Embark on a poignant exploration of a topic that's often cloaked in stigma yet crucial to maternal health: obesity and BMI during pregnancy. Join me, Florence, on the ObsPod, as we unravel the intertwined issues of weight management and prenatal care, delving into the NHS classifications that inform how expectant mothers with a BMI over 30 navigate their unique journey. This episode promises insightful discussions and a deeper understanding of the practical applications and limitations of BMI as a standard of health, particularly during such a life-changing period for women.
This candid discussion also brings to light the specific hurdles and advancements that shape the experiences of overweight women in pregnancy, from ultrasound imaging difficulties to anesthesia considerations during childbirth. We'll reflect on the latest innovations, such as the TraxiDrape and Alexis retractors, which have significantly improved caesarean section outcomes for both mothers and healthcare professionals. Throughout our conversation, the emphasis remains on fostering empathetic communication, empowering women to feel informed and supported—a commitment that transcends the clinical environment and touches the heart of human connection.
Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth. Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small. Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor. If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
Embark on a poignant exploration of a topic that's often cloaked in stigma yet crucial to maternal health: obesity and BMI during pregnancy. Join me, Florence, on the ObsPod, as we unravel the intertwined issues of weight management and prenatal care, delving into the NHS classifications that inform how expectant mothers with a BMI over 30 navigate their unique journey. This episode promises insightful discussions and a deeper understanding of the practical applications and limitations of BMI as a standard of health, particularly during such a life-changing period for women.
This candid discussion also brings to light the specific hurdles and advancements that shape the experiences of overweight women in pregnancy, from ultrasound imaging difficulties to anesthesia considerations during childbirth. We'll reflect on the latest innovations, such as the TraxiDrape and Alexis retractors, which have significantly improved caesarean section outcomes for both mothers and healthcare professionals. Throughout our conversation, the emphasis remains on fostering empathetic communication, empowering women to feel informed and supported—a commitment that transcends the clinical environment and touches the heart of human connection.
Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth. Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small. Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor. If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
Speaker 1:
Hello, my name is Florence. Welcome to the ObsPod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife, maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the ObsPod is for you.
Speaker 1:
Today I'm going to tackle a topic for which I've had a lot of requests. Many people have got in touch and said Florence, can you do an episode on obesity? Or Florence, can you do an episode on BMI body mass index? And you'll be able to tell from the fact that I've called this topic overweight, that I'm quite conflicted about this topic. I've thought long and hard about what to call this episode, and I think this is probably going to be one of a series of episodes on this topic, because I've come across a few people that are specialising in this area or doing research, and I'm hoping to get them to come on the podcast and talk to me soon. In the meantime, I thought I'd do a little bit of a kind of nuts and bolts and my thoughts. When I see a woman who's classified as overweight in the antenatal clinic.
Speaker 1:
I think we should start by thinking what do we mean by overweight? And it's true, we do tend to use body mass index, or BMI, as the best guide of that. And in thinking about this topic I've read a few papers that dither a bit about is BMI actually the best way of assessing obesity in a population? And the answer is it's not great, but it's the simplest and sort of best fit that we can use. But we do need to bear in mind it doesn't work for some populations. For example, there are some ethnic differences in its application. There are some differences in age, so it's less good for the very young or the very old. And you could say well, that doesn't apply to an obstetric population in the main, but it doesn't really take account of muscle mass, bone density and all sorts of other factors. So the starting point is BMI is the best thing we've got, but we need to remember it's not great. Then what do we classify as being overweight?
Speaker 1:
If you look at the NHS website, then there's some nice little ranges. So BMI of 20 to 25. Yay, that's green, you're okay. There's a BMI of 25 to 30. You're considered overweight and that's where I sit, being brutally honest. And then you get above 30. It starts to talk about obesity. So, strictly speaking, if we're going with the general NHS calculation, anyone with a body mass index of over 30 is overweight In pregnancy.
Speaker 1:
This can be complex because we also need to think when are we weighing people? I mean, generally, a weight is taken at the beginning of pregnancy, at booking appointment, but people's weight varies hugely during pregnancy and often when we're thinking about weight and BMI in pregnancy, it might be at the end of pregnancy when we're perhaps on the labour ward and thinking about whether or not this woman needs to go to the operating theatre, and we'll often have a conversation about the BMI. Was this at booking? But it's probably more like that now, because women put on an incredibly variable amount of weight during pregnancy. Right? So you might think super simple anyone over a BMI of 30 is overweight and we need to do different things for those women, or do we? Well, there are things that we know are a bit more common in women with a higher body mass index. But if you look at the RCOG green top guideline on obesity. That's what they call it. You'll see that is very confusing for staff. I've put a link in the show notes and I'm not going to comprehensively go through every single point on it now, but it's 45 pages. You need to do one set of things if a woman's BMI is over 30, needs to do another set of things if it's over 35, need to do another set of things if it's over 40, and another set of things if it's over 50. So this is very confusing for staff, but equally it must be very confusing for women.
Speaker 1:
One of the things I find most difficult is when a woman turns up in obstetric clinic at 16 weeks. So she's had her booking, she's seen her midwife and she's been screened by all the questions and things that have been asked and deemed so-called high risk and I say so-called inverted commas because I don't really like that terminology but she's been deemed to need some obstetrician input. That would be a better way of describing it. When I see a woman at that point in clinic, I always look at the kind of tick box checklist that the midwives complete at booking, because I need to figure out why is this woman in the obstetric clinic Because hopefully, a totally uncomplicated woman with no medical problems and no problems in her pregnancy wouldn't turn up in my clinic. She would be being cared for by her midwife. So in some situations I turn to that tick box and I can see the only thing ticked is BMI.
Speaker 1:
Now I don't know about you, but many of us are quite sensitive about our weight and our body. We live in a society which is very focused on diet culture and there's a fantastic TEDx talk by a dietician, which I will also include in the show notes, which discusses this. So starting a conversation with a woman it has solely been sent to see me because of her weight is a very sensitive topic and I find it difficult. Does she know why she's been sent to see me? Is she aware that it's because of her weight? Some women are very frank and open and they understand and they will open up the conversation and then we can have a good conversation without me feeling that I'm insulting and defending them. And I'm assuming that's because they're aware, but also because the midwives had a conversation with them about the fact that there are some slightly different things we might need to offer them during the pregnancy. But for some women. I've got to start and broach the conversation, and that can be difficult.
Speaker 1:
If you look at the tick box in our notes and also at the RCOG green top, on which it's based, much of what we're supposed to discuss with women in this situation is the risk of this, the risk of that. You've got a higher risk of blood pressure problems. You've got a higher risk of gestational diabetes. You've got a higher risk of venous thrombore embolism or blood clots. You've got a higher risk of a big baby and perhaps a more difficult birth as a result. Wow, I mean, put yourself in the shoes of the pregnant women. You're pregnant, you're excited and you go and see the doctor and all the doctor wants to talk about, or the midwife, is the risk of this, the risk of that? You'd probably feel quite scared.
Speaker 1:
I distinctly remember a consultation I had with a woman in which she said to me I know I'm at a higher risk of all these things, all these complications, but at this point in time there's nothing I can do about it. I'm already pregnant, I'm in this situation and now the maternity team are just making me feel petrified. I need help to get through this safely, me and my baby and telling me I have all these different risks really isn't helpful. And it wasn't like I hadn't thought about it in that context, but her talking to me like that really made me think, and so I really try and unpick and help women understand. You've got a slightly higher chance of this, but therefore we're going to offer you a test for that. You've got a slightly higher chance of that, but it's okay, we can offer you this treatment for it.
Speaker 1:
And I do frequently tell women that the most likely outcome is that you're not going to have any of these things and everything is going to be completely fine, but you're going to get to see me and the midwife and have a few extra bits and bobs given to you. And it's a tricky one because it's part of that paternalism or not paternalism, isn't it? Do we keep to ourselves that the woman has all these risks and issues or do we share with her so that she's well informed about her own health and that of her baby? And I think there's a good argument for sharing all these things, because she knows her body best, she knows her baby best, and if we can make her aware of all these issues in a sensitive way, then she can be vigilant and be watching out for any changes in how she feels or how her baby is, so that we can tweak things accordingly and pick things up early if they do happen. But it's got to be done in a sensitive way.
Speaker 1:
So if you're overweight depending on how overweight you may be offered a glucose tolerance test to check for gestational diabetes. You may be offered some blood thinning injections, particularly in the throat thinning injections, particularly in the third trimester, from 28 weeks, to try and reduce your chance of getting a blood clot in your legs. You're likely to be offered a 36 week scan growth scan because it's a little bit harder for us to assess the size of your baby by measuring the fundal height, the top of the womb, in centimeters, and we know that women who are heavier are more likely to have a macrosemic or bigger baby. It may also be harder for us to determine which way up your baby is. So doing a scan at 36 weeks means we can plan birth and talk to you about your options if the baby happens to be in a different position. So we're checking the growth and size of the baby and its presentation, what position it's in, one of the other key things we need to think about when we're thinking about blood pressure and chance of blood pressure issues is measuring the blood pressure correctly.
Speaker 1:
The size of the blood pressure cuff depends on the circumference of your upper arm. So early on in pregnancy, staff should be measuring and checking your upper arm to decide which blood pressure cuff you need, because if your arm is bigger you need a large cuff, not the standard cuff. Otherwise we won't be able to get accurate readings of your blood pressure. So I've definitely had situations in which women have been thought to have raised blood pressure and then, when we do it with the correct large cuff that fits their arm appropriately, actually their blood pressure is normal. So something really important you can do as a pregnant woman is, if you know you need a large cuff and the member of staff tries to take your blood pressure with the smaller cuff, tell that member of staff. Actually the midwife usually uses a large cuff. I need a large cuff and sometimes we'll write on a woman's notes large cuff so that we know what we're using, so that we can get those accurate measurements.
Speaker 1:
There are some additional things we will suggest you might take in early pregnancy. Again, depending on your weight, we may recommend that you take aspirin 150 milligrams once a day from 12 weeks and that's to reduce your chances of growth restriction in your baby and blood pressure problems for you. And we may also recommend a higher dose of folic acid. So you know, it's recommended women take folic acid if they're trying to conceive or in the first 12 weeks of pregnancy. So women with a higher weight need a higher dose of folic acid five milligrams and also some vitamin D supplementation because you're more likely to be vitamin D deficient. So either we or your GP will suggest that you're taking these things from early on in the pregnancy. So there you go. You've booked in, you've seen your midwife, you've been given some extra supplements, you've been told a bit about what to expect during your pregnancy and what we're going to offer you. Happy days.
Speaker 1:
Then you go for your scans. Now I've already mentioned perhaps doing an extra 36-week scan fantastic, but actually scanning through a bigger layer of body fat is quite challenging and the images we get may not be as clear and good as if you were less heavy. So in our guidance it recommends that we talk to women about the limitations of ultrasound and that the views of the baby may be limited by the excess tissue and it makes sense that it's harder to see because your ultrasound waves are having to go through more layers, so there's a different depth from the probe to the baby than if the woman was thinner. And we do need to accept that ultrasound for any woman is never 100% accurate. Some things are harder to see than others on scan. So there's always a bit of a caveat that we may or may not be able to see all issues on scan antinatally for any woman. So I'm not sure how helpful it is to tell a weight woman that actually her scans are going to be harder or we may be more likely to make a mistake.
Speaker 1:
It feels a little bit like when you have those things on television, particularly in America, where they say, oh, take this drug or buy this thing, and then they read out very, very fast some terms and conditions about this investment may go up or down and you may or may not get all these side effects or this, and that may happen. It's kind of a bit of an embarrassing cover. All Well, you're overweight, so we might botch it up. Well, that's not really very trust inspiring or good at building a relationship between that woman and her maternity care provider. So I think it is important that we're realistic with women, that we may not be able to see everything on scan and that may be a little bit harder for women to have more adipose tissue, but actually the same is true for any woman having an ultrasound scan and I'm not sure telling people they've got a higher chance of us missing something is necessarily helpful. Okay, so you've got three pregnancy.
Speaker 1:
Now we come to birth planning. This is a minefield and I see quite a few women in my clinic who want more personalized care planning who fit into this situation. The guidance is that we should suggest all obese women to give birth on an obstetric unit. There are rules and I'm calling them rules because it is guidance but people behave as if they're rules about not using the birthing pool, which, let's face it, there's no evidence for this whatsoever. It's sort of health and safety gone mad type situation in which we're really worried. What if the woman collapsed in the pool and then it was really difficult to get her out and we'd need a hoist, and it's a nightmare for the staff and we don't want her to drown in the pool if she collapses, but actually is she any more likely to collapse than any other woman. No, it's just a bit more logistically difficult to get her out. So don't get me started on that one.
Speaker 1:
Then we have the difficulty of anesthetics. Now it's true that giving an anesthetic to a pregnant woman a general anesthetic that it is is very high risk For lots of reasons. Anesthetic is less safe in pregnancy. A woman may have significant swelling around her throat, her neck, which makes it harder for our colleagues to intubate. They've also got more acid reflux coming back up their gullet. They've got a large pregnant uterus pressing up on their lungs and compressing their major blood vessels.
Speaker 1:
There are all sorts of concerns about anesthetizing pregnant women, and then that is even worse if you're pregnant and overweight. The reason that this is relevant is that regional bloc such as spinal or epidural, which is what we would prefer to use in labor, is much harder potentially to cite in a woman that's overweight, because you just need to feel down her back and between her vertebrae and nowhere to put their needle. The needle's got to go much deeper and it's much harder to identify the spaces between the vertebrae. So, for many reasons and concerns and fears from our anesthetic colleagues, often women that are overweight are recommended to have an epidural just in case. Sometimes they're even told have an epidural.
Speaker 1:
You might not want an epidural, but if you have an epidural and we cite it, even if we don't put anything down it, then if there's an emergency you're already. We can top it up, we can use it in an emergency situation and we're not struggling where we can't get a spinal into your back and therefore we're not then increasing the chances of you needing that more risky or dangerous general anesthetic. And there is some rationale to this, because if you're in an emergency situation and you've got a distressed baby that's at risk and you need to quickly deliver the baby, then actually the speed of anesthetic and the ability to be able to give that anesthetic is quite a high-pressurized situation. So we don't want to be ending up in a situation where the anesthetists can't get in an appropriate anesthetic, the baby's at risk and, god forbid, something happens to the baby because we're unable to safely anesthetize the mother. So that's how the thinking goes. But if you have an epidural cited, then that restricts you immediately. You can't use a birthing pool and I've already discussed why we might be worried about you using a birthing pool.
Speaker 1:
But is it right that we're restricting women's choices in this way. I had a situation in which a woman wanted a home birth. She'd had a home birth previously, she was overweight and actually the only reason she'd had a home birth previously is the midwife doing her booking had made a mistake in calculating her body mass index, so it looked like she was lighter than she was. So the woman was baffled because she came to us and said I'm exactly the same weight as I was with my last baby. You were perfectly happy for me to have that baby at home. Why is there now an issue? So we're really restricting women who weigh more in their choices around birth, birthplace pain relief options, and I don't think that's right. There's no evidence for it. It's dealing with obstetric and anesthetic and midwifery anxiety and fear about something going wrong, and it's restricting women's choices in a way that is probably not rational and certainly is not evidence based. Yes, we are the people that have seen things when they go badly wrong, and the woman hasn't, but should we be pressing every woman who's overweight into having an epidural?
Speaker 1:
Then there's the business of monitoring the labor. It's much harder to monitor someone with a continuous CTG cardiotocular graph if they're overweight. Again back to the ultrasound thing. There's a bigger layer of the mom's body to go through before those ultrasound waves hit the baby's heartbeat and bounce back so often. It's harder for us. So then we say we should put on a fetal scalp electrode. We should attach a little electrode to the scalp of the baby. We can monitor the baby more effectively continuously and the woman will be able to move around. And that's absolutely true and that's great if you definitely need continuous monitoring.
Speaker 1:
But do we have a question? We recommend continuous monitoring and if you go back and listen to my excellent conversation with Dr Kirsten Small in episode 157, you'll see that there's no evidence that actually we should be continuously monitoring the baby's heartbeat. And actually for women that are overweight, maybe listening in intermittently would be easier, would be better for them, would be better for us. Actually, all that loss of contact that we're worrying about on a continuous CTG wouldn't matter if we were listening in every 15 minutes. The woman might be more comfortable, more able to move around, therefore more able to have the birth that she wants, and we wouldn't be fussing about the fact that we're not continuously listening in to the baby. So the labour care of women who are overweight, I feel is quite messed up. A lot of what we're suggesting is not evidence-based but more anxiety-based. It is true when you look at M-Base that obesity plays a role. It often crops up in reports as a risk factor for both women and their babies. So we need to be conscious of that.
Speaker 1:
But medicalising everything I don't believe is necessarily the answer. And don't get me wrong choice goes both ways. I can clearly remember the first time a woman with a body mass index of over 40 came and asked me for a maternal request cesarean. She felt for her that a cesarean birth was what she wanted and what she needed to meet her baby in the best possible way. And I remember it because I was hesitant. I was thinking that you're more at risk of complications, you're more at risk of a wound infection, you're more at risk of blood clots in your legs. I've seen some really nasty, difficult wound infections that have taken weeks or even months to heal in women who are overweight, not least because the panacea that sort of flap of body fat, that kind of flops over where we make the incisions sometimes can make it very difficult to keep that area clean and dry while the wound is healing.
Speaker 1:
So I really struggled in my mind with this request, but I rationalised it to myself that Because of her weight, why should she have any less choice than anyone else? If I explain the risks to her and that her personal risks are perhaps a bit different from someone else's personal risks, then she has the right to choose just as anyone else does. If a woman can come in and ask for a caesarean birth, then that should be true of every woman. It shouldn't be that if you're thinner, yes, you can choose a caesarean. If you're more overweight, no, you can't. That's discrimination. And that brings me on to gadgets. I'm not a big fan of gadgets in general, but there have been some fantastic advances in things we use to operate. We do caesareans for people who are more overweight, and this has made a big difference to me.
Speaker 1:
It used to be, if we had a woman who was very overweight, that rather than having a surgeon and an assistant, we would need a surgeon and two assistants. Like I said, there's often some body fat that needs holding back so we can get in to the abdomen, get in to see where the womb is. So you need someone whose job it is to do that, and it's physically very demanding job operating on someone who's overweight. You've got to go through a significantly thicker layer of tissue before you reach the rectus sheath the muscles that hold the abdomen together and then get in to the abdomen and be able to see the womb. Getting a baby out through that depth of tissue is difficult. You need space and it's challenging. You'll come out of that surgery physically exhausted from what you're doing, as well as mentally, because you've got to concentrate. And that sounds bad. Like we don't concentrate when we're operating. Yes, we do, but it's a more challenging operation than if the woman had less body fat.
Speaker 1:
But now we have some new inventions. So there's a great thing called a traxidrape. It's like a giant sticky thing and you place it on before you clean the woman's abdomen and start your cesarean. So she's had her anaesthetic, she's lying on the table and you put on the traxidrape and it's this massively sticky thing and it pulls everything up out of the way. So you no longer need that second assistant, that person whose entire job is to pull back that body fat, because this traxidrape, this sticky thing, does it for you.
Speaker 1:
It's a little bit fiddly to apply the first time you do it and you might think that you could only use this for a planned cesarean birth, but I have done a category one cesarean where I've been incredibly worried about the baby, where I have used the time we've been waiting for the anaesthetic to work, which it's only a few minutes to get the midwives to apply the traxidrape. And at the time the midwives were like, why are we faffling around with this? It's a massive emergency. But I've explained to them that knife to skin from when I start the operation to when I get the baby out will be significantly quicker if we spend this time while we're waiting for the anaesthetic to be effective, applying that traxidrape. And indeed it enabled me to do knife to skin to baby out in one or two minutes. It's genius invention. The other thing we have that's new is called an alexis retractor. It's like a giant ring or two rings joined together with basically what looks like a plastic bag, and once you've opened the abdomen you pop that in and again it holds everything back and everything open so that you can clearly see the womb and get your hand in to deliver the baby without having multiple assistants having to hold everything back for you Again, genius.
Speaker 1:
So now when I do a caesarean for a woman who's significantly overweight. I can use the Traxidrape, I can use the Alexis. It makes my operation much less challenging and it makes it safer, because it's easier for me to get in focus on what I need to do and get that baby out safely. At the end of the surgery we can apply my final favourite gadget, the Pico dressing. And the Pico dressing is a specially designed dressing that has negative pressure. So it's a dressing that you put on over the caesarean wound and you seal it on with lots of strips of sticky stuff, a bit like cellotape, and then it has a little battery pack which you activate and it creates negative pressure which makes it a bit harder for the bacteria to grow. That means that when the woman stands up and that excess body fat flops over the wound, the wound is protected, it's clean, it's covered and there's evidence that you're less likely to get a wound infection and it's more likely to heal better.
Speaker 1:
So when we're doing our who, our safety briefing that I discussed in episode 104, we will discuss this woman. She's got a raised BMI. These are the issues and these are the pieces of equipment we want the theatre staff to get ready. We'll discuss whether we're going to use the Traxy Drape, the Alexis and the Pico dressing and in that way, hopefully, we can offer women who are overweight, who either want or need a caesarean birth, the safest possible way of having that birth with hopefully less chance of complications.
Speaker 1:
And for me, this is revolutionised how easy or difficult it is to operate successfully on these women, and it's important because there are increasing rates of obesity and weight issues in our population. When I started out in obstetrics, I remember we were shocked if we saw a woman whose body mass index was over 40. And those women had to go and see an anesthetist and have special care. Now we're in a situation where the goalposts have moved and now this applies to women whose body mass index is over 50. So, whilst weight is a sensitive issue, it is also a health, population issue, and so it's really important to have these tools at our fingertips and have the experience of operating on women of all shapes and sizes so that, in an emergency situation, you know exactly what you can do to minimise the risk for mother and baby, make it as safe as you possibly can.
Speaker 1:
So that's my little whistle stop tour of overweight. As I've said, it's a topic I'm probably going to come back to, and I haven't given you a comprehensive guide. I've just given you my thoughts and experiences. So, from my zesty bit, I think the key thing is, when you're talking to women who are overweight, think about what your biases are. Think about how much of what you're telling them is because we, as health professionals, are anxious and fearful. And remember that actually the care we're offering should be for her, not because of us, and try and have really good but sensitive conversations so that she knows what our anxieties are but doesn't feel helpless. Make her feel that she is central to that team that are monitoring the health of her and her baby and that we're there as a supporting act, rather than making her feel guilty and ashamed just because she is the shape and size she is. And if you're pregnant and expecting a baby and you're on the slightly bigger side, don't be frightened to have conversations with your health professionals. Give them the advice they're giving you and make sure you're making the right choices, for you Know that we really are trying to have your best interests at heart, but it doesn't always come out the right way. I hope this has given you food for thought that might help you with some of these conversations. Thanks for listening.
Speaker 1:
I very much hope you found this episode of the OBS pod interesting. If you have, it'd be fantastic if you could subscribe, rate and review, on whatever platform you find, your podcasts, as well as recommending the OBS pod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalogue from clinical topics, my career and journey as an obstetrician and life in the NHS more generally. I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary.
Speaker 1:
If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at the OBS pod on Twitter and Instagram and you can email me theobspod at gmailcom. Finally, it's very important to me to keep the OBS pod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free, via my link, to buy me a coffee, don't feel under any obligation, but if you'd like to contribute, you now can. Thank you for listening.