Can an Obese Woman Have a Natural Birth?
Being overweight is a chronic problem for many adult women. According to NIH, 26% of women in the United States are considered overweight and 40% are considered obese. Being overweight or obese can have a significant impact on a woman's pregnancy and the health of her baby.
This is a hard subject to talk about, right? You do not want to be judgemental or politically incorrect. We want to accept all women as they are. America is doing a better job of this today (although we still have a ways to go).
But this is not being judgemental. The harsh reality is that women that are considered medically obese, no matter how they look or how beautiful they may be, are at greater risk to have an unsafe pregnancy. This is risk for both the mother and child. So it is important that women get the correct information.
If you are reading this page, you want real information about what pregnancy might be like for you and what you can do to decrease the risks if you do decide to have a child or are already pregnant. The the latter scenario, what is done is done. There is no looking back so let's find the best path to having a healthy baby.
There is no question that it is best to a healthy weight before becoming pregnant, to avoid potential problems including labor complications and birth defects. Women who are already overweight when they become pregnant can still have a normal, healthy pregnancy, but it may require more careful management and attention. Understanding how and why a mother's body weight can affect pregnancy is an important part of effective management.How Do I Know If I'm Overweight?
Mostly, you know if you are overweight. Medically, there is a tool called a body-mass index (BMI). A BMI is calculated by using the mass and height of a person and then assigning them a number value that determines if they're underweight, average weight, overweight, or obese. In general, a BMI of 25.0-29.9 is considered to be overweight. An obese person will have a BMI of 30.0-40.0, or possibly higher. To find out your BMI, you can use this link to calculate it.How Does Being Overweight Affect My Pregnancy?
Being overweight or obese can have effects on your fertility before you get pregnant. Overweight women are more likely to have infertility problems, which make it harder to naturally become pregnant. Certain fertility treatments may not be as effective if you're obese, such as in vitro fertilization (IVF). The more overweight you are, the less likely it is for you to get pregnant from IVF. Other pregnancy complications that come as a result of being overweight include:
- Preeclampsia: This is a potentially dangerous pregnancy complication that's characterized by high blood pressure after 20 weeks gestation. It can result in damage to the organs and cause a baby to be born prematurely.
- Blood clotting problems: This is when a clot limits or completely restrict the flow of blood in a blood vessel. Overweight women are more likely to develop a dangerous blood clotting condition called venous thromboembolism (also called VTE).
- Gestational diabetes: This is a condition where a woman develops diabetes during pregnancy. This may resolve after pregnancy but puts a woman at an increased risk of developing type 2 diabetes later in life. Babies affected by gestational diabetes are also at an increased risk of birth injury.
- Sleep apnea: Overweight pregnant women can start experiencing sleep apnea, which is when a person temporarily stops breathing during sleep. Having sleep apnea increases your risk of preeclampsia and eclampsia.
- Giving birth via C-section: Due to complications from being overweight, doctors may feel a C-section is a safer option than traditional vaginal delivery. However, overweight women are more likely to have complications from a C-section, such as infections or hemorrhaging.
- Staying pregnant past original due date
- Having a complicated or prolonged labor and delivery
- Having trouble losing pregnancy weight after birth
- More infections: Overweight women have an increased risk of developing urinary tract infections (UTI) during pregnancy, as well as other infections.
- Problems with breastfeeding: Studies have shown that obese women breastfeed for a shorter period, are less likely to initiate breastfeeding, and experience delayed lactogenesis.
Being overweight can also cause problems for your baby, including:
- Premature birth: Doctors may want to deliver your baby early if you're already experiencing complications, such as preeclampsia or macrosomia. A premature baby is at a higher risk of both short-term and long-term health conditions.
- Birth defects: The most common birth defects from being overweight are heart defects and neural tube defects (NTD). NTDs are birth defects that affect the baby's brain and spine.
- Macrosomia: This is when the developing baby is larger than normal, usually weighing more than 9 pounds, 15 ounces (or 4,500 grams). Delivering a large baby puts them at risk of complications, including injury during delivery. A C-section may be required to safely deliver them.
- Stillbirth: This is when a baby dies in the womb after surviving through the first 28 weeks of pregnancy.
- Increased risk of developing diabetes, heart disease, and obesity later in life
Doctors recommend you try to lose weight before you get pregnant. This is the best way to prevent complications during pregnancy. Don't feel like you have to lose a dramatic amount of weight to have a normal pregnancy, losing even a small amount of weight (10-20 pounds) can greatly improve your overall health. However, if you're struggling with obesity, there are more intensive measures such as bariatric surgery that can help you lose weight in a timely manner. If you plan to get surgery for weight loss, talk to your doctor about how long you should wait before getting pregnant.
A preconception checkup can help you determine how healthy you are before you get pregnant. Your doctor will give a physical examination, check your vitals, and may order some blood work. At this appointment, you and your doctor can discuss the best ways for you to keep a healthy diet and stay active before and during pregnancy.
Here are some general guidelines that can help you take the right steps towards a healthy pregnancy:
- Talk to your doctor about ways to stay active: Staying active during pregnancy is beneficial to every woman, regardless of her weight. Daily light exercises, like water aerobics, can help you stay healthy.
- Regularly go to prenatal care: Overweight women should make sure they attend every prenatal checkup, even if they're not experiencing any symptoms. Your doctor has tests available that can screen for health conditions like gestational diabetes, and they can provide an ultrasound to see how your baby is developing in the womb.
- Eat healthy foods: A nutritionist can help you create a meal plan centered on your specific needs. A healthy diet also provides your baby with the best nutrition.
- Monitor how much weight you're gaining: You may not need to gain as much weight during pregnancy if you're overweight or obese. Doctors recommend overweight women gain around 15-20 pounds, while obese women should gain about 11-20 pounds.
- Do not diet: Pregnant women should not diet or restrict food intake during pregnancy as it can limit the amount of nutrition being passed to the baby.
Reading about all the potential complications with an overweight pregnancy can make you feel discouraged about getting pregnant. That is understandable. The key is making the most informed decision that you can and doing everything within your power to put your yourself and your unborn child in the best possible position for a healthy outcome.
So one obvious key is taking early action and discussing plans with your doctor before trying to conceive. There are also several types of doctors that can assist you during pregnancy, including nutritionists and obesity specialists. We will wish you the very best in your journey.Sources and Additional Literature
- Husain, T., Fernando, R., & Segal, S. (Eds.). (2019). Obstetric Anesthesiology: a case-based approach. Cambridge University.
- Simko, M., et al. (2019). Maternal Body Mass Index and Gestational Weight Gain and Their Association with Pregnancy Complications and Perinatal Conditions. International Journal Of Environmental Research And Public Health, 16(10).
- Holton, S., East, C., & Fisher, J. (2017). Weight management during pregnancy: a qualitative study of women's and care providers' experiences and perspectives. BMC Pregnancy And Childbirth, 17(1), 351.
- Dodd, J. M., & Briley, A. L. (2017). Managing obesity in pregnancy - An obstetric and midwifery perspective. Midwifery, 49, 7-12.
- Hill, B., et al. (2017). Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation. Midwifery, 49, 13-18.
- Gaillard, R., et al. (2016). Childhood Health Consequences of Maternal Obesity during Pregnancy: A Narrative Review. Annals Of Nutrition & Metabolism, 69(3-4), 171-180.
- He, M., et al. (2016). Placental findings associated with maternal obesity at early pregnancy. Pathology - Research and Practice, 212(4), 282-287.