Obesity and Cesarean Sections

Cesarean section delivery rates have rose sharply in the past twelve years. One reason may be the increase in obesity in women.

Obesity and Cesarean Sections

It seems like every so often, we start hearing reports about cesarean sections as a method of giving birth. The general consensus seems to be that the medical community is too quick to do them, women are too easily led into them, and we need to do something to get the cesarean section rate down.

How about losing weight? Before you get pregnant, of course.

Cesarean sections actually declined in the United States in the seven years following 1989 according to the Division of Vital Statistics. It is believed that this was due in part to the fact that U.S. birth certificates began requiring method of delivery on birth certificates in 1989.

But the cesarean section rate has spiked recently by over 9%. And one of the contributing factors is overweight women. In 2003, approximately one third of women had gained prepregnancy weight beyond recommended guidelines.

There are other factors, of course. There has been a 37% increase in twin births between 1990 and 2003. Twin births are done cesarean section many times because one or both of the babies are in a breech position in the womb. The percentage of older mothers (over 35 years of age) has risen, too. A 38% increase in mothers 35 to 39 and a whopping 58% increase in mothers aged 40 to 44 contributes to cesarean section births due to the increase in some complications or even an increased chance of multiple births.

But a shocking number of cesarean sections occur indirectly because a mother is overweight. Some studies have determined that heavier mothers are almost twice as likely to have a c-section as a mother of normal weight. And the odds of delivery by c-section go up the heavier the mother is. A woman with a BMI of 35 to 39 is over three times as likely to have a cesarean section as the average mother.

Serious complications resulting in cesarean sections such as preeclampsia, eclampsia, dystocia and diabetes are all significantly higher in mothers who were overweight or obese at conception. Another possible reason for the higher incidences of cesarean sections in obese women is longer labor. A heavier woman will be in active labor (defined as between 4 and 10 centimeters) as much as an hour and a half longer than the average woman. Some doctors, not aware of the propensity for longer labors in overweight women, move to c-section because these women exceeded the usual time limits for labor.

Another reason obese and overweight women are more likely to have cesarean section deliveries is they often have larger babies. Whether the babies are larger because of gestational diabetes, genetic factors, or weight gain during pregnancy, larger babies are harder to deliver vaginally.

Being overweight has complications during and after a cesarean section, too. Some of these include difficulty placing an epidural; problems inserting a breathing tube if general anesthesia is needed; and blood clots or incisions that do not heal properly.

A plus-sized woman who becomes pregnant can take some steps to control their weight during pregnancy and give themselves and their baby a healthier chance. These steps include:

You may also want to ask your doctor about seeing a nutritionist or other professional to help you create a healthy diet you can live with. If you are diabetic, or if you have gestational diabetes, controlling and monitoring your diet is crucial for both you and your baby.

Most overweight women have happy, healthy deliveries whether by cesarean section or not. But the time before you get pregnant is the best time to think about your weight, fitness level and overall health.

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