Use Positioning to Help You

Squatting or knee-chest positions help to open the pelvis, so these positions might be effective for you. Use gravity to help you and walk and move around during labor if possible. Try to avoid just laying in bed on your back throughout your labor.

Be Aware of Longer Active Labors

A 2004 study showed that plus-size women tend to have longer active labors (the time it takes to go from 4 cm dilation to 10). Normal women took about 6.2 hours while overweight women took 7.5 to 7.9 hours on average, Plus-size women tended to stall between four and six centimeters while medically obese women stalled under 7 cm. You should keep this study in mind and discuss it with your health care provider before you agree to a C-section for failure to progress. Because your body naturally may have a longer labor, things might actually be progressing at a reasonable rate for you, whereas it might seem too long when compared with smaller women. If you can wait out the extra bit of time (which might not sound like a lot now but can feel like a lifetime when you’re going through it), your labor may get through the stalled period and then move along.

Induces Labor Last Longer

A recent Saint Louis University School of Medicine study showed that plus-size women who had their labors induced took longer to deliver than smaller women. The study did not take into consideration evidence that plus-size women have naturally longer active labors.

The study also showed that plus-size women need more medication to induce and it took longer for the induction drugs to start working. The physician who did the study suggests that plus-size women wait for spontaneous labor instead of having labor induced if they want to reduce their chances of a C-section (a longer labor increases your chances of a C-section).

The Epidural Controversy

Some physicians now believe that all plus-size women should routinely be given epidurals as soon as they are admitted to the hospital. Recent studies have shown that epidurals do not slow labor at all and may allow it to actually progress faster because the mom is relaxed. Unfortunately, your comfort is not the reason behind this recommendation. Many physicians believe that plus-size women are more likely to have C-sections and putting an epidural in place eliminates the need for emergency spinal anesthesia (which can be difficult to place in a larger woman). The problem is that once you have an epidural you won't be switched to a spinal should you need surgery, and epidurals can provide incomplete pain management during C-sections. Ultimately, the choice whether to have an epidural is yours alone and it is something you should discuss with your health care provider.

VBAC (Vaginal Birth After Cesarean)

The tide is changing on VBACs and many physicians now discourage women from attempting them. Most physicians now believe that an elective C-sectin is safer for mom and baby instead of a VBAC. However, it's important to consider why you had a C-section the first time. If it was because of failure to progress, there's a good chance that might happen again and you would end up with another C-section after hours of labor. If your previous child was C-section because of a breech, it's unlikely that would happen again.

A recent study in the American Journal of Obstetrics & Gynecology found that the chances of a successful VBAC decreased with heavier women. The heavier the woman, the less likely she would be successful. The news may be discouraging for some women, but it's important to remember that many women in the study who were overweight were able to have successful VBACs. This same study, however also showed that when VBAC was attempted, the risk of uterine rupture was low.

The take home message on VBAC is that this is something you should discuss carefully with your health care provider. You also need to take some time to consider your own feelings. Some women feel cheated out of a vaginal birth and don't want to have another surgery. Other women are happy to schedule a section. It's a very personal choice, and you need to do what you are comfortable with, after getting personal medical advice from your physician. There are a lot of people with very strong opinions about this, but you have to decide what is right for you in your situation.