds, but I'm by no means a 300 lb. woman. Luckily, no one talked to me like they did you-I might've smacked them if they had. lol

But if a hospital isn't equipped to deal with any birth complications whatsoever-and it sounds like that's the case-they really shouldn't be delivering babies. Anyone can have complications, not just obese women.

It makes me sad that they don't have the funding to at least buy equipment like forceps.

Amie - posted on 11/18/2009

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Laura you asked a good question. For our city and surrounding area. (Which encompasses about somewhere between 5-10 towns) There is only 1 hospital that handles deliveries. All deliveries are routed to that hospital, regardless of a woman being high risk or not. It was quite some time ago but our city did have the split hospital policy, where low risks were ok to stay at one of the two other hospitals but it's all been switched to just one. I can't remember when that happened but it was a long time ago.

Sarah - posted on 11/18/2009

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Quoting Laura:

I guess my thoughts are this...any pregnancy can have complications. My daughter had her chord wrapped around her neck, my son was in the process of his first bowel movement during labour, my brother's son needed to spend the first 24 hours of his life in an incubator. Many of the women on COM have expressed thoughts on the difficulty of a labour gone wrong, even without the added complication of being morbidly obese.

If this hospital is unequipped to deal with "difficult" deliveries and births, should they be performing ANY?


That's a good point. Personally, i think for a town the size of Weston, the hospital SHOULD be better equipped. 



However, i guess a large proportion of births DO happen naturally with no complications, and being in a hospital near to home would be preferable to one further away.



To get to Bristol where St Michaels is takes about 30-40 mins in a car.......when i was taken in an ambulance it took literally half the time, so i guess it's not considered too high risk for mothers to make that journey if complications do arise.



As i've said tho, i think Weston should be better equipped then it wouldn't be an issue at all. :)

Isobel - posted on 11/18/2009

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I guess my thoughts are this...any pregnancy can have complications. My daughter had her chord wrapped around her neck, my son was in the process of his first bowel movement during labour, my brother's son needed to spend the first 24 hours of his life in an incubator. Many of the women on COM have expressed thoughts on the difficulty of a labour gone wrong, even without the added complication of being morbidly obese.

If this hospital is unequipped to deal with "difficult" deliveries and births, should they be performing ANY?

Sarah - posted on 11/18/2009

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Yep! Been in Weston General myself a few times!
When i had Cadence i started off there before getting rushed to......yes you've guessed it....St Michaels!!
I have ALL the inside gossip! haha! :)

Sara - posted on 11/18/2009

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I agree Sarah, I don't think the hospital is being unreasonable at all. Obviously, they're just being realistic about the kind of care they can give...they wants what's best for their patients.



How weird that you live in that town, BTW, so you can give us a first hand account!?!

Sarah - posted on 11/18/2009

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This story about Weston General has bugged me ever since i saw it in the local paper.
While i'm truly not advocating the rudeness that Sara endured obviously, it annoys me how the press has skewed the issue into Weston General being 'fatist' when that is clearly NOT the case.

Weston General has to turn down many women for a variety of reasons. If they were only turning away obese women, then it would be a different matter.

I really wish the media would report PROPERLY on things!!!!

Oh and how cool is it that little 'ole Weston-super-Mare is famous now!!! (even if it is for a dodgy reason!! LOL!)

Sara - posted on 11/18/2009

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Thanks Mary! It's nice to get the perspective of an L&D nurse...you guys really are angels, you know that, right?

I called that Doctor "doctor Doom" behind his back. My insurance has since changed and I go to a much better OB/GYN now, who is really great. So, I anticipate my next pregnancy (which I will hopefully weigh less before getting to) will be a better experience for me!

Mary - posted on 11/18/2009

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Sara, I am so sorry that you had that experience...it is unacceptable!! No women, regardless of her size, should be demeaned and sermonizing while doing your repair, after you did everything in your power (and more than most!) to ensure the health of your baby and self is just pointless, not to mention just plain unkind. Having seen pics of you, I know that you by no means fall into the category of women that I am referring to.

The girls I believe fall into this category are well over 300lbs. To give everyone an idea, the typical hospital bed is only good for people that weigh under 300-350 lbs. Beyond that, we need to use a bariatric bed. OR tables generally are ok up to 500lbs, but need to have side panels added on to accomodate the additional width. Most hospitals built prior to 1990 have wall-mounted toilets...they are only made to withstand up to 300lbs, or they are at risk for ripping out of the wall (this is true in public restrooms as well)...we have to place a bariatric commode over our existing toilets for patients larger than this. Something as simple for me as placing a foley catheter usually requires 1, if not 2 additional people just to retract enough for me to get to where I need to be, and even then, it's often a Hail Mary attempt. IV access is challenging, often requiring anesthesia to place a central line. They also need to have extra-long needles for epidural or spinal placement, which is also more difficult....these procedures are done soley by feeling for the epidural space, and additional padding makes that nigh on impossible. All of these things I have mentioned are more staff and time consuming...which is a luxury we do not often have in an emergency.

Despite all of this, I do feel strogly that is NEVER appropriate to be nasty, condescending or judgemental of a morbidly obese patient. Trust me, these girls already know that they are big, and are embarassed by the extra measures that caring for them requires. The last thing they need is someone belittling them or making them feel badly at a time when they are already scared and vulnerable.

ME - posted on 11/18/2009

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I have a SIL who is over 400lbs and pregnant right now...i am very worried for her and the baby because I am aware of all of the problems and complications that can go along with pregnancy and obesity! If there are no other hospitals in the area, I could see these women getting upset, but if the precautions are in their best interest, then they should probably be grateful!

Sara - posted on 11/18/2009

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You know, my sister's step daughter just had a baby two weeks ago and she weighs over 400lbs. It was difficult and she ended up with a c-section. I agree with Mary, obesity is a factor and women need to be cared for where they have access to the kind of care that they need.



That being said, I am an obese person...not morbidly obese, but I probably need to lose 50lbs or so to be at a normal weight. All during my pregnancy, and maybe it was just the doctor, I really felt that I was treated far more rudely and put down than a normal weight person was, just comparing my experiences with friends who went to the same doctor. I developed GD and was told that even though my A1C levels were in the normal range, I was a type 1 diabetic (which is not true, my blood sugar levels are totally normal now). I followed the GD diet to the letter, gained only about 18 pounds over the entire pregnancy (which was all but gone the day after I delievered), but was constantly talked down to by my doctor. I had to wait until about 27 weeks to find out the sex because they refused to tell me at ultrasounds before that saying that my abdominal wall was too thick for them to tell (although they could see enough to know the baby didn't have a cleft lip or spina bifida...so go figure) It was the first time in my life that I think I have been discriminated against like that. In fact, I did give birth vaginally after pushing for about 45 minutes, it went great, but the doctor (while he was stitching me up) gave me a lecture about how diabetic women can have awful deliveries, blah blah blah. I honestly believe that part of my joy in being pregnant and giving birth was taken from me because of my weight, and I know I'm far from the largest woman that has ever had a baby, I can only imagine what it must be like for them.



So, I just wanted to add this because while I feel that this particular hospital has good reason for making the decision to not treat obese women, I think that obese mothers are discriminated against and it seems to be something that is perfectly acceptable in our society.

Sarah - posted on 11/18/2009

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PETHADIN!!!! That's the name of the drug! Sorry, it's been bugging me since i posted!!

?? - posted on 11/17/2009

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I was watching some show on TLC some time ago that was about obese pregnant women and the complications / monitoring they had to go through all throughout their pregnancy - I could understand a small hospital being unable to care for an obese pregnant woman but once a hospital is a certain size, and has the staff, equipment and hopefully the ability to care for them, they should do their jobs.



The hospital where I was born no longer does labor & delivery of a first child or a pregnancy where there is any chance of complication. It's just not the safest place and most women, as soon as it gets close to their due date, they are ready to go, either found somewhere to stay in town (here or in Vernon, Kelowna, or Nelson depending on who they go to see through their pregnancy) or have someone on call to drive them to the closest hospitals which are 2 hrs away (where I live now) or 2 hrs the other way over a mountain pass - there are quite a few children born in the middle of the trip to either hospital too.

Amie - posted on 11/17/2009

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Wow I have an obese friend. She had her first through C-section because she couldn't give birth naturally. Can't remember why exactly but her weight played a factor in it.

She's currently pregnant with her 2nd. I can't imagine what she would do if she was told she wasn't allowed to give birth at the hospital.

I do think women should have a choice in how they want to give birth, regardless of their weight.

[deleted account]

Can they legally do that? I think it's wrong, wrong, wrong. It's yet another way to make overweight people feel like shit.

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