I did not want to leave the topic of obesity without talking about how it affects midwifery practice. Because of the increased cost, time and risk involved in providing care to an obese woman, some obstetricians have BMI restrictions for their practice – instead requiring women with high BMIs attend a high risk, maternal fetal medicine practice.
If you work with obese women into your practice, you can expect on average 1 in 3 will need something beyond standard care. How that affects your practice will depend on many things – like your fee structure, your physician back-up, your ability to admit women to a hospital. This makes for some very difficult decisions on the part of a midwife.
Questions to Consider
When you go through informed consent with your clients, do you give risk numbers? If so, do you need to give BMI specific risk numbers for obese women?
If her odds are higher that she will need a physician, is she better served by finding physician back-up she is willing to work with earlier?
How do you balance the mother’s desire for a normal birth with the increased risks she faces? How far do you feel comfortable with your role as a midwife if a woman refuses tests, or care that you recommend? Will this be different for an obese woman?
How does the higher rate of complications affect your costs? Could it make limiting the care you provide necessary to maintain your business? But what happens if you have cut-offs based on weight? Is that unfair to the 2/3 who will have normal pregnancies?
Are you even the person who makes the decision about policies and protocols in your practice, or does a physician make these decisions for you – limiting the women you are able to serve, but leaving you having to explain why?
There are many more questions to consider. Leave me a comment if you have an issue to consider that is unique to your practice.
Some Guidelines to Review
For readers who want a little more, here are some links to practice guidelines you can use if you are currently updating your practice guidelines for women with pre-pregnancy obesity.
Thank you for learning about pregnancy and obesity with me, and come back on Monday when we start the series on statistics.
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