The Well-Rounded Mama

The Well-Rounded Mama

For quite a while, doctors have noticed a higher Cesarean rate in high-BMI women but blamed this solely on weight problems always. But how would obesity impede labor and result in more cesareans, you ask? Yet no one was asking whether the way labor was handled in “obese” women contributed to this high Cesarean rate. Now, for the very first time, FINALLY someone is needing to ask these relevant questions!

A Canadian research out earlier this season examined labor management of obese women compared with other women. As I am saying for years, they found that the labors of women of size are maintained differently indeed, with more interventions and a much lower threshold for surgery. There are always a handful of interesting items in the analysis worth a closer look. First, induction rates proceeded to go strongly as BMI increased up.

A great deal of research shows that induction of labor is linked to higher cesarean rates. This is particularly true for first-time women or moms who’ve never really had a vaginal delivery before, or whose cervix was not ripe before the induction. Why don’t any experts (including that one) connect the dots between such an extremely high induction rate in women of size and a resulting high Cesarean rate?

The authors don’t really touch upon the induction rates or question them whatsoever; most research never does. Most authors assume that all these inductions are truly indicated, in women of size especially. But frankly, they have to question such a higher rate of induction more closely. Just how many of the inductions were for real medical signs, and just how many were for dubious indications like suspected supplier or macrosomia dread?

We know from research that inducing early for a suspected big baby does not improve outcomes, and highly increases the cesarean rate in many studies actually. Yet it is common practice still among clinicians to induce labor early if a big baby is suspected, especially in women of size. So, when you start to see the 50% induction rate in “morbidly obese” women, how many were for “very soft” signs like suspected macrosomia? And that which was the Cesarean rate among those induced for “soft” signs?

I would love for analysts to look more carefully at induction signs and how that affects Cesarean rates in women of size. We know from another lately published research that high induction rates definitely do have a solid impact on Cesarean rates in obese women. We conclude that morbid weight problems are associated with a significantly higher threat of pre-existing medical conditions, developing antenatal problems, induction of labor, cesarean section, and higher birth weight. However, there was no significant difference in cesarean section rates when adjusted for induction of labor.

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  • Camala Rodriguez
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More research is required to further clarify the impact of high induction rates on Cesarean rates in obese women, and researchers need to finally start questioning the validity of many of these inductions. Another interesting finding that deserves further investigation is a major difference in cervical status upon admission and what might be influencing this.

In this research, 37.9% of women of average BMI had minimal cervical dilation (2 cm or less) upon admission to the hospital. Compared, 55.7% of “morbidly obese” women got minimal cervical dilation upon admission. Yes, this is surely partly due to an increased rate of inductions, and therefore less spontaneous labors in the high-BMI group, but it additionally shows that perhaps this group is far less ready for labor when being induced.

Again, many authors have observed this, and have blamed it on “inefficient uterine contractility” or hormonal deficits, but imagine if there are other factors they aren’t considering? The scholarly research found that there was more use of oxytocin enhancement and epidurals as BMI increased. The pit augmentation increase might reflect the low degree of cervical ripeness before labor, but it may also reflect the common perception among some clinicians that obese women won’t labor sufficiently independently.