DOI: 10.1111/tog.
12562 2019;21:154–5
The Obstetrician & Gynaecologist
http://onlinetog.org
UKOSS update
Outcomes for women with
BMI>35kg/m2 admitted for labour care to
alongside midwifery units in the UK: A
national prospective cohort study using the
UK Midwifery Study System (UKMidSS)1,2
Midwifery-led care during labour and birth in the UK is
increasingly important given national commitments to choice
of place of birth, reduction of unnecessary intervention and
improving women’s experience of care, and evidence on safety
and benefits for ‘low risk’ women. Further evidence is needed
on safety and potential benefits of midwifery-led care for some
groups of ‘higher risk’ women and about uncommon adverse
outcomes or ‘near-miss’ events. UKOSS has been conducting
studies of ‘near-miss’ events and other uncommon
complications in obstetric units since 2005. UKMidSS was
established in 2016 and uses similar methodology to UKOSS to
conduct national observational studies to investigate
incidence, prevalence and outcomes of uncommon
conditions or events in UK midwifery units located on the
same hospital sites as obstetric units (alongside midwifery
units). This first UKMidSS study investigated the outcomes for
women with body mass index (BMI) >35 kg/m2 admitted for
labour care to alongside midwifery units in the UK.
 Recent evidence indicates that selected subgroups of obese
women may have lower intrapartum-related risks than
previously thought. It has therefore been suggested that
some women with BMI >35 kg/m2 might be considered
suitable for planning birth in a midwifery unit, as one
approach to improving outcomes.
 The aim of this study was to describe outcomes in severely
obese (BMI >35 kg/m2) women who were admitted for
labour care to alongside (co-located) midwifery units
(AMUs) in the UK between 1 January 2016 and
31 December 2016 and who went on to give birth in the
same admission, irrespective of where they gave birth, and
to compare their outcomes to other women admitted for
labour care in the same units.
 1112 women with a booking BMI >35 kg/m2 admitted to
an AMU were compared with 1949 women with a booking
BMI <35 kg/m2. 92% of the severely obese cohort had a
BMI of 35.1–40 kg/m2.
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UKOSS update
 Severely obese multiparous women were no more likely
than comparison women to experience the composite
primary outcome (one or more of: augmentation,
instrumental birth, caesarean, maternal blood
transfusion, 3rd/4th-degree tear, maternal admission to
higher level care; 5.6% vs. 8.1%, adjusted relative risk
[aRR] 0.68, 95% confidence interval [CI] 0.44–1.07).
 For severely obese nulliparous women, there was a non-
significant 14% increased risk of the primary outcome
(37.6% vs 34.8%, aRR 1.14, 95% CI 0.97–1.33).
 High proportions of severely obese women had a
‘straightforward vaginal birth’ (nulliparous 67.9%;
multiparous 96.3%).
 Severely obese women were more likely than comparison
women to have an intrapartum caesarean section, but
caesarean section rates were low and the absolute difference
small (4.7% vs 4.1%; aRR 1.62; 95% CI 1.02–2.57).
 In nulliparous women, severely obese women were more
likely to have an urgent caesarean section (12.2% vs. 6.5%,
aRR 1.80, 95% CI 1.05–3.08), or a postpartum
haemorrhage (PPH) ≥1500 ml (5.1% vs. 1.7%, aRR 3.01,
95% CI 1.24–7.31).
 Noting that women admitted for labour care in AMUs
were carefully selected, this study showed no evidence of
significantly increased risk associated with planning birth
in an AMU for multiparous severely obese women with
BMI 35.1–40 kg/m2. The results of the study should not be
considered applicable to women with BMI >40 kg/m2.
 Severely obese nulliparous women have a potential increased
risk of having a more urgent caesarean section or severe PPH
compared with other women admitted to AMUs.
Marian Knight MA DPhil FFPH FRCP Edin FRCOG
Professor of Maternal and Child Population Health
National Perinatal Epidemiology Unit, Nuffield Department of Population
Health, University of Oxford, Old Rd Campus, Oxford, OX3 7LF, UK,
Email: marian.knight@npeu.ox.ac.uk
References
1 Rowe RE, Kurinczuk JJ, Hollowell J, Knight M. The UK Midwifery Study System
(UKMidSS): a programme of work to establish a research infrastructure to
carry out national studies of uncommon conditions and events in midwifery
units. BMC Pregnancy Childbirth. 2016 Apr 14;16:77. https://doi.org/10.
1186/s12884-016-0868-1.
ª 2019 Royal College of Obstetricians and Gynaecologists

2 Rowe R, Knight M, Kurinczuk JJ; UK Midwifery Study System (UKMidSS).
Outcomes for women with BMI>35kg/m2 admitted for labour care to
alongside midwifery units in the UK: A national prospective cohort study using
the UK Midwifery Study System (UKMidSS). PLoS One. 2018 Dec 4;13(12):
e0208041. https://doi.org/10.1371/journal.pone.0208041.ecollection2018.
Acknowledgement
Thank you to all members who contributed information to
this study.
ª 2019 Royal College of Obstetricians and Gynaecologists
UKOSS update
Further information
Details of these and other UKOSS and UKMidSS study
results can be obtained from the UKOSS website http://www.
npeu.ox.ac.uk/ukoss/completed-surveillance-ukoss or the
UKMidSS website https://www.npeu.ox.ac.uk/ukmidss/
publications. If you would like a reprint of any publications
please contact ukoss@npeu.ox.ac.uk.
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