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NHS unprepared for obese pregnant women

Guideline says improvements needed to raise standards of care

OnMedica staff

Friday, 19 March 2010

Although most maternity units care for obese pregnant women, more than half have no local guidelines on caring for them, the Centre for Maternal and Child Enquires (CMACE) has found in its survey of NHS maternity provision for obese women. It is launching at today's conference Management of women with obesity in pregnancy a joint guideline developed with the Royal College of Obstetricians and Gynaecologists (RCOG).

In 2008, CMACE conducted a survey of NHS maternity service provision for obese women. Survey responses were received from 88% of the 364 maternity units in England, Wales, Northern Ireland, Scotland and the Channel Islands and Isle of Man.

All 220 of the obstetric units that responded, 54% of 13 alongside midwifery units, and 62% of 87 freestanding midwifery units reported caring for obese mothers. But 124 (44%) of the maternity units that responded did not have local guidelines for the care and management of women with obesity.

Most maternity units said they had appropriate delivery beds and blood pressure monitoring equipment for obese women, but many had no immediate access to other equipment such as extra-wide chairs, ward beds, and, in a tenth of obstetric units, operating theatre tables.

Only a third (33%) of obstetric units provided specific advice on dieting and 6% provided preconception care and advice. CMACE and the RCOG say that patient information about maternal obesity should be developed. Fewer than one in five (18%) maternity units provide printed information for women specifically addressing obesity and pregnancy.

Most maternity units agreed that women with a BMI ≥35kg/m2 should be advised against a home birth; four in five (80%) had a weight threshold above which home birth was advised against.

The joint CMACE/RCOG guideline includes standards of service provision for local maternity units. This guideline will address many of the needs above as trusts and maternity units will now have evidence-based national guidelines to ensure that obese mothers-to-be are given appropriate care and treatment during pregnancy.

Professor Sir Sabaratnam Arulkumaran, president of the RCOG, said: “Obesity is a public health concern in the UK and this is reflected in our specialty by the increasing numbers of overweight pregnant women being seen in maternity units. It can be addressed in the NHS by having good clinical guidelines and the appropriate resources in place.

“The long-term challenge however is behavioural. We need to start before a woman becomes pregnant by encouraging her to lead a healthy lifestyle and by providing her with the support and means to do so, so that she can then go on to have healthy pregnancy.”

Professor Cathy Warwick, general secretary of the Royal College of Midwives, agreed: “The bottom line here is that we need to help women to improve their lifestyle and health, for the sake of their own long-term health, and not just in pregnancy. Midwives have a crucial role to play in offering care and advice for obese pregnant women.”

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