MARCHING ON

Pregnant And Obese: Are The Maternity Services Adequate?

The UK public is getting heavier. March statistics show that 1:4 of the population is now clinically obese. This has meant a steep increase in obesity related health disorders including type II diabetes, hypertension, high cholesterol and joint problems. As a result, many patients have considered bariatric surgery to treat their obesity. Celebrities such as Sharon Osbourne and Fern Britton have alerted the public to the successes of obesity surgery procedure such as laparoscopic adjustable gastric banding and roux-en y gastric bypass surgery

This clearly has implications for providers of health services but is especially important within the area of maternity care, since the implications of poor outcomes affect mother, child and the extended family. 1:5 pregnant women are now clinically obese. Recent research by The Centre for Maternal and Child Enquiries has shown that half of all maternity units were short of basic equipment such as extra wide operating tables and beds. As a result, they have teamed up with The Royal College of Obstetricians & Gynaecologists to produce guidelines to advise maternity units of how best to improve the services and meet the special needs of pregnant women who are obese.

The UK remains one of the safest nations in which to give birth and has a better maternal and perinatal mortality rate than the USA. This is almost certainly associated with the NHS/socialised medicine offering care to all regardless of ability to pay. Regardless of social status, the vast majority of UK women utilise NHS services and many private hospitals depend upon NHS services for obstetric emergencies and specialist neonatal care.

Obesity is associated with an increase in pregnancy and labour complications such as gestational diabetes, hypertension, miscarriage, stillbirth and birth injuries. It is also clear that obesity can make diagnosis technically difficult as ultrasound waves struggle to move through fat meaning that images may be less clear.

Annette, 35, underwent a keyhole gastric bypass with bariatric surgeon Guy Slater:

“I had two miserable pregnancies both resulting in emergency caesareans. In the second one it was difficult to monitor the baby in labour as the fat made it hard to pick up his heartbeat. I had to have an emergency caesarean which was awful. The theatre table was a bit narrow and I was terrified of falling off. The pregnancy was awful too as my diabetes meant the baby got very big. I hated having the growth scans since the scanners struggle to get good pictures and I felt really guilty.

After my gastric bypass I tried pregnancy once again. It couldn’t have been more different. I was more comfortable, less breathless and everything was so much easier. I had a normal sized baby and was thrilled to give birth naturally. I can’t thank Mr Slater enough for advising that bariatric surgery and the gastric bypass was the right option for me.

Toni Russo is a bariatric nurse consultant for Streamline Surgical who has worked as a midwife in fetal medicine. She says:

“Simply telling women to lose weight is unhelpful and does not help with the current pregnancy. Many of our patients have bariatric surgery and procedures such as the gastric bypass or gastric band as they want to have children. They have had fertility problems, miscarriages or a previous bad experience giving birth. In an ideal world, all women would be fit and well prior to conception and follow the RCOG’s advice to lead healthier lives before becoming pregnant. However, we don’t live in an ideal world. Pregnancy is a difficult time for many women. It is imperative that they are not made to feel guilty for being overweight, they are offered the correct equipment and treated with dignity.”

Obesity will not disappear in the near future and it is likely that more women will choose bariatric surgery and procedures such as gastric bypass surgery and gastric band surgery to help them to address their weight problem. It is also likely that many women will still be obese and the maternity services offered need to cater for these women.

About the Author

At Streamline Surgical we offer a group of bariatric specialists for gastric band and bypass surgery providing the best care for our patients.The most common obesity surgery is gastric band surgery and gastric bypass surgery done by our experienced Bariatric Surgeons.

Cornell Big Red Marching Band $60.54 High Quality Content by WIKIPEDIA articles The Cornell Big Red Marching Band is the only traditional marching band (as opposed to a scatter band) in the Ivy League. It performs at all home, and most away, Cornell Football Games. In addition, the band has performed at half time for numerous National Football League and Canadian Football League games, and began a tradition of an annual Spring Concert in 2006. Author: Miller, Frederic P./ Vandome, Agnes F./ McBrewster, John Binding Type: Paperback Number of Pages: 64 Publication Date: 2010/12/22 Language: English Dimensions: 6.00 x 9.02 x 0.15 inches

Marching Band $70.1 Marching band. Rehearsal, Bands of America, Brass band, Color guard (flag spinning), Drum and bugle corps (classic), Drum and bugle corps (modern), Drum major, Marching percussion, Military band, Scramble band, United States Scholastic Band Association,Ottoman military band. Author: Miller, Frederic P./ Vandome, Agnes F./ McBrewster, John Binding Type: Paperback Number of Pages: 100 Publication Date: 2010/08/02 Language: English Dimensions: 5.98 x 9.01 x 0.23 inches

Waconia Marching Band $76.47 High Quality Content by WIKIPEDIA articles The Waconia Marching Band, based out of Waconia, Minnesota, is a class AAAA youth Marching band that competes at the high school level. It represents Minnesota school district 110.The Waconia marching band was founded in 1972. Their first official performance was in 1973. Now in its 37th year of Marching, the Waconia marching band is regarded as one of the best marching bands in Minnesota.In 1982, the Waconia Marching Band was the first marching band to play inside the Metrodome in Minneapolis, Minnesota. It turns out NFL teams can only invite a high school band to do a half time show once, though the Minnesota Vikings invited Waconia back four times. Author: Surhone, Lambert M./ Timpledon, Miriam T./ Marseken, Susan F. Binding Type: Paperback Number of Pages: 116 Publication Date: 2010/06/29 Language: English Dimensions: 5.98 x 9.01 x 0.27 inches

University of California Marching Band $87.62 Please note that the content of this book primarily consists of articles available from Wikipedia or other free sources online. The University of California Marching Band, usually shortened to Cal Band, is the marching band for the University of California, Berkeley. While the Cal Band is studentrun, it is administered under the auspices of the university and represents Cal at sporting events and social gatherings. The name of the band is The University of California Band by the constitution, but is typically called The University of California Marching Band or The Cal Band. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 120 Publication Date: 2011/04/01 Language: English Dimensions: 9.02 x 5.98 x 0.28 inches

The Pride of Oklahoma Marching Band $92.4 High Quality Content by WIKIPEDIA articles The Pride of Oklahoma Marching Band, known as The Pride, is the student marching band for the University of Oklahoma Sooners. The Pride was founded in 1901 as a pep band to play at Sooner football games. In the early years, the band was composed mostly of Norman residents and was disbanded every year after football season. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 130 Publication Date: 2010/09/13 Language: English Dimensions: 6.00 x 9.02 x 0.31 inches

Sacramento State Marching Band $95.59 High Quality Content by WIKIPEDIA articles The Sacramento State Marching Band, known as the The Spirit of Sacramento, and sometimes informally known as the Sac State Band, Sac Band or SSMB, is the official marching band at California State University, Sacramento. The Band was formed in 1958 as the Sacramento State Marching Musicians. To this day the band performs at all home football games and various away games during the football season. The Band also functions as the defacto student cheering section at athletic events. The Band also is present every year during The Causeway Classic against archrival UC Davis. The band motto: Without Us, Its Just A Game , was adopted in 1996. In 2008, Dr. Clay Redfield, 84, became the newest director of the band. He is the first alumnus to ever lead the band. Author: Surhone, Lambert M./ Timpledon, Miriam T./ Marseken, Susan F. Binding Type: Paperback Number of Pages: 142 Publication Date: 2010/08/10 Language: English Dimensions: 6.00 x 9.02 x 0.33 inches

Yale Precision Marching Band $81.25 High Quality Content by WIKIPEDIA articles The Yale Precision Marching Band (affectionately known as the YPMB) is the official marching band of Yale University. It is a scatter band (what some peers might call a scramble band ), as distinct from university marching bands that emphasize precise movements and geometric field formations. Band members refer to themselves as The Members of, which is derived from their introduction at Yale events. The repertoire of the YPMB is constantly evolving, driven by student arrangers and pop music trends. Besides standard types of band instruments, the YPMB includes violins, bagpipes, accordions, keyboards and air guitars, and was the first scatter band to incorporate electric guitars. The YPMBs Squids section creates large cardboard props for halftime shows. The Squids evolved from the Appoges (pronounced p od z, after appoggiatura, a grace note) of the 1980s and 1990s, who handled props but also carried their own instruments (frisbees, stuffed giraffes, lounge chairs). Author: Surhone, Lambert M./ Timpledon, Miriam T./ Marseken, Susan F. Binding Type: Paperback Number of Pages: 114 Publication Date: 2010/07/31 Language: English Dimensions: 6.00 x 9.02 x 0.27 inches

National Institute of Statistics (Romania) $78.07 Please note that the content of this book primarily consists of articles available from Wikipedia or other free sources online. The National Institute of Statistics (Romanian: Institutul Na ional de Statistic ) is a Romanian government agency which is responsible for collecting national statistics, in fields such as geography, the economy, demographics and society. The institute is also responsible for conducting Romanias census every ten years, with the latest census being organised in 2002. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 76 Publication Date: 2011/06/04 Language: English Dimensions: 9.02 x 5.98 x 0.18 inches

Alfred Publishing 0026524 Marching Fundamentals $38.12 Geared for incoming freshmen this DVD explains and demonstrates marching basics and familiarizes the student with all standard marching commands and positions. Can be used as a selfstudy aid.Contributors: By Greg MartinInstrument: Marching BandFormat: DVDCategory: Marching Band DVD

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The Ohio State University Marching Band $70.1 High Quality Content by WIKIPEDIA articles The Ohio State University Marching Band (often called The Best Damn Band in the Land or TBDBITL) is one of the few allbrass and percussion bands in the country, the largest of its type in the world. Military training was an important part of the early curriculum at Ohio State, and a band was formed to provide music for the cadets to drill to. The first appearance of the OSU marching band was in 1896. Gustav Bruder, a professional musician with military band experience, was hired to lead the band. Under Bruder, the band grew in size and began playing and marching for all military and athletic events. The OSUMB grew over the years, from 100 members in 1920 to 225 members today. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 80 Publication Date: 2010/08/14 Language: English Dimensions: 6.00 x 9.02 x 0.19 inches

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Rhythm Band Instruments RB911 Marching Drum $33.08 The Rhythm Band marching drum delivers percussive sound that children will find enchanting. Rhythm Band includes rubber safety springs a pair of drum sticks and a head of durable Melinex plastic with the kidsized drum.

University of Montana Grizzly Marching Band $78.07 Please note that the content of this book primarily consists of articles available from Wikipedia or other free sources online. The University of Montana Grizzly Marching Band is a select, fun and closeknit group of hardworking, dedicated students. The band is open to everyone on the UM campus regardless of year or major. In fact, it has members of the band from virtually every major and discipline on campus and from almost every corner of the United States and around the world. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 84 Publication Date: 2011/05/19 Language: English Dimensions: 9.02 x 5.98 x 0.20 inches

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