Gina Ritter, a mother of three from Wappingers Falls, N.Y., was
about 220 pounds when she had an emergency C-section. She isn't sure
if obesity played a part in it, but figures there may be a
connection. She also thinks it's important for weight challenged
mothers to educate themselves on the subject beforehand so they know
what risks they may be facing.
"Talking to a midwife about the obesity/C-section link might shed
a ton of light on the subject," says Ritter. "I do think it can play
a role, but it can be helped, too."
Dr. Jacques Moritz,
the director of gynecology at the St. Luke's Roosevelt Hospital
Center in New York City, believes the number of C-sections has risen
dramatically in recent years due in part to the increased rate of
obesity. "C-sections rates are rising quickly in the U.S., and there
are many reasons for this," says Dr. Moritz. "For one, there is an
increase in the birth weight of babies as well as an increase in
weight for the mothers."
Dr. Moritz believes one of the major medical problems facing
obstetricians today is patient obesity. Not only can it cause
problems for the mother-to-be, such as maternal diabetes and high
blood pressure, but it also can increase her chance of having a
C-section as opposed to a vaginal birth.
Brette Sember, co-author of Your
Plus-Size Pregnancy (Barricade Books, 2005), says the link
between obesity and C-sections has been proven. "A Case Western
Reserve University study showed that plus-size women had twice as
many first time C-sections as other women," says Sember. "The study
separated out gestational diabetes and isolated weight as a separate
risk factor."
There are
several reasons why obesity increases the chance of an emergency
C-section. One of these is a longer labor time. Sember says a
University of North Carolina at Chapel Hill study showed larger
women have naturally longer active labors – defined as the time
going from 4 centimeters to 10 – between one and one and a half
hours longer.
"Many of these women, if allowed to continue to progress, can
have successful vaginal births, but many physicians are unaware of
this study, so women who could probably deliver vaginally instead
end up on the operating table because they exceed the usual time
limits for labor," says Sember.
Another reason is that larger women also often have larger
babies, either because of gestational diabetes, genetic reasons or
because of weight gain during pregnancy, and larger babies are more
difficult to deliver vaginally.
Sember found during her research that there is a prevailing
belief among many physicians that plus-size women have a slim chance
of delivering vaginally. According to Sember, a recent Duke
University study found that plus-size women should be
given epidurals upon admittance to the hospital to prevent the need
for emergency anesthesia should a C-section become necessary.
Obesity can cause complications in pregnancy, birth and delivery.
These complications can include gestational diabetes; delayed active
labor; problems placing epidurals; difficulty inserting a breathing
tube for general anesthesia; and complications from C-sections such
as blood clots and incisions that don't heal properly.
"However, I really do want to emphasize that most plus-size women
have healthy and happy deliveries, whether by C-section or not,"
says Sember. "I say in the book that all women come to pregnancy
with their own risk factors. No one is guaranteed a healthy
pregnancy and being plus-sized is just another one in a variety of
possible risk factors.
"The thing to
keep in mind here is that if you had trouble controlling your weight
before you got pregnant, it isn't going to be any easier with baby
on board," says Sember. "You're supposed to be hungry and you're
supposed to be eating when you're pregnant, and you shouldn't feel
bad about that. However, you've got to keep your eyes on the prize,
which is a healthy pregnancy and a healthy baby, and that means
making good decisions for both of you."
Sember gives plus-sized women the following tips to help control
their weight during pregnancy:
- The most important thing is to learn what the recommended
weight gain is for you. Most physicians now believe that plus-size
moms should gain about 15 to 20 pounds during pregnancy. Some
women who are very obese may have different recommendations, so
that's why it's important to have a conversation with your health
care provider about it.
- Exercise is important. Sember encourages plus-size moms to try
to get some exercise most days. "Now, when I say that, some people
envision step aerobic classes and marathons and think 'I can't do
that,'" she says. "When I say exercise, I mean moving your body –
walk the mall, swim, lift some small weights, do some Pilates or
yoga. Exercise doesn't have to be horrible, and pregnancy is not
the time to decide to take up kickboxing if you aren't already
doing it. Do things that are comfortable for you."
- The next advice is to eat more frequent, smaller meals. You're
going to be hungry during pregnancy so you've got to eat more
frequently. For example, make yourself half a big bagel instead of
a whole one and say you'll have the other half later in the
morning instead of right now.
- Drink a lot of fluids – not only do you need them, but they
help fill you up. Don't deprive yourself. Eat healthy food, but
make sure you're satisfying your cravings.
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