Excerpt from: Obesity and normal birth: A qualitative study of clinician’s management of obese pregnant women during labour
Angela Kerrigan, Carol Kingdon, and Helen Cheyne
Currently one-fifth of women in the UK are obese.
Obese, pregnant woman are at an increased risk of experiencing complications of labour and serious morbidity.
However, they are also more likely to undergo medical interventions such as induction of labour and caesarean section which in themselves confer additional health risks for obese women such as wound infection and deep vein thrombosis.
Reducing unnecessary interventions and increasing normal birth rates for obese women would substantially improve their postnatal health and wellbeing and reduce the burden of NHS resources required to care for them post operatively.
This research aimed to explore practitioners’ experiences of and strategies for providing intrapartum care to obese women.
Women’s reluctance to mobilise
One of the major difficulties encountered by midwives when caring for obese women during labour was motivating them to be mobile during labour and have an active birth, with many women wishing to be relatively immobile during their labour.
They found motivating them to get off the bed and move around to be particularly challenging.
“It’s hard to get them up, it’s hard to move them about” (MW FG)
The physical size of the women and the extra effort that it took to be able to mobilise was seen as a reason for the reluctance.
“I think sometimes that the very biggest ladies do tend to be a little bit more reluctant to do that [mobilise], only because you can see it just takes so much more effort for them to move” (MW Int)
However, some midwives recognised that although obese women were more likely to be less mobile during labour, they also acknowledged that some obese women were embarrassed that they found it more difficult to mobilise and even though they were less mobile, it was not necessarily through choice.
“I don’t think they like being immobile. I think they find it embarrassing” (MW FG)
Discouragement of water birth
Finally, the discouragement of hydrotherapy and water birth for obese women was an important factor that contributed to the medicalisation of obese birth.
“No I don’t think they are allowed in the pool” (MW FG)
The reasons for obese women being discouraged from using hydrotherapy for either analgesia or birth were commonly related to manual handling risks, in particular the need to evacuate the pool in an emergency
“I had a large lady a few weeks ago and she said to me ‘oh I was told I could have a pool birth’ and I said ‘no, because it would be difficult to hear your baby and to get you out in an emergency” (MW FG)
Contrary to this, the multiple benefits of hydrotherapy for obese women were acknowledged, in particular the benefits of relative weightlessness and buoyancy to aid mobility during labour.
“One of the difficulties that people with high BMIs have is difficulty in changing positions….and to have somebody like that buoyant in water takes all the pressure off their pelvis……”
“That’s the difficulty with water birth isn’t it? Because they are the ideal sort of group to benefit….the weightlessness” (MW FG)
The discouragement of water birth for obese women was viewed as a contributing factor to the medicalisation of care for obese women.
The reasons for obese women being discouraged from using hydrotherapy were stated to be related to manual handling risks, but the multiple benefits were also acknowledged, including the increased ability to stay mobile during labour.
Swann & Davies suggest that the advantages of using water in labour are equally, if not more applicable to obese women and include the use of water as a mobility and positon aid, increasing the pelvic outlet and reducing the potential for delay during labour .
Difficulties monitoring the fetal heart rate are commonly cited as reasons for discouraging water birth in obese women, Swann & Davies suggest that the use of waterproof telemetry could overcome this difficulty and with the increasing availability of wireless telemetry, this could also be utilised to facilitate the use of hydrotherapy for women who require continuous electronic fetal heart monitoring.
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