Plus size cesarean

[elliemcx]

Hi everyone, I'm due to have a section in the next few weeks and was wondering about anyone's experiences with a section if you are overweight. MY Bmi is about 36 and I'd love to hear from others who had a section and their experiences with the operation and recovery. Thanks

I’m wondering too.

BMI is 37.

I’ve had two sections before but I was thin then, Bmi was 25.

I’m shitting it this time.

Hi Connie, me too. Its all a mystery. I wonder if the extra weight changes everything. Hopefully someone will share.

The main thing I’m worried about is them putting in the spinal.

I’ve had two bad experiences already with that. I know my size might make it more difficult.

Hi both, I had a c section and I think my BMI was around 36 maybe more I can’t quite remember

It was all very straightforward. I had an emergency one with my first baby when I was a similar size.

Recovery was fine - I made sure to rest up for the first few days but then I was ok.

I also had gestational diabetes with my second.

Did you have any specific questions? It was a very positive experience for me overall.

How was the spinal? Did they have any difficulty?

Re the spinal - yes it was a little tricky to get it in - but you just sit very still - you are already numbed - a lovely nurse was holding my hand and they did get it in. I think they thought it might be an issue but it wasn’t.

See above - in end no - it was fine. I remember feeling scared but they were very reassuring

I had an emergency c section after 60 hours of slow slow labour. I will hasten to add that I am extremely needlephobic so it possibly could have been sooner to agree.

The actual c section was lovely after having been in pain, couldn't feel a thing but I did lose quite a bit of blood. It took them nearly an hour to sew me back up to to the fat around the stomach. I had a BMI of 45. I was given a new type of dressing called a pico which has a battery pack attached, it vastly reduces reinfection rates of the scar and I was given it as was high risk.

You can never tell who is going to recover well, I was out of the hospital 36 hours after being on the operating table, was walking properly within 5 days and ould have easily driven by 4 weeks. A NCT friend had the opposite where it took her 10 weeks to recover and she had a normal BMI.

Happy to answer any specific questions if you need.

And I think that they were concerned because of something in my notes from my first c section - that it had been hard first time round - but that was an emergency and I was contracting while they were trying to get it in - um yeah, it wasn’t fun, I don’t think it was just because of my weight

Mine were fine. Have had two - EMCS and planned. Don’t have a non-plus sized experience to compare to but it has been fine.

Yeah like moonlight I recovered very well and was driving pretty soon etc

A friend of mine has a BMI of 40 and recently gave birth. She was advised a planned C-Section rather than attempt natural birth (and have an emergency c-section) as the consultant said her weight would cause complications post general anesthetic. The consultant seemed to prefer doing it with an epidural / spinal so you have nothing to worry about with the birth itself.

One thing you may need to be careful about is keeping the scar clean. My friend has an overhanging belly due to her weight and has really struggled to both keep the area clean and also finding clothes that skim over the scar appropriately - but you are a lot slimmer than her so might not be a problem.

Can I ask a silly question? Is it your pre-pregnancy BMI that the medical team worry about? Mine is much higher now I’m nearly at the end of pregnancy obviously!

It’s given me such anxiety that I’ve really tried not to gain any weight in this pregnancy. 24 weeks and I’ve lost 2lbs.

Hospital have been no help. I just get the registrars that I’ve seen struggling their shoulders.

I met with a consultant anaesthetist before my last section as I was petrified of the spinal after my first experience, she assured me it would all be fine. On the day she was there but was instructing a junior doctor on how to put it in. It was terrible. I was begging her to take over but I was ignored. So I don’t have high hopes for this time.

This pregnancy was as a result of fertility coming back due to weight loss - I lost 6 stone last year and the pregnancy happened faster than I expected after that!

I'm worried about the weight on scar, and will I be able to walk and get out of bed without it splitting open. I don't have an overhang or anything but wonder is it easier for slimmer women. Also a bit freaked with the risk of dvt which the consultant really seemed to want to make sure I understood. But I know this is rare.

Also on a completely other first world problem level, are there things you have to do before? Remove nails, what do you have to wear?

DVT is rare across all pregnancies but is more common as your BMI goes up, which is probably why your consultant is worried. Are you on blood thinners and Aspirin? If not discuss this with your consultant as they can help reduce some of that risk.

Can I ask a silly question? Is it your pre-pregnancy BMI that the medical team worry about? Mine is much higher now I’m nearly at the end of pregnancy obviously!

When you get to the stage of being consultant-led you get weighed almost every visit. And while they worry about your pre-pregnancy weight they will also be very concerned if you have gained weight when you were already obese or morbidly obese. But if you have certain conditions / risk factors then they may worry if you slip into overweight territory too.

For example I have a clotting disorder and my pre-pregnancy BMI was on the border of 25/26 so I was calorie counting to ensure I didn’t gain weight (with my midwife’s full support). But even then in my third trimester I gained 5kg which put me in the overweight category and my consultant wasn’t happy.

I haven't put any weight on at all through the pregnancy. I have gestational diabetes too, but I had piled on weight after having breast cancer a few years ago, my thyroid stopped working during the chemo so just before I fell pregnant I was getting that regulated and I think because the weight gain was unnatural really, due to previous treatment, I am naturally still losing anyway, even though I'm definitely eating plenty.

Interesting about dvt, I find it so scary.

@elliemcx are you on aspirin? I’m on 150mg a day.

I’m having the GTT in two weeks.

Is yours controlled by diet or meds?

Hiya I had an elective at a BMI of 35. It went like a dream, both the procedure and the recovery. DH had to take on nappy changing duties for the first couple of days when we were in hospital (I was only kept in due to DS' feeding, not to do with his birth or my health) and I did find getting up off a low seat difficult for a couple of weeks but no more than I did heavily pregnant. Good luck, I'm sure you will be just fine xx

Im not on aspirin, I should ask about that. Im on 1000 mg metformin morning and evening. My fasting levels are still a little all over the place, so I have another growth scan next week.

I'm worried about the weight on scar, and will I be able to walk and get out of bed without it splitting open.

My pre pregnancy BMI was 47.2 and I had no issues whatsoever. Mine was an unplanned section due to failed induction. I had the spinal at around 1pm and it had worn off by about midnight. I'd had two failed epidurals as well by that point. Didn't feel a thing during the surgery.

Don't worry about the weight on your scar. It's so incredibly rare for your section stitches to open. They told me that they sew you up so thoroughly that it'll basically never happen. It's easier to carry on as normally as possible - don't be frightened to cough or poo... I hadn't been for 8 days when I finally needed to go for a poo and I found gently pressing a rolled up towel against the wound area really helped. Getting out of bed was difficult, rolling onto my side helped tremendously.

They pump you full of air during the section so remember to drink lots of peppermint tea. I didn't even need paracetamol by day three but the shoulder pain from the air was the worst as I couldn't really do anything about it.

They don't tell you that you effectively lose any kind of core strength. I went to wash my hair, lifted my arms and just kept going backwards until I quickly gripped the shower rod

This was all really helpful thanks everyone. I'm definitely going to ask about the aspirin and see what they say. Im so relieved that not everyone has a hard time with recovery.

Increased risk of blood clots in legs and lungs, excessive bleeding and wound infection. These are risks anyway but with higher BMI even more so. So you will be on blood thinners afterwards, need to get moving as soon as possible after surgery, keep wound clean, lift any overhang you may have regularly throughout the day to air it out.
If you have a previous CS, may be adhesions which can make the surgery more tricky.

Good luck, hope all goes well. Lots of fluids, healthy diet also to help with healing

Ask about blood thinning injections too OP. Heparin with aspirin can help reduce the risk of dvt substantially