Can I birth on a midwife led unit with raised BMI?

BMI – Place of birth & Induction of labour

NICE recommendations say that women with a booking BMI greater than 35 have planned labour and birth in an obstetric unit/ consultant led unit. Those who have a BMI of between 30 & 35 at booking should have individualised assessment of place of birth…. However, a further look into the research since the above recommendations (from the BirthPlace Study) suggests that the risks to women with raised BMI are actually lower than once thought. So the RCOG guidelines (the guidelines which obstetricians are guided by when giving you advice) state that ‘class 1 and class 2 obesity is not a reason in itself to advise to give birth in a consultant led unit’

With Class 1 being a BMI 30-35 & Class 2 being a BMI 35-35.99. So… if your BMI is less than 40, your BMI in itself wouldn’t be enough for your team to recommend you having your baby in a consultant led unit over a midwife led unit.

At 36 weeks, you can discuss with your team about where you want to give birth. Your consultant may talk to you about women who have a BMI over 30 have a higher risk of potential labour & birth complications. These can include potential anaesthetic and obstetric complications, availability of senior obstetrician and anaesthetist, facilities for pain relief (women with a higher BMI have a higher incidence of asking for pain relief), access to theatre (because of higher instrumental and caesarean section rates and PPH (higher blood loss) amongst women with raised BMI) and neonatal facilities. 

So depending on where your hospitals and midwife led units are, it might be that if your maternity led unit is far away from the hospital, there may be different BMI guidelines to if you are advised to birth there, compared to for example if the midwife led unit is attached to the hospital. I also just want to make it really clear that even though these are “higher” in women with raised BMI, it is still low, and the majority women with raised BMI go on to have straightforward births & healthy babies.

Induction of labour at term in women with raised BMI may reduce the chance of caesarean birth without increasing the risk of adverse outcomes (such as neonatal admissions). Women with raised BMI who were induced between 37 weeks & 39 weeks had less cesarean births than women who had the usual management (ie. awaiting to go into labour naturally or being induced when going over due). There were also a lower amount of “large” babies.

I would really encourage having an individualised risk assessment with your team to decide if a waterbirth or induction is right for you, discussing the….

BENEFITS

RISKS

ALTERNATIVES

….and then making a choice that suits you. How to make choices with regards to your birth, having a positive birth in a consultant led unit, and how to have a calm induction are all covered in the antenatal & hypnobirthing online course with midwife, Beth.

This information here is to help you make informed decisions when speaking to your obstetrician. I (Beth) am not an obstetrician, I am a midwife, so this information should only be used to spark conversation between you and your obstetrician. This information should not replace the advice that you receive from your obstetrician and midwifery team. They will be able to give you more specific guidance by looking at your health overall and considering what facillities you have in your area. Remember to use your EBRAN with your healthcare team when making decisions.

This information was all found in the following guidance s…

This one is made for pregnant mothers and their partners to read….

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-being-overweight-during-pregnancy-and-after-birth-002.pdf

This one is more of the research…

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15386

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