Pregnancy :: Impact of maternal obesity on the NHS

A new study reveals the true costs of the increase in maternal obesity and how it is impinging on service delivery in the NHS. It was carried out by The Centre for Food, Physical Activity and Obesity Research at the University of Teesside with 33 healthcare professionals based in the North East of England recruited for the study.

The results are published in this month?s BJOG: An International Journal of Obstetrics and Gynaecology. Previous studies have concentrated on the effects of obesity on pregnant women and the subsequent public health risks.

The findings of this study uncover five recurrent themes relating to maternal obesity: booking appointments, equipment, care requirements, complications and restrictions and current and future management of care. The main points are summarised below.

Equipment
Obese patients require specialised equipment for surgical deliveries including theatre tables and scales. Other equipment such as specially modified ward beds, chairs and wheelchairs are required. The costs of these, though considered less-expensive, are cumulative.

Care requirements
More guidance is required in antenatal and postnatal care provision as obese women have higher levels of maternal morbidity and a higher dependency on care. The risks involved include misdiagnosing conditions such as high blood pressure and determining fetal size. There is more demand for one-to-one specialist care, specifically, for a consultant obstetrician to be available at the time of birth rather than a registrar. All those interviewed also agreed that multidisciplinary care (MCD) is needed, with dietetic and physiotherapy services working with maternity units when caring for an obese patient. Given these extra demands, there are further implications on waiting times and staff resources.

Complications and restrictions
Obesity results in problems for the mother throughout the antenatal period. Common problems include deep vein thromboses (DVT), incontinence, diabetes and pre-eclampsia. Problems extend into the labour stage such as the need for increase pain relief and reduced mobility for women during labour. Complications during delivery for the baby include fetal distress and birth trauma. Postnatal problems for obese mothers include increased support for breastfeeding, and a higher rate of infection because of the slower rate of healing in obese women.

Maternal obesity also reduces patient choice. There are restrictions for pool and, in some cases, home births. Given the higher incidence of emergency interventions, emergency caesareans are usually carried out for obese patients.

Current and future management of care
Better and more consistent maternal nutrition guidelines are needed. Pregnant women that are obese need to be informed about the appropriate weight gain and made aware about the issues surrounding their condition and how to manage the potential risks to mother and baby if weight is not controlled.

Healthcare professionals agreed that consistency of tone is required in the way obese women are communicated to given the difficulties and emotions involved. There is a need to strike a balance between providing information and doing it sensitively so patient dignity is maintained. Similarly, obese mothers need to realise that they must take responsibility by managing their body weight sensibly.


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