Impact of obesity on womens health during pregnancy

Impact of obesity on womens health during pregnancy Obesity is a clinical term used to describe excess body fat. The most common method of measuring obesity is the Body Mass Index (BMI). BMI is used because, for most people, it correlates with their amount of body fat. It is calculated by dividing a persons weight measurement (in kilograms) by the square of their height (in metres). a BMI of 30 or above means that person is considered to be obese (DoH, 2010). Rising rates Obesity is an increasing phenomenon worldwide. In 2008, the Health Survey for England (HSE) data showed that 61.4% of adults (aged 16 or above) in England were overweight and of these 24.5% were obese. They found this was an increase since 1993. In pregnancy- In pregnancy the incidence is around 18-19% in the United Kingdom (Kanagalingam et al, 2005). Between 2004 and 2007, 15% of all UK maternal deaths occurred in women with a BMI of more than 35, half of which had a BMI of over 40. Fifty-two per cent of deaths occurred in women with a BMI of over 25, which is classed as over-weight (Lewis, 2007) Dangers and complications- Obesity is a common risk factor in many conditions, especially metabolic (e.g. type 2 diabetes), circulatory (e.g. cardiovascular disease) and degenerative (e.g. osteoarthritis). For women, the risk of gynaecological complications, like endometrial cancer, infertility, menstrual disturbances and ovulation disorders, increase if the woman is obese. There are many significant risk factors during pregnancy that are affected by obesity. These include early miscarriage, gestational diabetes and pregnancy hypertension/pre-eclampsia (Andreasen et al, 2004/Duckitt et all, 2005/Erez-Weiss et al, 2005/Shaw et al, 2000), venous thromo-embolism and anaesthetic problems, e.g. tracheal intubation or epidural/spinal insertion (Irvine et al, 2006). If maternal complications develop the fetus/neonate is also at risk of neural tube defects (Shaw et al, 2000), late still birth (Irvine et al, 2006) and neonatal death (Kristensen et al, 2005), fetal macrosomia (Yogev et al, 2005), fetal trauma and neonatal unit admissions (Irvine et al, 2006). Obesity also causes issues pertaining to the value and reliability of certain aspects of care during the antenatal period. These include difficulties in performing amniocentesis (Irvine et al, 2006), difficulties in achieving venous access, difficulties in performing abdominal palpation (Farrell et al, 2002) and difficulties obtaining ultrasound data for fetal anomalies and growth (Martinez-Frais et al, 2005). There are significant risk factors due to obesity during the intrapartum period. These comprise increased rates of prolonged labour (Vahratian et al, 2004), risks associated with macrosomia e.g. shoulder dystocia (Irvine et al, 2006/Andreasen et al, 2004), increased rates of operative birth (Irvine et al, 2006/Fraser, 2006), especially for primigravida (Dempsey et al, 2005), difficulties in undertaking instrumental and operative procedures (Irvine et al, 2006/Andreasen et al, 2004) and difficulty siting an epidural or spinal for labour or caesarean section (Irvine et al, 2006). Postpartum related obesity issues consist of longer post-operative recovery times and increased rates of post-operative complications, e.g. infections of wounds and urinary tract (Irvine et al, 2006). Women who are obese during pregnancy exhibit a tendency to retain fat centrally on their abdomens postnatally, which may results in increased morbidity and mortality later in life (Soltani et al, 2002). Contraception choices will also be influenced by the presence of complications. Whilst out on my community placement, I was involved in the care of a woman who had a BMI of 52. We were caring for her postnatally after an elective caesarean section. Most likely due to her weight, the surgeon chose to use metal skin clips on her wound, rather than a suture (Irvine et al, 2006). On day five postnatally we were due to remove alternate staples. However, we could see the wound was still gapping and not fused closed so we left them for one more day. On day six we returned and removed the alternate clips with no problem. Irvine et al (2006) recommend an interrupted suture or skin clips on the basis that if a small haematoma or a localised area of infection develops, a few clips/sutures can be removed to aid resolution. When we revisited the woman on day eight, we found the wound to be very red, oozing puss and giving off a very offensive smell. The woman simply could not get any air to the wound, due to the over-hang of her stomach on to the wound. Even whilst lying down, the stomach still covered the area if it was not held up and supported. I feel this was an important factor to her getting a wound infection. Due to the over hanging of the pannus, women are significantly at increased risk of wound infection even if given postoperative prophylactic antibiotics (Irvine et al, 2006). Discuss differing health promotion strategies according to context of the case study Obesity levels in England have currently reached epidemic levels and Suffolk is consistent with this. Suffolk is below the average obesity level, but this varies across the county (Transforming Suffolk, 2008). A new project has been launched, called Healthy Ambition Suffolk to make Suffolk the healthiest county in the UK by 2028. Part of this includes tackling obesity. Governments 5 a day scheme In January 2009, the Government began a campaign in response to the rising rates of obesity. Change4Life is Englands first ever national social marketing campaign to promote healthy weight and supports the overall Healthy Weight, Healthy Lives strategy. One of Change4Lifes recommendations is to eat 5 A DAY as part of a healthy balanced diet (DoH, 2010). Eating at least five portions of fruit and vegetables everyday seems valuable, however it is hard to see exactly how this will help with the fight against obesity, unless it is thought that consuming more fruits and vegetables will transfer calories from other sources. Healthy start vouchers The Government has also introduced another health promotion strategy called Healthy Start. This consists of vouchers with a monetary value which can be used against fresh fruit and vegetables, fresh milk and also infant formula. Not every woman will be able to claim these, they are income assessed and women need to fit certain criteria (DoH, 2006). Dietian/nutritionalist referrals In accordance with the National Institute for Health and Clinical Excellence (NICE, 2010), pregnant women with a body mass index of more than 30 will be under consultant led care and receive any additional care they require. Midwives should refer women to a dietician for assessment and advice on healthy eating and exercise. However, they should not recommend weight-loss during pregnancy (NICE, 2008). In 2003, a report on obesity by the House of Commons demanded six other government departments joined forces. These departments were: Department of health: Main responsibility as obesity is a public health issue. Department of culture, media and sport: For promoting sports and physical activity. Department for education and skills: To ensure that children get adequate physical education at schools and have access to food at schools. Department for transport: For making healthy transport policies to encourage cycling and walking. Department of environment, food and rural affairs: For farming and produce of healthy food. Department of trade and industry: For food manufacturing and retail industry Analyse concepts of poverty, disadvantage and inequality and the impact on childbearing women, babies and their families. There is evidence that maternal obesity is related to health inequalities, particularly socioeconomic deprivation, inequalities within ethnic groups and poor access to maternity services (Heslehurst et al 2007). Healthy food is often more expensive and gyms facilities and fitness classes are not readily available for low income families. Analyse and reflect upon the role of the midwife and other professionals in their contribution to the public health agenda The Faculty of Public Health define public health as the science and art of preventing disease, prolonging life and promoting health through organised efforts of society (Acheson, 1988). Public health is about promoting physical, mental or emotional well-being by inspiring, educating and empowering the public to stay healthy (CSP, 2010). Midwives play a very important role in achieving this. When initially booking women for their pregnancy care, if there are any health concerns the midwife should advise and refer to other health professionals if necessary. The role of the midwife has evolved in recent years with more emphasis on a public health role (DoH, 1993). It is reasonable to expect that midwives should have a working knowledge of the effects obesity, as well as other common public health issues, including teenage pregnancy, drug and alcohol abuse and smoking. They should have an understanding of the common risks associated with obesity and what they should be able to offer by way of support (English National Board, 2001). The Saving Mothers Lives report (2003-2005) carried out by the Confidential Enquiry into Maternal and Child Health (CEMACH) recommends that obese women should receive help to lose weight prior to conception. However, this is not always possible. I believe the Government are currently taking the correct steps to combat obesity. Whilst working on community and undertaking booking appointments, I have not actually seen women being referred for high BMIs. This is due to my Trust not taking a womans height and weight at the booking appointment so their BMI is unknown. These details are recorded when the women go for their 12 week dating scan. Therefore, referrals for high BMIs are carried out from the antenatal clinic. As midwives, we are used to managing women with complex needs in partnership with other agencies. I believe it is working within the multi-disciplinary team which gives the best care to women. The Royal College of Midwives (RCM) surveyed midwives and new mothers, which were published during Midwifery Week 2008. They showed that due to the shortage of midwives women are being short-changed on essential public health services and advice and are not getting the level and quality of service needed in areas such as obesity, smoking cessation, breast feeding and alcohol intake. The level of help that obese pregnant women are receiving is a cause for concern. Only 8% of women were offered help and advice, while the amount of women who said they would have liked to have had the service was 30%. The midwives surveys supported these findings, with only a fifth (22.5%) stating that they are able to offer or run obesity clinics, and 71% saying their Trust do not run them (RCM, 2008).

Graduation Speech -- Graduation Speech, Commencement Address

Well, this is it. Our last night. The last page of the scrapbook we call high school. Our scrapbooks are filled with memories from the first day we walked into these halls ... to this very night. Pictures crammed in, ticket stubs nestled between them, adorned by dried corsages and newspaper clippings, yellowed with every fond recollection. The smiling pictures are the friends we?ve made in high school. Friends are what make life special. Every person we encounter has a definite effect on our lives. If one face in our scrapbook were missing, a part of our lives would disappear also. Remember the football game where you finally got the fight song right? That?s your ticket stub. Maybe it was the musical that you rehearsed months for. Or cheering at the state basketball tournament. Or ... Graduation Speech -- Graduation Speech, Commencement Address Well, this is it. Our last night. The last page of the scrapbook we call high school. Our scrapbooks are filled with memories from the first day we walked into these halls ... to this very night. Pictures crammed in, ticket stubs nestled between them, adorned by dried corsages and newspaper clippings, yellowed with every fond recollection. The smiling pictures are the friends we?ve made in high school. Friends are what make life special. Every person we encounter has a definite effect on our lives. If one face in our scrapbook were missing, a part of our lives would disappear also. Remember the football game where you finally got the fight song right? That?s your ticket stub. Maybe it was the musical that you rehearsed months for. Or cheering at the state basketball tournament. Or ...

Corporate Social Responsibility as Business Strategy Essay

There is a visible attention being paid towards social and environmental consequences of business and yet performance in this front is far from satisfactory. Common trait seen across companies is that social concern and business are seen as two independent responsibilities and often at loggerhead. As a consequence, companies lose focus of how social responsibility could have been integrated with the long term business outcomes. Businesses across the world are so obsessed with the immediacy of results that they cannot sight the vast opportunity that discharging of social responsibility holds for the long term sustainability of the organizations. As a result, based on the maturity of strategic thinking in the company, CSR is being implemented in one or more of the following ways as shown here: CSR as Reactive strategy CSR has in general been a reactive strategy for reviving drooping fortunes of the company by gaining the confidence of the communities in which they operate. The case of Shell in Nigeria and that of Nike in Asian countries are just two examples to quote. With such instances on the rise companies have started adopting a â€Å"proactive approach† analyzing the cost of not discharging the social responsibility and as a result do the bare minimum to pull on and thus minimizing their spending on this account. CSR is viewed by these companies as a cost and compulsion. This approach only obscures a business from identifying the real potential CSR holds with respect to their core business. Any complacence by such companies may result in the kind of corporate scandals that we are comming across today. Corporate misdeeds are indeed costly, if caught. CSR as Image building exercise Efforts of companies to recover from the effects of not discharging social responsibility can broadly be classified as damage control exercise as far as their image is concerned. Here the businesses have their back against the wall. However, CSR today is seen by companies as an opportunity for building corporate image. Keen on drawing attention of media and general public, companies announce their plans for various kinds of philatropic activities. There is nothing wrong with this kind of approach, except for the fact that such initiatives are not emphasized in the maze of important and urgent business calls. If a company can develop a systematic and delibrate approach for maintaining the focus on social welfare activities, this will not only enhance its image in the immediate future but consistency on this front will help the company in building a positive reputaion of societal concern. Such image will definitely help the company in its future business forays in the region. On the other hand, the image building campaign includes CSR reporting where a series of disjointed anecdotes of companies’ contribution to society are highlighted, which are in no way related to implementation of the business strategy of the company. This underlines the fact that potential of CSR as a tool for image building is more easily comprehended by corporate offices rather than as a means of creating a sustainable business. CSR for improved operating efficiency There are other set of companies that take care of environment because not only does it help in operating with in the environmental norms set by statutory authorities but also reducing their costs by improving operating efficiency. Operating barely with in the norms set by statutory authorities is being in the compliance mode. As companies deliberately plan and move beyond the compliance mode, find the case for integration of CSR and business goals, where improved productivity or operational efficiency in current time frame also results in better environmental conditions that fosters better living conditions for future generations. This in fact is a business necessity today for improved profitability for industry and cleverly used by companies for projecting a business case for CSR and showcasing the integration of CSR and business outcomes. CSR as Source of competitive advantage Business must have clear understanding of the communities that they impact and must give a serious thought to the question – How the strategy helps these communities grow qualitatively along with the business in the short and long term? The answer to this question may not be obviously forthcoming but an open debate among the executives and strategic managers may open up options, that may help improve the quality of life indicators for the communities around in a way that enhances business opportunity for tomorrow if not the current profitability. The challenge for industry today is to identify social issues that drive its competitiveness both now and in the future. For this to happen managers must first believe that social concern or CSR as it is popularly known is a source of business opportunity and competitive advantage. This integration then would pave way for all round sustainability and growth. Sooner than most of the experts suspect, the issues relating to climate change and social responsibility in the area of operations will be decisive factors for survival of businesses. CSR has the potential to change the way business is conducted the world over.

Darwinius - Facts and Figures

Name: Darwinius (after naturalist Charles Darwin); pronounced dar-WIN-ee-us Habitat: Woodlands of western Europe Historical Epoch: Middle Eocene (47 million years ago) Size and Weight: About two feet long and 5 pounds Diet: Probably omnivorous Distinguishing Characteristics: Small size; primate-like anatomy About Darwinius To many paleontologists, Darwinius is a case study in how scientific discoveries should not be communicated to the general public. Although the well-preserved fossil of this prehistoric primate was unearthed way back in 1983, it wasnt until recently that an enterprising team of researchers got around to examining it in detail. Rather than share their findings with other paleontologists, the team started a bidding war for book and TV coverage, so that Darwinius was announced all at once to the world in 2009--most notably in an extensively hyped documentary on the History Channel. The premise of all the publicity: Darwinius lay at the root of human evolution, and was thus our oldest direct ancestor. As you might expect, there was an immediate backlash from the scientific community. Some experts maintained that Darwinius wasnt all it was cracked up to be, especially since it was closely related to another well-known early primate, Notharctus. Most at issue was the TV documentarys breathless use of the phrase missing link, implying that Darwinius somehow led directly to modern humans (to most of the lay public, the phrase missing link in the context of human evolution implies a simian ancestor that lived at most a couple of million years ago, not nearly 50!) Where do matters stand now? Well, the scientific community is still examining the fossil evidence--as should have happened before the announcement of Darwinius, not after.