Managing women in pregnancy after bariatric surgery: the midwife as the co-ordinator of care
Bariatric surgery is a recommended, cost-effective, evidenced-based intervention to reduce weight and associated comorbidities in severely obese people. People with a BMI of 40 kg/m2 or more, or a BMI between 35–40 kg/m2 with other medical conditions such as diabetes, hypertension, high cholesterol and obstructive sleep apnoea meet the criteria to be considered for bariatric surgery. Over the past 10 years, bariatric surgery in the UK has been more widely accessible and consequently midwives may be required to care for pregnant women who have undergone bariatric surgery such as a gastric band, sleeve gastrectomy and gastric bypass.
Midwives are required to work co-operatively, recognising and working within the limits of their competence and providing leadership. The aim of this article is to consider the midwife's role as co-ordinator of care for pregnant women who have undergone bariatric surgery. It outlines the most common bariatric procedures and specific considerations, including nutritional supplementation required when providing care to women in the antenatal and postnatal period.
Obesity is graded according to a BMI measurement >35 kg/m2. Morbid obesity is classified as a BMI measurement >40 kg/m2 (National Institute for Health and Care Excellence (NICE), 2014). It is predicted that 48% of adults in the UK will be classified as obese by 2030 (Wang et al, 2011). Obesity is strongly linked to metabolic diseases (cardiovascular disease, diabetes mellitus, non-alcoholic fatty liver disease and polycystic ovary syndrome (PCOS)), musculoskeletal and respiratory disorders and psychological illness; losing weight can improve these co-morbidities (Whitehead and Bano, 2019). Weight gain can be attributed to many factors, such as excessive food intake, sedentary lifestyle, socioeconomic deprivation, medications, depression, genetic and endocrine disorders (Whitehead and Bano, 2019). Several hormonal imbalances affect obesity, including ghrelin—which is produced in the fundus of the stomach—androgens and oestrogens. Ghrelin levels increase before eating a meal, leading to hunger. After eating, ghrelin levels reduce, which leads to satiety (feeling satisfied). Women with PCOS have low levels of ghrelin that are not affected by eating, therefore causing reduced satiety, which results in increased food consumption and weight gain. Androgens increase visceral fat (fat around the organs) and oestrogen is responsible for subcutaneous fat distribution, mostly on the hips (Whitehead and Bano, 2019).
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