Labor in large women « Back to Group Discussions

[iixivboots]

Via The Ample Mother, thought we'd have a lot to discuss about this article.

http://wellroundedmama.blogspot.com/2012/01/news-flash-labor-managed-differently-in.html

I'm reeling from that 50% induction rate for my BMI range.

[scowgirl]

That 50% figure really is shocking. At my last appointment, my midwife said that it was in my file that the high-risk docs had discussed with me a scheduled induction at 39 weeks. First of all, they had not discussed that with me. I would have been pretty upset. Second of all, the m/w said that there is no evidence that this is actually good for fat women or their babies. I'm going to stick to this woman like glue because she is the ONLY provider I've had so far who treats me like a regular person and not a troubling freak show.

I have not been as aware of my weight in YEARS as I have since I've been pregnant. And with all the panic and tests and weight-shaming I have experienced thus far, they haven't even found anything wrong! It is infuriating. If I need a C-section, I'm thankful they are available and safe, and am more than willing to get one. But I don't want to be just another fat lady who "needed" a C-section because they mismanaged my care and treated me like a ticking time bomb for no reason. It's kind of like the tests they ordered at my high-risk consult at 12 weeks. They cost almost $800! Thank goodness we have good insurance. But anyway, it came into my mind that some people would consider this a prime example of how obesity drives up health care costs. "Fat women need more tests and that costs so much money!" Even looking at it conservatively (I could see, for example, why they might look at my weight and want me to start monitoring my blood sugar at home as a precaution), it is highly questionable whether these stupid tests were necessary. It seems like a large percentage of assumptions about fat people are a result of self-fulfilling prophecies resulting from people not questioning WHY certain outcomes occur.

I mean, even if it had turned out that I was diabetic, there are probably some thin undiagnosed diabetics out there too, and they would never have had to take the GTT or A1C at 12 weeks, so how would they ever know? Whereas if they obsessively test me for this and that and finally find something wrong, it's more and more fuel for the anti-fat fire.

I realize I am getting pretty far afield of the topic, but it's all intertwined in my mind. Every obese woman who has a C-section becomes another statistic to fuel future lazy assumptions about more obese women needing C-sections. If a thin woman has a C-section, it's just an isolated instance of a thin woman needing a C-section...

[cristeen]

I honestly can't say I find any of that surprising.  Disgusting.  But not surprising. 

[Beccadoula]

I'm a doula and I'm telling you now - you can have a wonderful birth, but you may have to fight for it a bit.  I highly recommend finding yourself a good doula who will help you stand up for your rights and avoid getting induced.  Just a thought. 

[lisarenee25]

BeccaDoula is absolutely right.  It's known that larger women have larger gestation times.  I think I have proved that theory over and over again.  I think I go one or two weeks longer than most women, which is why a natural birth in a birth center or hospital would be impossible for me.  Home is my only option.

I had to fight for it though.  I had to do weekly nst and sonograms, and my midwife still threatened taking me to the hospital- which for me was devestating.  I stood firm.  They use all kinds of scare tactics, but everything was looking fine in the tests.

She also made me go through castrol oil and accupuncture, etc.  I did it all to no avail.

There was no danger to the baby or me so I let the pregnancy take it's course.

Finally, i did go into labor.  It was like a 4 hour labor and 10 minutes of pushing.  When the baby came out, my midwife and doula said it looked like a 40 week old baby.  She showed no signs of being in too long.  None.  Had I gone on with the induction - and she wasn't ready - just imagine the outcome.  C-section.

[Ninetales]

I like my doctor so far - she has six kids and she actually had one at a freestanding birth center and one at home, so she at least "gets" me.  She doesn't seem concerned about my weight - when I brought it up she gave me some websites to look at to help with nutrition if I wanted.  Unfortunately I feel like my particular issues with food really require some kind of therapy.  But she isn't put off by my weight or my insistence on a VBAC barring any complications.  I hope the other doctors are as supportive - I haven't seen them yet.  :/

I really want a doula but it's going to take a lot of scrimping and saving to afford the least expensive one around here.

[LivingSky]

Ninetales - I've found a lot of doulas that are willing to give a cut rate if money is an issue, or do payment plans, if you ask them. Can't hurt to try!

lisarenee25 - I think each woman has their own individual gestation time - and maybe even each baby has his or her own gestation time. The 40 week idea is definitely insane. My (very slender) SIL was induced around 41 weeks and almost ended up with a c-section, and her son was definitely not quite full term. She got pregnant through IUI so knew her exact due date, but baby just needed some more time. On the other hand, my DS was born at 38w1d and was definitely 'fully cooked' . So I think gestation time isn't really related to the size of the mother, but to each individual mom/baby pair.

I do definitely agree that a larger woman can have a wonderful birth experience, especially if you're willing to fight for it!

[iixivboots]

Wish me luck, ladies, I am going to meet a doctor in my OB practice for the first time tomorrow. She's not "my" doctor but I kind of arbitrarily chose one, anyway (it's a pretty small practice with three female docs). If I like her, I may just switch.

I am going to try to bring up my concerns about being pressured into induction and C-sections. I am going to mention that I saw a statistic that the induction rate for women in my BMI range is 50%, and while I understand that there are some risk factors, I feel that some of this is unnecessary. I'm going to ask her what their experience with larger patients is. Of course, I don't know that she's going to be like "oh yeah, we push C-sections" but at least I will get it out there.

[scowgirl]

Good luck! I think your approach is good. It sounds like a good way to feel out the doc and see if they seem to feel that C-sections are totally cool, especially for fat ladies, or if they do think there is a benefit to trying to avoid them where possible.

[wellforth]

My baby decided to come out at 42w, 4d.  I narrowly escaped being induced the week before (and it felt like a c-section was inevitable, given all the arbitrary rules) at the hospital.  Though home birth is illegal here, I managed to find a midwife who would take me so late--a day before the induction!  I had a 13-hour labor, and my son was born in water in our living room. 

Though I had a healthy pregnancy, I dealt with a lot of stress from the hospital midwives.  I gained 40 pounds, going from 195 to 235.  I was advised to limit my eating.  I've had a lot of issues with dieting, and that's the surest way for me to gain weight!  I ended up 10 pounds over their water birth weight limit.  And so forth.  I am really glad the water birth at home worked out, with no arbitrary time or weight limits.  The home birth midwife was quite supportive of my son taking his time to come out on his own.

Edited by wellforth - 2/20/12 at 5:06pm

[menageriemama]

bootsvalentine, I would love to hear you report back on how the convo went with your doctor. I hope it went well.

As for me, with my first I was induced at 39w5d and had a c-section for failure to progress. I had gestational diabetes, but all signs pointed to my baby being healthy. I was induced because I was convinced it was sooooo dangerous to go past 40 weeks and that I was lucky they "let" me go that far. Honestly my first OB completely snowed me from the beginning and told me everything I wanted to hear or totally glossed over my questions completely. I really wish that I had pushed back--or more importantly, switched--but I guess that was an important lesson I was supposed to learn. Or something. The interesting thing to me is that I am sure there are plenty of people who would look at my records and attribute my c-section to my weight. Either because my weight caused my GD and thus the induction was medically necessary (which it was not in my opinion) or that something about my weight made me unable to dialate or whatever. After many years active in the cesarean awareness world I have heard it all and I am sure a lot of it could falsely be applied to my situation.

Here's my happy ending, though. In between pregnancies I found a OB with a brain who was not afraid of my size or my GD. He agreed that he would not do anything to mess with my pregnancy unless my baby was in imminent danger. We did not talk induction. I fully expected to go well past 40 weeks, particularly because my first daughter was almost 40 weeks at my induction and based on how it went it seemed that she was not ready to be born then. With my second daughter I went into spontaneous labor at 39 weeks. I labored like any other woman, used movement and remained up right, and pushed her out. Ta-da. Boo-yah. Guess my body can birth, after all. It did it quite easily really. Funny how that happens when no one is messing with the natural order of things.

[Viola]

That's interesting.  I'm in the 40+ range too, and my doctor wanted to induce me with my first pregnancy.  I was 28 weeks when she scheduled my induction for my due date, and I thought the desk personnel was mistaken when she told me she had just scheduled my induction.  She also said she didn't want any "heroics" like pushing for 2.5 hours.  She definitely seemed nervous about the whole big baby thing, and made me get my blood sugar drawn again, just to make sure I didn't actually have GD.

[Breathless Wonder]

I suppose I should read the article, but I just wanted to say, I have had 3 homebirths, during which I weighed between 260 and 300 lbs. (I am 5'8")  It can be done.

[lisarenee25]

I have also had 2 successful homebirths weighing 260 lbs - and am planning another one.

I don't care what anybody says, it is possible.