This article I present with almost no comment, because… WTF?! Pertinent quotes below:
“The Lancet said mothers-to-be should not be able to opt for [home births] if they put their babies at risk – under UK law women can override medical advice…
The editorial was written following the publication of a study in the American Journal of Obstetrics and Gynaecology….
The relevance of the US study to the UK was questioned by medical bodies as midwives in the NHS are said to have better training in resuscitating babies in home birth situations.
The Lancet said: “Women have the right to chose how and where to give birth, but they do not have the right to put their baby at risk.””
Except… we do, actually. It’s not illegal to drink, smoke or take drugs during pregnancy. Not that I’d be surprised if it became illegal in the near future. Anyway, I leave you with the last paragraph of the article, a quote from Mary Newburn from the National Childbirth Trust:
“Pregnant women have the same rights as other adults.”
You wouldn’t think so, sometimes, would you?
Hey, guess what? Pregnant women are doing it wrong again! I’ve transcribed the interview between John Humphrys and Mike Kelly that forms part of this article, because I actually couldn’t believe what I was hearing. I would say “enjoy”, but, well… you probably won’t.
JH: Eating for two is dangerous. Women have been for generations – forever perhaps – that that’s what they should do when they’re pregnant, but National Institute for Health and Clinical Excellence says they shouldn’t. Professor Mike Kelly is the institute’s public heath director, good morning to you. Um, why not?
MK: Because if they do, they’re likely to put on more weight than they need to and um produce an obese, er, an obese pregnancy, and that’s very bad for them and very bad for their baby.
JH: But haven’t you got to eat a bit more if there’s another little person inside you munching away as well?
MK: In the third trimester, in the last three months of pregnancy, the woman should be eating about 200 calories a day extra, that amounts to about two pieces of toast and a milky drink, that’s all.
JH: I see. I have this image of pregnant women, who goodness knows have enough problems – some of them anyway, not all of course – but thinking, the one thing I *can* do is a little bit of comfort eating – is it really going to hurt them that much?
MK: Yes it is, the – um. Well, first off, around about 40% of women of childbearing age are already overweight or obese and presenting at our –
JH: [interrupting] – Are they 40% of –
MK: – That’s –
JH: [incredulously] – of women of childbearing age are *obese*?
MK: Overweight and obese.
JH: [skeptically] Mmm, yeah, there is a big difference, isn’t there.
MK: Overweight is a body mass index over 25, and obese over 30.
JH: But I mean, can we put it into very simple terms – if you look at somebody who is, as you say, overweight, do you say “oh my word, that’s a fat person”?
MK: Not necessarily.
JH: Right. So therefore aren’t we getting this a bit out of proportion?
MK: No, not at all. Because it’s um, a direct, um, line, if you like, a ratio, as with each pound that’s put on, the risks increase.
JH: [surprised] Really?
MK: Yes, indeed. And the risks that we need to get people to understand range from miscarriage, subsequently, pre-eclampsia, thromboembolism, gestational diabetes – and that’s very important because the diabetes often continues post-pregnancy, so the woman is becoming diabetic for life potentially. During delivery more pain relief is required, slower wound healing, potential miscarriage, foetal death. The risks are enormous. This is not a minor minor problem, this is a major difficulty. It also of course adds cost because if a woman has to have a caesarian as a consequence of having a larger baby, that’s an additional around about £2000 per delivery. [Emphasis mine, because… wow.]
JH: But I come back to this difference between being obese and overweight. I mean, *clearly*, if somebody is grotesquely overweight, then there are going to be – we can all see that, that’s blindingly obvious, but aren’t we in danger of *scaring* women into thinking “oh my god, I can’t have that extra piece of toast or bar of chocolate or something because I’m gonna put my baby or me at risk”?
MK: What we should be doing is explaining that the amount of extra calories that are required, they’re very small amount and they’re only in the last three months of pregnancy, and that’s why this business of eating for two has to be knocked on the head. What we need to do is make clear that a healthy diet – this is the diet that you or I needs to stay in reasonable shape based on starchy foods, avoiding sugary drinks, drinking plenty of water, avoiding fatty food, all that sort of thing, that’s a healthy diet and that’s what a pregnant woman should eat, that’s what a woman before she gets pregnant should eat and that’s what she should eat afterwards. It’s the standard advice on diet and nutrition that we’ve been giving for forty or thir- forty years or so. Nothing in that regard has changed. The myth about eating for two is one that needs to be knocked on the head, as is the idea that they need to do the same when they’re breasfeeding – they *don’t* – a small amount of extra calories during breastfeeding, the natural bodily processes will take care of it. We need to alert health professionals as much as anybody that this is a significant problem.
JH: Professor Kelly, thank you very much indeed.
I’m a skeptical soul, but I’m also running a temperature, so I’m not about to do any sums for you. Not even to prove how awesome I am. I have, however, found the guidance from NICE, which contained the statistics that Mike Kelly was quoting:
“At the start of pregnancy, 15.6% of women in England are obese (Heslehurst et al. 2010).”
“About half of women of childbearing age are either overweight (BMI 25–29.9 kg/m²) or obese (BMI greater than or equal to 30 kg/m²) (The NHS Information Centre 2008).”
Personally, I wouldn’t be at all surprised to find that women who are “obese” have a higher risk of having a caesarian delivery in part because their doctors think they ought to have one because they’re “obese”. Not because they actually needed one.