Let’s talk about plus size pregnancy UK guidelines! Alice Keely, Registered Midwife, MSc, Ph.D., is a plus size-friendly UK midwife who believes guidelines are not rules. She helps people expect the best during pregnancy while providing self-advocacy tips.
Plus Size Pregnancy UK Support
With a Ph.D. in plus size women’s experiences in pregnancy care and over twenty years of experience as a midwife, Alice Keely is passionate about supporting plus size pregnancy in the UK.
What has been your experience helping people in larger bodies navigate the NHS medical system?
I teach student midwives in universities and help with their training. One of the things that I teach is plus size care. So I’m a real advocate for everyone being a plus-size-friendly care provider.
Similar to the US, we have quite an obstetric lead rules-based module around Body Mass Index (BMI).
I encourage people to look at each case, not just a woman’s BMI.
Unfortunetly, too often, I hear women say they weren’t allowed their birth preferences because their BMI is over 35.
In the UK, there isn’t legally such a thing as “not allowed,” but that’s how it gets presented to women, who don’t know any better.
And also, you want to avoid going into labor having that fight.
What are tips for working around plus size pregnancy UK guidelines?
The Royal College of Obstetricians and Gynecologists makes national guidelines for all the complexities of pregnancy, including caring for plus sized women.
They say that if women with raised BMI have no complications in pregnancy, they should be cared for as per the standard lowest guidelines. So, they’re saying that being plus size isn’t a problem in and of itself.
With this said, there are specific guidelines for people with a high BMI during pregnancy in the UK.
And women are often told they may not be allowed to go into midwife-led units because the guidelines say if your BMI is 35, sometimes even 30 or over, then we don’t recommend having your baby here.
But they are guidelines.
Guidelines are not rules!
Usually, women can push a little bit harder. They can request to see a more senior midwife who is a bit happier to discuss the very paper-thin evidence about why it’s not a good idea. Then women can way the risks and benefits and push for the midwife-led unit rather than the maternity ward if that’s their preference.
Can women switch providers if they are assigned someone who is fat-phobic?
You’ll be assigned a midwife locally to you. And if you feel that you’ve received disrespectful treatment, you can request a different midwife.
The same goes for when you’re in labor and giving birth!
In the NHS system, research shows poor communication leads to weight stigmatization more often than overt fatphobia, which is much more common in the US.
For example, a booking appointment will happen around ten weeks of pregnancy. Your midwife should get to know you and explain the pathway of care based on your BMI. But that doesn’t always happen.
So a woman might come away from that appointment feeling positive. Then unexpectedly, get a text or an email saying they’ve been booked for a consultant because of their BMI. That can feel offputting.
Midwives need to do a better job of communicating with women the expectations of supporting plus size pregnancies.
How can I advocate for myself during care provider visits?
Plus size women should expect the best care and have open conversations with their healthcare advisers and midwives regarding any concerns about weight. You don’t need to wait for providers to raise anything concerning.
Bringing a supportive partner, family member, or friend along can be helpful.
And rehearse what you’re going to say in advance.
You can say, “Thank you. You’ve said that before and we don’t need to address that anymore.”
Or say, “I feel concerned today because…”
You should expect that you will get kindness and compassion from your care!
Learn much more about supporting plus size pregnancy in the UK during episode 193 of the Plus Mommy Podcast. Alice also covers tips for labor and birth.
Recording & Show Notes: Plus Mommy Podcast Episode 193
Transcript happily provided upon request.
Resources Mentioned On The Show
Alice is a midwife, teacher, writer, and a mum of 3. She trained as a midwife in London over 20 years ago. She quickly developed a passion for supporting plus size women. Alice has helped hundreds of women with her unique skill mix of clinical knowledge, PhD-level academic skills, and her personal warmth and passion for helping folks.