Obesity and Caesarean Deliveries

August 18, 2010

It's no secret that one in four people in the United States is obese - that is, their BMI (body mass index) exceeds 30 on the MBI table. Those who have a BMI in excess of 40 are considered to be morbidly obese. Consequently, many women who become pregnant are overweight to some degree and by the time they are ready to deliver, the risk for a caesarean has increased exponentially. The larger a woman is when she checks into the hospital to deliver her baby, the greater the probability of a caesarean delivery.

Brazil - Obesity Increases the Risk of Caesarean Delivery

A Brazilian study investigated the association between pre-gestational obesity and weight gain with caesarean delivery and labor complications. The study found that increased weight at the beginning of pregnancy was linked to a higher risk of meconium (contents of baby's intestines gathered during pregnancy) with vaginal delivery and perinatal death and infection in women who had caesarean delivery. Also, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women who had vaginal delivery and the risk for premature infants was increased for caesareans. The conclusion of this study was that obesity increased the risk of caesarean delivery and increased the negative outcomes of vaginal deliveries.

US - Higher BMI Increases Risk for Caesarean Delivery

In another study in the US, data was collected on 125,000 women who gave birth between 2002 and 2008. Fourteen percent of these women underwent caesarean deliveries. It was found that for every unit increase in BMI, as measured when the woman arrived at the hospital for delivery, the risk for a caesarean delivery increased by four percent. The risk varied with certain conditions such as whether the woman had given birth before or had had a previous caesarean birth. A rise in BMI of one unit increased the risk of a caesarean by five percent for a first delivery, two percent for a woman who had children and prior caesarean, and five percent for women with children but without having had a caesarean prior.

But, The Caesarean Research is Still Incomplete - More is Needed

Caesarean deliveries are major surgery, and as such, there are serious risks involved in them. This surgery has been linked to such complications as infections in both mother and baby, hemorrhage, and hysterectomy. Still, the numbers of women who are having them continues to increase. Obesity is certainly a factor in the equation, however, Dr. Hugh Ehrenberg of The Ohio State University, suggested that performing caesareans could represent differences in provider attitudes as a result of varying levels of experience.

"If you're not seeing a lot of obese women at delivery, you may more readily cut somebody because you're uncomfortable and not because they've failed in labor," said Ehrenberg. "Being really big doesn't necessarily mean you shouldn't be allowed to labor."

There is enough evidence to convince some doctors that caesarean deliveries are the best choice for obese women, however, the exact contribution obesity makes to the need for a caesarean still needs to be researched. There is no final answer.

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