Hi BMI - What are the extra risks if C-section.

[flopsy1974]

Had a very bad labour and shoulder dystocia last time. Hoping to get an ELCS this time round but have high BMI. keep getting told by the doctor that there are more risks to me with CS but never bothers to tell me what they are.
36 weeks and starting to worry about the birth of this baby. Can anyone shed any light on this.

Afraid I have no answers Flopsy but just wanted to reply, as a fellow high bmi'er it seems that we are at risk of all manner of other things.
I have high BMI but I am ordinarily very active (not at 33 weeks pregnant in this heat though) and I don't understand why people that don't fall within a certain weight bracket are destined to have lots of medical intervention.
I worried a LOT more in my first pregnancy, but not so much in this one. But for what its worth the last time I went to see my consultant, who is a very lovely (slim) lady and I mentioned my high BMI and she said "oh I don't even look at it, its irrelevant" (unless you are at the extreme end) she said that on the weight charts she was considered obese and she must have been a size 12! Was VERY reassuring!
HTH

Hopefully someone more knowledgebly than me will be along shortly but I think it's not c-section specifically but more the added risks of a high BMI and any surgery IYSWIM. Next time the doctor says about the risks (or next time you see him/her you should bring it up) ask what the risks are and if you don't understand what he/she is telling you then ask again until YOU are satisfied with the answers.

As the PP says, there are more risks with surgery when v high BMI. If you have a spinal anaesthetic that does reduce some risks though - I've heard of consultants that will not do ELCS under GA for women with high BMI because of the increased risk of complications with the anaesthetic.

Plus I heard the op can take longer if you have alot of fat on your abdomen as this obviously has to be got out of the way during the op.

Being overweight is, as others have said, a risk factor in any surgery not just CS, but that the greater risk would be the GA than a CS under spinal. There are other risk factors though such as blood pressure and age so you need to weigh it all up.

The spinal, however, can be harder to if you're overweight - my consultant warned me that there was a small percentage failure rate for spinal (which could mean GA being the only option) but this is only ever something he had experienced happening in overweight mothers. That said, the risk of it happening at all is still very small.

I had emergency c-section last week with high BMI. They were still making GA/epidural decision when I was wheeled in to theatre. Given epidural when sat up with head on knees... how fat would you have to be for your spine to be inaccessible in such a position?

Everything went fine.

I had an emcs and my BMI was and still is high - epidural went in first try no problems.

From a pure vanity point of view though, the larger your tummy the worse overhang you get where the scar cuts through all the muscles and your tummy just folds over. It is not attractive and I will need a tummy tuck in future once I've finished having babies. If I had known this in advance I think I would have tried harder to lose some more weight before I got PG!!

If you have high BMI, and are also inactive your healing is likely to be slower, and more prone to infection. This is because your blood supply is not so good, and also because you may have impaired glucose tolerance (you may be completely unaware of this as it may not show up as sugar in the urine in your routine tests). This also impairs healing.

If you are big, but active (proper workouts, several times every week), your risks drop down to a similar rate to someone with normal BMI.

Same for the GA risk - fat and fit is a lot less dangerous than fat and inactive, as your blood pressure and heart rate should be normal if you are active.

(I speak as a very active "big girl", perfect blood sugar, heart rate and blood preasure). Most of the risks used to scare us larger ladies are true only if you are fat and inactive (and indeed if you are slim and inactive you those risks too).

They will need to use a longer needle for the epidural if you are larger.

It's never too late to start getting active - but gentle (swimming for example) would be best. 3+ times a week is better than once a week, do what you are comfortable with. Try to walk 30 mins a day too, most days. Even doing this for a few weeks, if you keep at it, will improve your healing ability and be great for your heart/blood pressure, all of which will make for a safer CS and hopefully a better recovery.