Obese mums trial drug to make baby smaller

It has frequently been discussed in the media and in medical research that obese women are not only likely to have larger babies but that they are more likely to require a caesarean (and that caesarean delivery is ‘riskier’ for obese women).

Patrick O’Brien (RCOG)  said “When you are overweight in pregnancy you are at increased risk of just about every complication you can think of.”

While women have long been encouraged to eat sensibly rather than excessively when pregnant, dieting once pregnant is strongly discouraged. The difficulty is that an ever increasing number of women start their pregnancy already obese and unable to take significant dietary action. Not only this but for some women, a life time of eating habits can feel impossible to alter even when the risks to an unborn baby are explained.

The Telegraph  reported on a trial starting back in 2012 which involved 400 women in Coventry, Liverpool, Sheffield and Edinburgh using a drug (Metformin) traditionally reserved for diabetic women to restrict the growth of their unborn baby. Half the group took the drug , the other half received a placebo.

The senior lecturer in obstetrics leading the trial, Dr Weeks explained some of the reason behind the investigation saying “The difficulty comes when you have been living in a particular way for years that is not healthy…To suddenly change to a different lifestyle is not easy to do.”

Will Williams, scientific advisor for All About Weight (a weight loss organisation) express concerns about the implications of treating obesity issues in this way. The concern being not only that is there no information about the long term effects on children of having been exposed to these drugs inutero but also that resorting to pills to reduce foetus weight “is unlikely to break the cycle of an unhealthy lifestyle leading to overweight children and the continuing rise of obesity and diabetes in the general population.”

I will report back when the results are released, but the earliest this will be is 3 years from now when the trial completes.

Drop in clinic on Netmums

I will be running a caesarean birth drop-in-clinic on Netmums this Friday (2nd March). Join me there to ask any questions you have about any aspect of caesarean birth.

“Whether you are a first time or experienced mum, the prospect of giving birth can be a daunting and exciting at the same time…We hope this will give you the opportunity to ask questions and to discuss your forthcoming birth with experts other than your regular midwife.”

RCOG list Caesarean Birth: A positive approach to preparation and recovery

Professor Jim Dornan (ex Senior Vice President of RCOG) reviews ‘Caesarean Birth: A positive approach to preparation and recovery’.

“The book is an excellent read, and has already been endorsed by, amongst many others,  James Drife, Phil Steer, Brian Beattie, and myself. [RCOG members]…It’s a fact that 25% of OUR charges end up having a caesarean and yet there is a paucity of information for mothers and this book address ALL the major issues in a non judgemental manner. It neither promotes caesarean birth nor does it castigate it as a method of childbirth. It is a book that is well overdue, and indeed it is sad that a member of the lay public had to be relied on to come up with it! It is incredibly well researched and referenced, and no serious studies have been excluded by it’s author.

Media reports on NICE caesarean debate quite balanced

Media debate over one of the key changes to the NICE caesarean guideline has been very thorough throughout the day. Focus has primarily been on the recommendation that women should have the right to request a caesarean even when they do not have a medical indication for one, (assuming that request follows detailed discussion about the benefits and risks of both modes of birth).

What is particularly impressive about the media coverage is the balance and accuracy achieved in so many of the interviews and reports.

NICE guidelines published

Today NICE released the 2011 version of their guidelines for Caesarean Section.

There are a number of significant updates. In particular:

  • women wanting to request a caesarean on the grounds of fear should be offered perinatal mental health support and if, following this, they continue to want a caesarean, this should be granted
  • women wanting to request a caesarean where there is no medical need should engage in a detailed discussion with their practitioners. All the risks and benefits of both vaginal and caesarean birth should be fully discuss but if, after this, the woman still prefers a caesarean this should be granted
  • not all women with HIV should be automatically offered a caesarean, they should be informed that “the risk of HIV transmission is the same for a CS and a vaginal birth” in specific circumstances – read the guideline (page 6) to get a summary of the specific circumstances where this is the case

There are also new recommendations regarding: timing of antibiotic administration, the use of colour-flow Doppler ultrasound scans etc.

The important thing to note is that this is a guideline, not a directive and some hospitals may still choose to ignore some of the recommendations.