Giving birth in a birth centre may be as safe for some obese women who have given birth before as it is for those with a lower Body Mass Index (BMI).
A new study, published in PLOS ONE and funded by the National Institute for Health Research (NIHR), has shown that, for women with a BMI between 35 and 40 who have given birth before and are otherwise healthy, planning birth in an alongside midwifery unit (AMU) can be just as safe as for women with a lower BMI.
Working with a network of midwives in AMUs across the UK, as part of the UK Midwifery Study System (UKMidSS), researchers at the NPEU, led by Dr Rachel Rowe, identified and collected information about all 1,122 severely obese pregnant women (with a BMI over 35kg/m2) who received labour care in AMUs, and 1,949 comparison women with a lower BMI who were looked after in the same units.
This initiative is the direct result of the involvement of our Diabetes in Pregnancy PPI group of women with lived experience of diabetes in pregnancy. Their support has already helped to secure funding for another project to understand why women may experience the life-threatnening condition of diabetic ketoacidosis (DKA) in pregnancy. This important project, led by Professor Marian Knight uses the UK Obstetric Surveillance System (UKOSS) and confidential case enquiry, and is funded by an NIHR Research for Patient Benefit grant (NIHR RfPB ref: PB-PG-0817-20004).
Director, National Perinatal Epidemiology Unit 1994-1995
It was with great sadness that we heard the news of the death of Professor Judith Lumley on 25th October 2018 in Victoria, Australia. Judith was a world renowned researcher who leaves a substantial legacy in the field of maternal and child health. Among her many great and lasting achievements she established and ran the Victorian Perinatal Data Collection Unit. This exemplified her early vision of the need for and importance of routine surveillance data and the role such data can play in conducting high quality research to improve health outcomes.
In 1991 Judith established the Centre for the Study of Mothers’ and Children’s Health in Victoria, which was later renamed ‘The Judith Lumley Centre’ in recognition of her contribution to building a programme addressing issues of major public health importance for mothers, babies and families.
Judith was recruited as Director of the National Perinatal Epidemiology Unit in 1994. She spilt her time between Oxford and Victoria during the two years she was Director of the Unit (1994 to 1995) following which she returned to the Centre in Victoria, where she remained Director until her retirement in 2008.
Her lifetime achievements were recognised in 2006 when she was made a Member of the Order of Australia (AM) for her contribution to public health and maternity care.
We understand that Judith died peacefully following a long illness. She will be greatly missed by everyone who worked with her and benefited from her gentle guidance and kind mentorship. Predeceased by her husband Peter, Judith is survived by her children, grandchildren and three sisters.
The fifth MBRRACE-UK collaboration’s annual report Saving Lives, Improving Mothers’ Care led by the National Perinatal Epidemiology Unit shows that the number of women dying as a consequence of complications during or after pregnancy remains low in the UK - fewer than 10 of every 100,000 pregnant women die in pregnancy or around childbirth. However, the report highlights striking inequalities: black women are five times and Asian women two times more likely to die as a result of complications in pregnancy than white women and urgent research and action to understand these disparities is recommended.
Heart disease remains the leading cause of women dying during pregnancy or up to six weeks after giving birth, followed by blood clots. Maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, but is the leading cause of death over the first year after pregnancy. Although there is greater awareness of the importance of mental health during pregnancy and in the first year after birth, there is still a long way to go in recognising symptoms, supporting women with mental health problems and providing access to specialist perinatal mental health care.
The report highlights the risk of blood clots, particularly among women who are overweight or obese, and emphasises the importance of awareness of symptoms, such as leg or buttock pain and breathlessness even in early pregnancy.
Women who are aged 40 or over have three times the risk of dying during or after pregnancy compared to women in their early 20s and although cancer in pregnancy is uncommon, women and their doctors and midwives need to be aware that it can happen.
The report emphasises the importance of considering the benefits of starting or continuing medication to treat physical and mental health conditions during pregnancy, as well as the risks. Many medicines are safe in pregnancy, and so ensuring a woman is properly treated while pregnant may be the best way to care for both her and her baby.
WHEAT stands for WitHolding Enteral feeds Around packed red cell Transfusion to prevent necrotising enterocolitis in preterm neonates. It is a multi-centre, randomised point of care trial. WHEAT is taking place in neonatal units within the North West London and Birmingham Neonatal Networks.
Chelsea and Westminster Hospital, Hillingdon Hospital and New Cross Hospital all recruited their first babies to the trial on Friday 19th October. Well done!