Pregnant and Overweight?

Pregnant and Overweight? A New Study says Midwives are a Good Choice for YOU!

Source: Journal of Midwifery and Women’s Health January/February 2017 titled, Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse-Midwife to Obstetrician Intrapartum Care. Authors: Nicole S. Carlson CNM, PhD, Elizabeth J. Corwin PhD, Nancy K. Lowe CNM, PhD.

Midwives are shown to be a very good choice for overweight pregnant women looking to avoid intervention and who prefer less invasive, more physiologic interventions. This study and other studies show that overweight pregnant women who deliver with a midwife are more likely to stay pregnant to term, no matter their weight. It is likely that overweight pregnant women are more often induced by an obstetrican because of fear of complications related to obesity. Whereas, midwives are more likely to offer preventative advice in the pregnancy to mitigate the effects of obesity on the pregnancy. Things like high blood pressure, poor nutrition, gestational diabetes and growing a larger than expected baby, are complications that can be anticipated and counseling can be initiated at the very first prenatal visit.

Quick Points From the Study

• There is a gap in our understanding of the optimal labor management for women who are obese.
• It is unknown if physiologic labor interventions like ambulation, intermittent fetal heart rate monitoring, and hydrotherapy are safe for use in women who are obese.
• Care during labor by a nurse-midwife compared to care by an obstetrician resulted in an 87.0% reduced chance of operative vaginal birth, a 76.3% reduced chance of a third or fourth-degree laceration, and less frequent use of epidural anesthesia or oxytocin augmentation among nulliparous women who were obese. By contrast, nurse-midwives more often used physiologic labor interventions (intermittent auscultation of the baby’s heartbeat, hydrotherapy and ambulation) compared to obstetricians.
• Physiologic labor interventions appear safe to use during labor in women who are obese.
• Physiologic labor management is one strategy for avoiding multiple high-technology labor interventions and may reduce the cost of birth care.

Studies show that overweight pregnant women take up to 7 hours longer to progress from 4 cm to 10 cm cervical dilation and that overweight women do not respond as well to artificial rupture of membranes (breaking the water) and Pitocin infusion when compared to women who are not overweight. Despite that known difference, when an overweight woman takes longer to labor, it is not considered normal for HER. She is put on the same labor curve as every other laboring woman and when she fails to progress quickly enough, interventions ensue that lead to poorer birth outcomes.

Midwives are simply more likely to take the time to plan with her client for the healthiest possible pregnancy as well as to cater labor management in response to the woman’s own particular needs and desires. As Midwifery becomes more well-known and accessible to all women, hopefully we will see an improvement in pregnancy and birth outcomes in New Jersey and the whole country.