Why are overweight / obese women more likely to have an instrumental birth?

[NakedInnocence]

I'll be honest from the outset, my BMI is over 30 (comfort eating after my dad died last year, and I have very broad shoulders and hips so have never been an 'ideal' weight).

DH are trying for our first baby, I've been to my GP and he said that he wasn't overly concerned as long as I am hyper healthly from now on and really controlled how much I put on in pregnancy I could get down to it .

I stupidly went on the NHS Website and am now scared senseless .

Two questions:

1. Has anyone out with a BMI over 30 had a 'normal' healthy pregnancy and birth?

2. Why does being overweight make you more likely to need intervention in labour?

I know the answer is to lose weight and I am working on it, but I hate the thought of having to wait to try to conceive while I lose the weight, especially as my GP said age was more of an issue than weight!!

Please someone reassure me that I'm not being totally naive

nakedinnocence not sure what my BMI is but I know I'm classed as being 'overweight' Have had two very straightforward pregnancies and am a third of the way through preg number three which seems to be straightforward so far. Gave birth with no intervention to both children (second child was 10lb6oz!) Also been tested for Gestational diabeties both times which has been negative. I can honestly say that out of all my friends there has been no correlation between who is big and who has complicated pregnancies, there are alot stronger influences than weight, such as age as your GP said.
So don't worry and enjoy getting pregnant!

In my opinion, BMI is a very crude figure. Mine was just under 30 at the start of my first pregnancy and I didn't put on much weight, and just over at the start of my 2nd pregnancy. I didn't have a totally "natural" birth in either case - ventouse in the first, emergency CS in the second. However, neither intervention had much to do with my weight. The first was because I had a really long labour and was terribly tired, and the second was because the baby got distressed and he had to come out. Both of those could have happened very easily to someone who wasn't overweight, I think.

Again, my complications in pregnancy such as they were were morning sickness and acid throughout my first pregnancy (in the second, they were just the first 16 or so weeks), and anaemia this time. Again, not associated with being overweight.

It also sounds like your ideal weight may be higher than average if you're broad framed.

The GP certainly doesn't sound overly concerned or think that you'd have huge problems.

I'd suggest that you get on with ttc. You could try eating more healthily and looking for exercise while you do so. If you get pregnant, I found aquanatal classes really helpful in making me feel more comfortable late in pregnancy, I just wish I'd started them earlier than 30 weeks and managed to get there more often.

no idea what my BMI is but ecpect it it very high.
I am obese and have had 4 babies all normal pregnancies and births with no interventions.

HTH

I have a high BMI (33 I think) and, apart from ongoing nausea, had a perfect pregnancy. High iron levels, low blood sugar, no tiredness, able to be active right to the end...wasn't even that big until I went over due.

I did have a ventouse delivery, mainly due to my astonishingly fast labour (1hr 50mins from first twinge to baby) that the baby didn't appear to cope with well (but he came out with an apgar score of 9 so I was bit about it)

Despite my size, my community midwives heartily recomended I have a homebirth next time to avoid giving birth on the roadside

My mum is very well padded and had four of us without hardly breaking sweat the way she tells it.

Thanks for the reassurance everyone, I should just trust what my GP said as he knows me and my health and isn't worried

I guess the website scared me and I've heard horror stories from some bigger friends about their booking in sppointments where the midwife calcualted their BMI and then pretty much sucked their teeth and lectured them about the danger of being obese.

I guess I'll just have to hope I get a nice midwife - or could just refuse to get weighed, they can't exactly force me wide backside on the scale

The reason I ended up with a instrumental delivery (forceps) was because they couldn't get a good reading with the heart rate monitor attached to my tummy due to the extra fat. Therefore they insisted on breaking my waters and putting a heart rate monitor onto dd's head. This caused me to have to lie in bed rather than move around, the pain was worse as I couldn't move around and I ended up having an epidural which really slowed contractions down, stopped me being able to push and resulted in forceps delivery. So in my case you could say that my weight did cause this scenario. However, I have friends who are not overweight who ended up in a similar situation so who knows?

Hangingbellyofbabylon - thanks for being honest.

If you don't mind me asking, why were they so adamant they had to monitor the baby's heart rate, I didn't think this was automatic for every birth (or is it done as standard (sorry for ignorance ))

I had to go to the high risk hospital locally as my BMI is over 30 (here you can't go to the mid-wife led unit if bmi over 30). At that hospital it's pretty standard practice. Tbh, they scared the hell out of me and I would probably agreed to anything - I imagine you could argue against continual fetal monitoring if you were expecting it and felt strong enough but I was in pain and just felt railroaded into it all. I think with hindsight I would have asserted myself more and remember, there are loads of people here with high BMI who have had really good births.

Bloody nhs and statistics IMOH BMI is a load of bulls**t!

I dont know my bmi and dont care to i am overweight i have always been since teen years size 18 bottom 20 top really just massive boobs!

i have had 2 dds and never any problems in pregnancy, they hit me with the gtt tests etc and all have been fine.(im 35 weeks pg with dd3 at the min) i have hardly seen a mw and havent seen my gp for over a year im never sick or have any health problems (touch wood)

they always tell me im having a massive baby as well dd1 was big she was 9lbs 13oz but i delivered her naturally on time and spontainious labours and with no tears etc and dd2 was 8lbs 13oz and easy birth as well this baby i had a growth scan last week and told me she will be big 10lbs plus yada yada

so we will see im not worried about it!

I hate the way health proffesionals bully overweight women. at my 20 week scan the sonographer wrote on my notes that he got "good view despite high bmi" i said to him did he not see everything he needed to he looked at me confused and said yes everything was fine so i asked him why he wrote the comment on my notes he was totally stunned and had no answer i though it was a cheek as my bmi hasnt even been calculated i asked him what his was as he was no slim jim either! he wasnt too happy with me and dp was mortified but i dont care im perfectly healthy and so is my baby so why make an issuse over bmi. anyway i saw same sonographer last week and he was brill with me and had a really nice scan and he even got a fab pic of babys face for me and printed an extra copy of it out in large size
for me to frame! ( im going to add the pic to my profile tonight!

anyway sorry for going on and on it just really gets on my nerves!!

Ps i dont doubt that some overweight women may need help but then again so do "normal" size women as well!

My bmi is 36, and I have horrible pregnancies. In fact am currently counting the minutes until the end of this one. However, I have seen friends of all shapes and sizes have the same or worse problems than me, and bigger friends who have sailed through pregnancy with no problems at all. I suspect it very much depends on the individual, myself!

I am sure loads of people (like the ones on here) have had trouble free labours with a BMI over 30, so it would appear that it shouldn't put you off trying. That said, being obese is statistically a much bigger risk factor for many things....and childbirth is one of them; so perhaps dieting at the same time would be the way forward.

As has been mentioned, monitoring is harder due to fat. Babies of obese mothers have a higher risk of being larger themselves and therefore need assistnace in getting out, plus an increased risk of things like shoulder dystocia. If a CS is needed then the operation is more complex in someone of a larger size, and the recovery is harder because of lack of finess, and the extra weight that you will be carrying around.

Plenty of people manager it, but if you could get pregnant AND slimmer then surely that would be better.

statistically speaking overweight mums are also more likely to have high blood pressure; doesn't mean it's going to happen to everyone

I weighed 120kg when I gave birth to my son, I had no issues through the pregnancy and he was born after about 6 hours of labour.. I didn't even have stitches

I have a BMI over 30. I was 40 when I got pregnant this time around.

I was categorised as low risk, because:

a) They can tell from my blood tests I eat well.
b) It's patently obvious I am basically pretty fit (at least I was before the SPD struck me down, but that's a different story)
c) I haven't had problems in any other pregnancies either and had easy births each time.

Your GP is right - age is the important thing.

My BMI is over 30 and I had DS2 at home with no intervention at all.

I think it probably depends on the individual person. If you eat healthily and try to exercise during your pregnancy you should be fine.

Good Luck.

I would add that IMO any mum TTC should consider a weekly exercise class, upping fruit and veg intake and reducing intake of refined sugar, if only to improve her own stamina and general feeling of wellbeing.

I had an interesting chat with my consultant the other day about fitness, weight gain and pg, because I have put on a lot this pg due to immobility, and I needed advice from her about this. She said that pg women were seen as a captive opportunity for general health promotion work, and that a lot of the advice and information they were given had more to do with that than obstetrics.

My BMI is 35ish. I have had 2 pregnancies with no complications and 2 births.
I had a cs with DD1 but she was a footling breech, so nothing to do with size.
DD2 was a vaginal birth with just gas and air, no issues.

The theory behind it is, that 'obese' mothers have fat between the muscular fibres of the uterus, therefore making contractions less effective. I'm not at all sure about that one!

Here the cut off for being high risk is BMI 35.

I'm of the opinion that it's less about medical reasoning, and more about prejudice on the part of the healthcare professionals. I'm sure they think if you are overweight you are also lazy, inert, undisciplined and stupid. They definitely treat you worse than the skinny people, who are obviously smart, motivated and go-ahead types.

I suppose also there would be issues over self-esteem and confidence. If weight is a struggle and an issue it really does affect your ability to stand up for yourself and make your voice heard... so you end up on your back with continuous monitoring, stressed to hell and starting off that chain of intervention because the MWs and doctors have you down as a second class citizen.

My BMI is over 30. My first daughter was born ny emergency c-sectionafter a textbook pregnancy. I was tested for GD etc, but was pretty fit having recently trained for the Moonwalk Marathon, regularly walking up to 20 miles in spite of my fat arse!

My section was due to back to back presentation and the refusal of my cervix to dilate even with drugs to help. I'm not sure either factor was down to excess blubber.

My current pregnancy has been exhausting, with 8 months of constant nausea, but again, GD tests clear, and I put my exhaustion and sickness down to a demanding job and having a two year old to run after.

Pinkbump3: PMSL! Shoulda got a pic of HIS face when you asked him his BMI!

If you visit the homebirth uk website and click on "You can't have a homebirth because..." there's a bit about being overweight/high bmi. If you click on that it tells you more about it (sorry the site doesn't let you do direct links). Hopefully that will help you to relax about it.

I'm my 3rd pregnancy and all have been probelm free. My 2 births have been quick and with just gas & air. Both babies have been over 9lb's and i have had no tears. I am about 4 stone over weight and over 35 yrs when i had my 1st and am 39yrs this time.

Nice to see you posting again nutty (we met online and later in rl with our first babies) - are you planning to have a homebirth this time round?

BoffinMum's posts make a lot of sense to me.

Hi Elkie. Yes, planning a homebirth and have booked an IM (lovely way to spend my maternity allowance ).

I had a very good pregnancy. BP was high before we conceived but had no problems throughout.
I had an epidural only because DS was 'coming on a bit fast' (wanted to push when only 6cm dilated but otherwise a totally normal delivery - DS popped out after 4 hours labour and 4 pushes