Bariatric Clients in Maternity Units

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Introduction

The problem of obesity is growing in the UK with every coming day which has resulted in the increased risk of handling the health and social care manually. Although the number of morbidly obese population is small, however they are significantly over-represented in their use of social and health services in the society. Out of many health issues caused by obesity, reproductive disorders are also a cause of occurrence in both obese men and women. Various studies and researchers have identified the fact that women who are obese have higher risk of complications during pregnancy and at the time of delivery which includes complications like pregnancy-induced hypertension, induction of labour, wound infection, late recovery from delivery, premature labour, diabetes and macrosomia. In some cases, there has also been prenatal death as a result of the pregnancy.

Obesity is defined as more of an abnormality then a disease as excessive fat accumulates that may damage health. Nevertheless, in history the weight gain issues over time have not been well documented. People are unable to maintain healthy weights throughout their life and it is normal for some fluctuations in the weight gain of an individual also age, sex, ethnicity work as the key factors in the weight gain of an individual. The stipulation of health and offering social care to obese bariatric patients presents difficulties in many aspects. Handling such patients manually presents a specific challenge partially due to the lack of space and equipment and partially due to the treatments being available (Hignett et al, 2003).  .

For the treatment and health provisions of the obstetric bariatric patients, there are specific policies being provisioned by the government. These policies are formulated to ensure the proper handling, care and treatment of the obese patients during their pregnancy. It is the duty of the hospital and doctors to ensure that the patient’s clinical needs are integrated and understood before formulating their care plan. This ensures that all patients are given fair treatment which in accordance to the policy formulated by the government.  As it has been proved by the epidemiological studies that the number of heavyweight pregnant patients is increasing in UK the safe and effective healthcare policies for this group of people are becoming the top most priority of the healthcare providers (Chu, Callaghan, Kim, Schmid & England, 2007).

Almost about 40 to 70 percent of hospitals and trusts do not have a bariatric policy however this absence cannot eliminate its importance as these policies lead to the process of planning and managing the lives of patients in a safe way. Government has set a number of provisions to maintain a quality of healthcare services being provided to such patients at the time of pregnancy and delivery. For the purpose of formulating a policy, bariatric refers to all the patients who are heavier than 114 Kg (Raatikainen, Heiskanen & Heinonen, 2006). For a policy to be successful it is important that it supported by the organisation as a whole.

There is prominent evidence that during pregnancy, obesity contributes to a great extent in the increased morbidity and mortality for both mother and baby. According to a report by maternal death enquiry, about 35 percent of the women who died during deliveries were obese (CEMACH, 2007). Also these cases of obesity increase the social financial costs as women who are obese and delivering spend an average of about 5 days more in the hospitals due to the increased risk of complications during labour which adds up to three times more cost then a normal delivery. Also, the cost that is related to the new born is also 3.5 percent more to the babies born to obese mother in NICU (Sharon, 2009).

The policy that is being formulated by the East Anglia government for the health an safety of obstetric bariatric pregnant women affirms that no patients is not able to fully enjoy their rights at the time of pregnancy (Sharon, 2009). According to the policy, hospitals are responsible to promote such teachings and workshops which are helpful for increasing awareness amongst staff members about the importance of handling such patients efficiently. As being an obstetrician, a doctor should work professionally and adhere to the proper standards of medical when dealing with a pregnant lady. The responsibilities of an obstetrician should reflect that pregnancy and the birth of a child is natural phenomenon in which his rule is to give the best possible advice to the patient to help them overcome the most crucial time of their life, without any danger to their life and by doing this, the obstetrician maximises the health and safety of the mother and the child (Bhattacharya, Campbell & Liston, 2007).

According to the policy, the doctors should treat an obsess pregnant lady with the same respect as they do to any other female patients and seek her cooperation and understanding of the issues that the patient is facing including the medical as well as the linguistic and cultural needs. Also, privacy of the patient should be the first priority of the doctor when taking history and performing relevant clinical examinations (Sharon, 2009). Also, every woman holds the right to know about the progress of her pregnancy and doctors should inform the patients about every change and progress that the baby shows during pregnancy. Thus, the patient should be well informed about what are happening; pregnancy, delivery and the postpartum period (Sue, Susan, Amanda & Paula Griffiths, 2007).

With all these clauses of the policy being set, there are still some negative responses of the people about the treatment option that is being adopted by the patients in treating the obese pregnant woman. The issue has been raised when some patients reported that they have been told to lose weigh during pregnancy be their doctors. This issue was one of the major concerns for the hospitals because pregnancy is the time when woman gain the most weight however this is not the case if you are obese because then you are assumed to be at a high risk already (Craig & Mindell, 2006).

Also, as mentioned in the policy, every woman has the right to choose the way of treatment and fully participates in the decision about her own health. Doctors sometimes ignore the fact that the patient has complete right to refuse to a treatment and are forced to comply with the ways that are decided by their doctors.  One of the major concerns of obstetric bariatric in pregnant woman is the constant pressure that they are under to lose weight by their doctors. They have the right to inform the patients with the options of services that are available for their treatment as well as their option to make their own decision.

Besides these aspects, hospitals are also responsible for providing the right care to these patients for instance, it is the responsibility of the hospital to ensure that a antenatal test is being conducted in which the weight of patient, her height and BMI is calculated in order to be documented in the records and tracked throughout the pregnancy. During pregnancy, there is a high risk of developing gestational diabetes in obese woman. Therefore, it is the responsibility of the doctors to keep a track of that as well (Driul, Cacciaguerra, Citossi, Martina, Peressini & Marchesoni, 2008). At the time of delivery, it is important for the hospitals to ensure the presence of special equipments that will be used by the doctors and the patient including examination couch, delivery bed, operational bed etc, keeping in mind the needs of the obese patient.  After the delivery, there are certain measures that are needed to be followed by the doctors, as the rate of recovery in an obese patient is far slower when compared to a normal delivery. According to the policy, every obese woman who has delivered and undergone obstetric procedures for delivery must involve a minimum of 30 minute in lithotomy position.

Maternal and child care has always been the utmost priority of the healthcare departments in East Anglia. The scope of these services range from managing the medical problems at the time of pregnancy to comprehensive care of low risk deliveries. When a woman is obese, there is an increased risk of complications during the birthing process which includes severe cases of caesarean birth or even post-partum hemorrhage. In addition to these, depression, hypertension, diabetes are also a few risk factors. However, these policies formulated by the government for the hospitals to follow ensure the reduction of risk and availability of resources at the time of emergencies.  The importance of looking after and providing care to an obese or bariatric woman at the time of pregnancy entails attention to the possible occupational health safety and welfare vulnerabilities (Walley Blakemore & Froguel 2006).

The formulation of such policies does not ensure that these policies are being implemented in the hospitals effectively. There are still some maternity units who do not have the special equipments used during the delivery of the obese patients. Therefore it is recommended that strategic policies which are formulated by the government or NMC are also implemented throughout East Anglia. These policies should assess the manual handling processes in the hospitals of such patients as well as buildings of vehicles and other designs to accommodate obese patients in safety and comfort and training is required to support the assessment of obese patients.

 

 

References

Bhattacharya S, Campbell DM and Liston WA (2007), Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health, Vol. 7, pp. 168.

Craig R and Mindell J (2006), Health survey for England. Latest trends. A survey carried out for NHS The Information Centre

CEMACH (2007), Saving Mothers’ Lives – findings on the causes of maternal deaths and the care of pregnant women: The Confidential Enquiry into Maternal and Child Health (http://www.rcog.org.uk/news/cemach-release-saving-mothers-lives-findings-causes-maternal-deaths-and-care-pregnant-women)

Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J and England LJ, et al. (2007), Maternal obesity and

Driul L, Cacciaguerra G, Citossi A, Martina MD, Peressini L and Marchesoni D (2008), Prepregnancy body mass index and adverse pregnancy outcomes. Arch Gynecol Obstet, Vol. 278, pp. 23–26.

Hignett S. (2003), Evidence-based patient handling tasks, equipment and interventions, London: Routledge, pp. 156-178

Raatikainen K, Heiskanen N and Heinonen S. (2006),, Transition from overweight to obesity worsens Pregnancy outcome in a BMI-dependent manner.  Obesity (Silver Spring), Vol. 14, pp. 165–71

Sue Hignett, Susan Chipchase, Amanda Tetley and Paula Griffiths (2007), Risk assessment and process planning for bariatric patient handling pathways, Loughborough University: Leicestershire

Sharon Van Hansen (2009), Bariatric Patient Policy, NHS Foundation Trust by Risk Management Committee.

Walley AJ, Blakemore AIF and  Froguel P. (2006), Genetics of obesity and the prediction of risk for health. Hum Mol Genet, Vol. 15, pp.124–130.

 

 

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