Why is there a higher risk of intervention in overweight women?

[CathyandHeathcliff]

Just that really.
According to my BMI I’m classed as obese, I don’t see myself as such and I don’t think others would either. But it is what it is.
I’m 34 weeks today and I’ve been told I will most likely need intervention during labour which makes me want to just have an elective anyway as they keep insinuating I won’t progress properly anyway due to my weight.

My BMI was 35 at booking and I’m a size 18.

Hi Op,

I don’t have an answer from a medical perspective, but I thought it might be helpful to say that my BMI was 30.4 at booking and the midwife gave me information about the possible birth interventions due to being overweight/obese and when I said I wanted a csection she then proceeded to list the reasons why that might be more difficult!
It seemed to be about blood pressure and less likelihood of an active labour that might bring complications in labour, plus scar healing if you have a big tummy for a csection.

Essentially it’s not a one size fits all and if you’re otherwise fit and well then there’s all likelihood you’ll be fine, the risks as a percentage aren’t that much higher at the statistics I’ve looked at. Look at Which birth choices for info on your hospital.
Good luck!

@Coffee3 I wonder why there’s less likelihood of an active labour. I’m not that fat that I can’t move! My blood pressure has been quite consistent throughout my pregnancy too.

Have you had your birth yet?

I am around the same and have had three labours with no complications or interventions .

@CantankerousCamel Ah that’s reassuring to hear!

My last birth, I refused all consultant led care because they were super pushy about interventions. I ended up having a water birth at home with two midwives and my husband present. I delivered my daughter myself it was idyllic and the perfect end to my baby growing please don’t deny yourself the chance to birth your own child because of over medicalisation.

We can do this, we are designed to

I'm not sure if exact cause has been found for every condition, but it is well evidenced that the rate of complications goes up with maternal weight. That doesn't mean everyone obese at the start of pregnancy will get one or more, just that the chances are rather higher.

I'm afraid that with a BMI a full 5 points over the 'obese' threshold, you will need to accept that you do go into the obesity-related higher risk category even though you don't see your weight as a problem the rest of the time.

My BMI at booking was 29.9, so just under obese, but I had a perfectly ‘normal’ labour and delivery, in the midwifery led unit with gas and air. Keep active! I did yoga throughout and reckon that really helped!

I had high blood pressure with my first child (was overweight) and I think this caused the baby distress because there was meconium in the waters which led to lots of intervention. I also lost a lot of blood.

The two big risks (before/during the birth) are GD and it’s complications and pre-eclampsia. I didn’t have either, I was under consultant care, although I was given the academic option to have an epidural in neither time did I make it to the hospital on time for an epidural and had two active labours (not stuck in a bed) with no interventions besides stitches after the first birth due to a tear.

Actually that’s not true, the first time they broke my waters to get a monitor on the baby’s head because the external one kept falling off. Second time I didn’t even get offered heart rate monitoring.

Thanks for all the responses so far. One of my biggest fears is losing too much blood after delivery. I know the likelihood goes up with my weight, but no one has explained to me how or why.

I am seriously considering an elective c section...but I can’t decide yet. They keep putting this horrible fear in me because of my weight. I’m feeling really rubbish about it all and that I’m going to cause something really bad to happen to me or the baby because of my weight. I feel really guilty.

I think it's more to do with the fact that as a general rule being obese means you are not at optimum health therefore your body will not be working in tip top condition for labour. It's very likely that you will be fine and there are plenty of slim, healthy, fit people who have issues in labour. They are just giving you statistics that you need to take on board. Best of luck x

I am classed as obese due to bmi and when I had the 1st consultant appointment she didn't see why I was referred. I confirmed I was told due to my weight and the answer I was met with was you look completely fine to me and once weighed me to check the community midwife wasn't wrong she didn't understand why I weighed so much but didn't look it.

I am 25+6 so but will see consultant at 30 weeks for a growth scan but only seen the consultant once so far.

I’m so anxious already and now I think maybe I’ll have a heart attack while in labour because of the stress on my body or something.

I bled a lot from my tear. More than I think the midwives and dr expected. I dunno why we’re more likely to bleed too much but we are.

But with my second I avoided this by not tearing.

Obviously I was more stretched out but what also helped was really listening to the midwives when they said not to push and to do the little breaths during crowning. The first time I was so desperate for it to be over with I just pushed as hard as I could whenever I got a contraction.

More likely to have failure to progress: "obese women tend to have ineffective uterine contractions in early labor"... "slower cervical dilation"...

Body Fat is an organ of its own, with hormonal effects. So probably affects hormone levels.

Somewhere else today I read that spontaneous labour is later with larger mothers, so the baby themself is larger to get out. Also I suppose if mother has any health conditions going on, she's more likely to be constantly monitored; any monitoring increases likelihood of further interventions.

I just wish I could turn the clocks back I really do. It’s too late now though. I’m terrified of what’s to come in 6 weeks time (maybe less)..

@DieAntword oh really? Did you need a transfusion or...?

I’ve been getting my DP to do perineal massage on me everyday for 3 weeks and will continue until the birth and taking raspberry leaf capsules, so I’m hoping those together will benefit my experience.

I was just below the cutoff for a transfusion.

And I did follow the pattern of being late (42 weeks 7lbs 12oz for the first, 41 weeks 9lbs 8oz for the second... incidentally I made less effort to control weight gain with the second).

Also neither time did I go to hospital until it was genuinely unbearable. First labour was back to back and lasted days, if I’d gone in early maybe I’d have had lots of interventions but I just gritted my teeth and an hour after I went in I was 9cm dilated. Second time I was 8cm on examination at triage (I went in because I had a very strong and in retrospect correct feeling that if I didn’t come in I would have an unplanned home-birth).

I’ve been getting my DP to do perineal massage on me everyday

C'mon now OP sop boasting, you'll make us all jealous!!!! It's statistics and research that says statistically your BMI puts you at a higher risk of a complicated birth. That doesn't mean it will happen, but it means it's more likely so they are keeping an eye on you. The chances are you'll be fine. If you keep getting your perineal (fandango) rubbed every day you'll sail through it 🌺

I have no human labour experience. Due baby no 1 in January. But my DH is a sheep farmers so have been lambing sheep for many years and overweight ewes definitley need more help lambing. With sheep when lambing you literally can have almost your whole arm inside and fatter ewes on the outside also feel fatter inside (around their pelvis etc) which leaves less space for the lamb to get through. I hope that doesn't offend anyone it might be an explanation why obese people are likely to need intervention

I am also "obese" although my friends, family and husband wouldn't say that. overweight yes but not obese. i am very active, have great fitness and blood pressure. i felt like a criminal when i was pregnant with my dd (nearly 2). I was sent for gd test after gd test as they kept failing to get blood out of me (as i have no veins - which is a problem i had before i was overweight fyi). my bmi was 33 on booking but i actually lost 2.5 stone during the first half of the pregnancy and slowly got back up to pre pregnant weight just by due date. i didn't ever go into labour though, so maybe thats a complication that extra weight can cause. im sure someone above has said that it can cause a delay. i went in for induction, had everything given to me and nothing worked. i had to have a csection. i did lose quite a bit of blood, almost a litre, but didn't have a transfusion. they didn't say why i lost more blood when i was in surgery. my scar healed fine, even though my stomach is where i hold my extra weight. we are now ttc #2 and i am already dreading the fat police. i do weigh less now than when i fell pregnant last time but still over 30 bmi i think, but i have found it much harder to try to lose weight since having a baby! i wouldn't have any induction this time though. if i dont go into labour, i will be booking myself in for a lovely planned section. i was terrified of having a section (as well as being terrified of all things medical/needles/stitches) but the op was so much less scary than i had thought it would be. it was very weird!! but fine. recovery was a bit tough and is longer than a normal vd apparently. speak to your mw/hv? if you want to go for a cs then go for it, if not try to do it the traditional way!

Also! i was terrified of labour too which can actually stop you going into labour so perhaps that played a part for me too. have you thought about doing hypnobirthing? they teach you all sorts on the course about birth as well as about calming techniques etc (haven't done it - plan to for # 2 but my best friend did it and swore it helped her be calm and enjoy her labour!)

I suppose the biggest risks are to do with diabetes and pre eclampsia, and having a big baby which can lead to interventions. But they are only risks and in no way at all a guarantee that things wouldn't go smoothly. Especially if you've generally been fit and well and preparing well for birth.

As an aside, I wish we didn't have to see the words obese and overweight as insults or words to avoid. It's to do with your weight and height, not what you look like, or whether you or other people consider you overweight or obese.

Also things can happen regardless of size. I had a healthy BMI with DD1, developed severe pre eclampsia and lost 3 litres (everything was fine and calmly dealt with so please don't panic reading that). DD2 I was overweight, and it all went smoothly! I did develop pre eclampsia postnatally but that just seems to be something I'm prone to rather than anything to do with weight.

Hello new on here! @cathyandheathcliff I wouldn’t let it stress you out too much. I’m an obstetrician and yes there is an increased risk when your BMI goes above 30 - mostly to do with gestational diabetes and pre eclampsia which means you’ll need extra surveillance during your pregnancy. Labour wise providing everything else is fine delivering in hospital is advised so your baby can be monitored properly in labour (we know it’s harder to pick up the heartbeat consistently when your BMI is >35) and so we can look after you more after you’ve birthed as your uterus isn’t as good at contracting down to reduce bleeding. Labour is so unpredictable and you can’t say how it will go until it’s all done. I really hope you have a lovely midwife and obstetrician who you can talk to about your concerns and if you aren’t happy with them it’s 100% your right to change your care provider.