Barely a week passes without another publication from another medical body about fat women having babies. Prior to the eagerly awaited triennial publication of maternal morbidity and mortality, the Centre for Maternal and Child Enquiries recently published another report recommending that we obstetric anaesthetists see all parturients antenatally if their BMI is over 40.

But why use outpatient time and resources to see these people? The short answer is that they are obese and everything will be difficult. The longer answer is that their veins are buried in podgy hands and their vertebrae blanketed beneath soft doughy folds, the blood pressure cuff bursts open under the strain of inflation and the velcro bits on the flo-tron boots don’t meet around the calf. They are more likely to need a Caesarean section. The obstetricians can’t identify the uterus easily and the bleeding and infection rate increases with the operation time. I could go on (for some their saving grace is the ubiquitous lumbar tattoo which unfailingly helps anaesthetists identify the midline and perform regional anaesthesia).

The only reason ever to weigh these people is to check the operating table will accommodate them. Our new table from the US can take 240kg, so (unfortunately) most of them do fit on the table. Weighing them takes a long time. First they ask to go to the toilet no doubt to rid themselves of a few fluid ounces, then they waddle back to the scales and gingerly begin to step on with one big toe while holding their breath before remembering that they still have in their pockets their phone and purse which will make them weigh heavy. After removing these items and several other outer garments they finally get on the scales.

Initially relieved to see the number 140, this soon evaporates when told that it is not 140 pounds, nor 14 stone, but indeed 140kg. “It’s all the baby weight you see,” they say. Yes, I do see, you must be having an elephant.

Ten years ago, when you had to have a BMI less than 28 to qualify for day surgery, we asked to see prospective parturients with a BMI over 30. As our clinic rapidly became inundated we raised this to 35. Again the prevalence caught up with our capacity so we stretched it to 35 with other comorbidites. In recent years the goal posts have had to move again as BMI of 35 is considered average in our part of the world. We asked the obstetricians to refer anyone with a BMI of 40 or over, with another co-morbidity.

And then we stopped. Why? Mostly because it doesn’t change our management and, as we were taught as house officers, don’t bother carrying out an investigation if it won’t change your management of the situation. Now we just send them a letter stating we will see them on arrival in labour or for section.

I would love to be able to have a consultation with a 150kg, 5 feet 1 inch mother-to-be and reassure her: “Don’t worry - I’ll have you down to a size 10 by your section next week”. If indeed I could do this I would be sitting not in said clinic but on my yacht sipping champagne.

In reality it is simple. They are fat. Anaesthesia and surgery will be difficult and complications higher. Why not spare us both the indignity and time wasting of the obese clinic and instead of producing more guidelines on who should be seen, when and where, channel that effort into information and education.

There are many leaflets along the lines of “Your obesity and your pregnancy”. The difficulty is knowing when to hand out these leaflets. It’s too late at the pre-op assessment, it’s too late at the 20-week scan, and it’s too late at the booking visit when the eating for two is well under way.

No, to have any effect at all, this information needs to be handed out in secondary schools enabling young women to inform themselves of the dangers of obesity and change their habits before attempting to become pregnant.

As everyone knows, you can’t have your cake and eat it.