Overweight pregnant women are more likely to be overdue and have more complicated births, a study has found.
Women who were overweight or obese before they conceived were more likely to have a longer pregnancy, need to have labour induced artificially and to go on to require caesarean section births.

The research was conducted by a team at Liverpool University who examined the records of almost 30,000 women who gave birth over four years.

Three in ten obese women were overdue, defined as still pregnant ten days after their due date, compared with around two in ten of healthy weight women.

More than a third of obese women had their labour induced, compared with just over a quarter of normal weight women, the study published in the British Journal of Obstetrics and Gynaecology found.

In addition almost three in ten obese women had an induction of labour which later resulted in a caesarean delivery compared to less than two in ten normal weight women.

However, more than seven in ten obese women still gave birth naturally and the rates of complications in labour and for the baby were the same as in normal weight women.

Other studies have found that maternal obesity is now one of the biggest risks in childbirth. In 2007 it was found that half of all women who died during pregnancy or soon after giving birth were overweight.

Maternity units have had to order special operating tables, wheelchairs and other equipment to deal with the increasing number of obese mothers and doors have had to be widened to accommodate them.

Management of obese prolonged pregnancies is often difficult as induction of labour is associated with a high risk of caesarean section and the possible complications that follow including infection, bleeding and clots.

Dr Sarah Arrowsmith, from the University of Liverpool’s Institute of Translational Medicine, and lead author on the paper said: “Maternal obesity has become one of the most commonly occurring risk factors in obstetric practice including greater risk of prolonged pregnancy.

“The importance of this research is that it investigates delivery outcomes for women who are obese with prolonged gestation and receiving labour induction. The fact that the majority of obese women did have a vaginal delivery, with labour complications being largely comparable to normal weight women, suggests that induction of labour in obese women with prolonged pregnancy is a safe method for managing these difficult pregnancies.

“Our findings were somewhat unexpected, given the well-reported complications surrounding obesity in pregnancy, but were clinically reassuring.

“Our current research is focused towards underlying causes of prolonged pregnancy, which can affect up to ten per cent of women, as currently we know little about it.”

Professor Philip Steer, BJOG editor-in-chief said: “Maternal obesity is on the rise and is associated with pregnancy complications. The risk of caesarean section is heightened when the woman is induced, however, it is promising to see that a large number of obese pregnant women delivered vaginally.”

From: http://www.telegraph.co.uk/Obese-pregnant-women-have-more-complicated-births-research

A coroner yesterday condemned a “scandalous” hospital maternity unit over the death of a third baby in its care.

Milton Keynes General Hospital has been heavily criticised over shortages of beds and midwives following the deaths of baby girls Romy Feast and Ebony McCall.

Yesterday, its maternity unit faced fresh scrutiny after an inquest found Alex Broughton died within a day of being born after staff failed to recognise a problem with his heart.

Thomas Osborne, deputy coroner for Milton Keynes, said by failing to recognise the baby’s deteriorating heart condition during birth, staff “lost an opportunity” to speed up delivery and treat him.

The child suffered severe brain damage during birth and died on December 3 last year after being moved to a specialist unit at the John Radcliffe Hospital in Oxford.

Mr Osborne said the way Alex’s heart was monitored was a “major area of concern”.

He said: “The monitoring of his fetal heart rate during delivery failed to recognise his deteriorating condition prior to his birth and thus failed to trigger any concern for his well being that resulted in a lost opportunity to expedite his delivery and render further medical treatment.”

The coroner added that there had been conflicting evidence about how a midwife had monitored Alex’s heart rate.

He said an Oxford medical student observing the birth had given “surprising and unhelpful” evidence by saying that he could not recall what monitoring method had been used.

The inquest also heard that Alex’s parents, Lorna Howell and Matthew Broughton, received a hospital “birth congratulations” letter on the day Alex died.

Speaking after the hearing, Alex’s grandfather, Alan Broughton, branded the treatment as “a disgrace”. He added: “It would seem that serious problems continue to exist in the maternity unit.”

The criticisms are the latest in a string of scandals to hit the Buckinghamshire maternity unit in recent years.

Last year, Mr Osborne complained that midwife shortages were “nothing short of scandalous” after the death of Ebony McCall on an overstretched maternity ward.

An inquest heard that Ebony would probably have survived, had her mother, Amanda, been given a caesarean section when she asked for one. But staff were too busy and told her they would only carry out the procedure in an emergency, the inquest heard.

The scandal came despite having already been investigated over the death of Romy Feast in the same unit in 2007, who died after her heart condition was misinterpreted. Following the inquest into Romy’s death, Mr Osborne reported the hospital to the Department of Health, which prompted an investigation by the Healthcare Commission.

Earlier this year, the Care Quality Commission, the health watchdog, issued a damning report saying its maternity unit still had too few midwives and beds.

In March, Monitor, the independent regulator of NHS foundation trusts, intervened by sending in a team of clinical advisers to ensure that services are improved.

The hospital yesterday said the circumstances surrounding deaths of the two girls and Alex had been different and added that there was “nothing to suggest that any aspect of treatment or management (of Alex) … was in any material sense deficient”.

A spokeswoman for Milton Keynes NHS Foundation Trust said: “After the death of Ebony McCall and Romy Feast, we accepted mistakes had been made and we have been making significant improvements to our maternity services over the last year.

“While equally tragic, the circumstances around the death of Alexander Broughton were very different. His mother was given one-to-one care by a qualified midwife and appropriate procedures were followed.”

From: http://www.telegraph.co.uk/Coroner-condemns-maternity-unit-after-death-of-third-baby

NHS Hospitals risk staff shortages because of the numbers of junior doctors becoming pregnant after getting their first secure job, medics have warned.
They have urged the Government to make better long term plans so that departments were not left struggling when several doctors go on maternity leave at once.

The British Medical Association’s annual junior doctors conference called on the Department of Health (DoH) to draw up long-term estimates which take account of the fact that the majority of medical graduates are now female, and likely to take maternity leave, while many would go part-time.

They said the DoH needed to draw up better plans, which might mean taking on more trainees, and pool jobs, so that departments were not left struggling when several women went on maternity leave.

Such plans should take account of the fact that women were more likely to consider pregnancy once they had the job security of a four-year specialist training post, at least seven years after starting medical school, she said.

The specialist registrar in genitourinary medicine said it was “incredible” that the health service did not make plans which took account of the growing numbers of women in its workforce.

Latest figures show 56 per cent of successful applicants to medical school were female, and the majority of doctors will be female by 2017, according to a report by the Royal College of Physicians.

Dr Draeger, who has a son Henry, aged 2 and a half, and baby Catherine, of six months, said: “When I was pregnant the first time, out of the 11 trainees on my rotation, four were pregnant at the same time. My consultant was surprised and I said ‘how can you be? You have appointed seven women in their early 30s to a four-year guaranteed job with maternity benefits. Of course some are likely to think it is a good time to get pregnant’.”

Under the current system, a junior doctor entering specialist training, after five years of medical school, and two years of general training, would be aged at least 25. Many are older, with some having taken gap years before or after university, or taken longer to find a training place in the specialist profession.

Dr Draeger said she did not want to see women being turned down for a job because they were of child-bearing age, but that national plans should be drawn up, with pooling of jobs regionally to ensure there were sufficient numbers of medics to avoid shortages in particular departments.

Dr Tom Dolphin, deputy chairman of the BMA’s junior doctors committee agreed with the calls for better planning, describing pregnancy as “entirely predictable at a population level”.

The conference in London last weekend heard that some medical specialities were hit particularly hard by sudden shortages of women, with 9 out of 10 women working on one paediatric specialist training rota becoming pregnant within a short period, and all planning to return to work on a part-time basis.

From: http://www.telegraph.co.uk/Hospitals-face-staff-shortages-as-junior-doctors-become-pregnant

The NHS is facing upheaval and cutbacks as a decade of budget increases comes to an end and £20 billion of savings must be found over the next five years.

Despite pledges from Labour and the Conservatives to protect front line services, there is evidence that their promises may have come too late.

A list of cuts has already been identified – including job losses, banning certain operations, closing casualty departments, downgrading maternity services and reducing the number of junior doctors. But these have been mostly quietly ignored by the three main parties.

The Conservatives pledged to stop all closures until they could be reviewed but, with billions of pounds of savings needed to cope with growing demand, cuts and closures are almost inevitable.

David Cameron emphasised that he was personally in favour of the NHS, after his experiences with his disabled son Ivan, who died last year, to combat arguments that the health service was not safe in Tory hands. The party manifesto contained promises about dentistry and round-the-clock GP services which appear too expensive in the current climate.

Both the major parties were accused of chasing the “fear of cancer” vote. The Tories said they would fund cancer drugs turned down by Nice, the health rationing watchdog, but did not mention drugs for other illnesses such as arthritis or dementia.

Labour said cancer patients would see a specialist and have test results back within a week. The party was criticised for unveiling its manifesto at a new hospital in Birmingham. It is against the rules to use NHS premises for election events.

But Labour pointed out that the hospital was still in the hands of the private finance initiative organisation – a policy which means the NHS will be repaying billions of pounds for new hospitals for decades.

Nick Clegg refused to ring-fence NHS spending given the size of the national debt.

The Liberal Democrat campaign focused on cutting waste on managers, scrapping regional strategic health authorities and pledging more power to communities to direct the health service locally.

From: http://www.telegraph.co.uk/General-Election-2010-cuts-inevitable-as-NHS-must-make-savings