VBAC and obesity

[callieollie]

Anyone know any info on any additional risk factors for VBAC if mom is obese? Would a C-section be safer in this instance? My friend is pregnant and really wanted a VBAC but can't find a doctor or midwife to do one. She has accepted that she's going to have a c-section but recently is second quessing that (she's around 28 weeks, I think). She has had several tests for diabetes (she had GD last pregnancy) and all is normal. Everything in her urine is fine, literally everything is perfect but her OB wants to do weekly ultrasounds and nonstress tests from now until the baby's birth. She thinks it's ridiculous but her mom is telling her that they are just doing that to make sure the baby is OK and there are risks to VBAC, etc. She is obese and has been told it's because of her weight that they are taking so many precautions. Anyone have any info on risk of VBAC vs. C-section, in general and also specifically for someone who is obese? Thanks!

[mollikins]

for general info on risks of vbac vs. csection, I really like www.childbirthconnection.org - it summarizes some research and gives good information to help a mom choose which is best for her. I don't think it has any specific info on obesity though, but I've never looked so it might be there.

I'm pretty sure there is a forum called 'plus sized mamas' that has a vbac section, I think I've seen it referenced on here but I'm sure another mama has more specific info on that.

The only thing I know of specific to VBAC with obesity is that if an emergency c-section is required, it is more difficult to do in an obese mom (longer time to anesthetize + more difficult to get to baby), so the chances of negative outcomes are greater with an obese mom than with one who is not.

[babycatcher12]

You might find this link helpful... http://www.plus-size-pregnancy.org/

I think it stands to reason that abdominal surgery for the obese patient is more dangerous and takes longer to heal. There is increased weight pushing behind the incision and can cause it to open. It also depends on how obese we're talking.

If I were her I would be very curious why they want to do weekly NST and sonos. Especially if all is well so far. Perhaps doing them monthly (?). IMO it's setting her up to say "see you're baby is too big to birth vaginally anyway so when do you want your c/s?"

I think if she wants a VBAC she should look for a provider who is willing to care for her. I have to run, but I'll be back to post more later.

[callieollie]

Oops, I was wrong in when they wanted to start everything. The OB wants her to have her 3rd ultrasounds at 32 weeks and then at 36 weeks, doing weekly nst and ultrasounds. She already feels like she's had a lot of tests done, which she was fine with since she did have GD before but since everything has shown up fine, she's getting frustrated that they continue to be doing so much.

The problem is that she lives in a very rural area, with nothing around for miles. She called places within an hour of her and everyone told her they would not do vbacs (one even told her they were illegal!).

Thanks for the links. I'll send them to her. Keep 'em coming!

[gypsywillow]

 I found this forum as I too was looking for information about increased risks for "Very Obese" ie those with BMI>40% and VBAC.  This is what I know and understand from our practice.

We are one of the few hospitals in our region that does VBAC. ACOG does not specifically state that obesity is a complicating factor or contraindication of successful VBAC.  In our practice pregnant women with increased BMI's have monthly growth sonograms  starting at 28 weeks because our traditional way of measuring fetal growth in not as reliable. Pregnant women with increased BMI's are at increased risk for GDM and HTN, Both of which can impact the growth of the baby. ( I have no idea why they are suggesting weekly NST's unless she has some other complication). 

This morning two of our attendings  were discussing why  we do not allow obese women to attempt to VBAC. One said she did not think it was a reason. The other said the reason was because on an obese woman it would take too long to preform an emergency C/section increasing the likelihood of an adverse outcome. There was a strong difference of opinion. ACOG statement is clear that there is few absolute contraindications to TOL/VBAC. This is available on line. I would have your friend read that. 

[roadfamily6now]

I know this thread is almost 2 years old but I have been overweight and obese for the last 6 of my 7 pregnancies. At no time was I told that I could not VBAC because of weight. I was also NOT given monthly ultrasounds due to my weight. My care providers were able to measure my uterus just fine.

Unless the mother is extremely morbidly obese, upwards of 300+ pounds then a vaginal birth is still quite acceptable and possible

[sunflwrmoonbeam]

http://wellroundedmama.blogspot.com/

This blog talks about obesity and pregnancy, and specifically VBAC quite a lot. I highly recommend any fat pregnant woman read it.