Many women feel uncomfortable with their body image during pregnancy and it can be especially hard if you may require special care because of your weight. If this information makes you feel uncomfortable or upset please ask your doctor or midwife about support and counselling.
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Obesity or being overweight can cause complications for both you and your baby. Complications can occur while you are pregnant, during labour and after your baby is born.
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The most important thing is that you and your baby are cared for properly. At the Women's we provide women, who are at risk, with special care and extra monitoring through our Maternal Fetal Medicine program.
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We can also offer you support with your body image, your diet and exercise programs through other services in the hospital.
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How we measure obesity
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Obesity is difficult to measure. The best measure we have is the BMI or Body Mass Index. Assessing obesity using BMI has some limitations. It doesn't take into account a number of things like lean muscle mass (which weighs a lot) and variations in the way that fat is distributed. It also fails to take into account age, sex and culture, which all influence the way we look and carry weight. However BMI is the internationally accepted practical way of assessing obesity, and it does provide a good guide to the risk of obesity-related health problems.
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The BMI is currently the best way that we can make sure that all women who are possibly at risk are getting the right treatment.
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Understanding the Body Mass Index or BMI
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Your BMI is calculated by dividing your pre-pregnant weight in kilograms by your height in metres squared (m²). The calculation is based on pre-pregnant weight.
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A healthy BMI is between 20 and 25. A result below 20 is defined as underweight; a figure above 25 is defined as overweight.
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What are the risks?
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All pregnant women have a risk of pregnancy complications, however most pregnancies are uncomplicated. Obesity increases your risk of having a number of pregnancy complications. The more obese you are, the more your level of risk will increase.
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You are at increased risk of the following pregnancy complications if you are obese.
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When you are pregnant
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- gestational diabetes - a form of diabetes that developes during pregnancy
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- pre-eclampsia - a condition that only occurs in pregnancy, characterised by hypertension (high blood pressure) and the presence of protein in the urine
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- abnormalities of the baby's growth, development and general health
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- sleep apnoea - a condition that causes you to temporarily stop breathing while you are sleeping.
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During labour
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- failure to progress in labour
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- shoulder dystocia (the shoulders get stuck during birth)
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- difficulties monitoring the baby's heart
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- difficulties with providing satisfactory pain relief in labour
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- increased risks with attempted vaginal birth after caesarean section
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- need for an emergency caesarean section
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- increased risk of complications related to caesarean section.
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After the birth
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- increased risk of wound infection
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- increased risk of blood clots (particularly following a caesarean section)
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Obesity and Caesarean Section
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The problems with operating on women with obesity include the following:
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- positioning, because you are unable to lie flat and to be moved if an emergency arises
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- an epidural or spinal anaesthetic is more difficult to site correctly and is more likely to dislodge or fail
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- it is more difficult to maintain airways (especially in the emergency setting)
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- the procedure is more difficult
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- extra monitoring is required
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- you may require admission to an intensive care unit after the operation.
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Despite these problems, obese women are more likely to require a caesarean section for a wide range of conditions / problems. Considering all issues related to your care (and that of your baby), the doctor may recommend an elective caesarean section.
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How we look after you and your baby
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In the Maternal Fetal Medicine program we will ensure you receive close monitoring and the very best care. The medical staff will consider all aspects of your pregnancy when planning your care.
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While you are pregnant
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- In the early part of your pregnancy you will be checked for pre-existing diabetes and at 26 weeks you will be checked for gestational diabetes.
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- Your baby will be closely monitored throughout your pregnancy.
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- You may be offered more frequent antenatal visits.
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- Between 28 and 34 weeks you will be referred to the Anaesthetic Assessment Clinic for consultation as a safeguard, even if you are planning a vaginal delivery, so everyone is prepared for every possible outcome.
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In labour
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Plans for your labour and birth will be discussed with you by your doctor as the time approaches, and will take into account your specific circumstances, as well as issues related to your obesity.
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For women who are very obese, staff will do what they can to encourage your baby's birth within normal working hours. This is to make sure that all required staff are in the hospital should there be any problems. If an emergency arises out of hours there may be a delay until the additional on-call staff have arrived at the hospital.
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After your baby is born
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Breastfeeding is the ideal food for newborn babies. It reduces the likelihood of childhood obesity and protects the baby from a range of infections and allergies. It also helps you to lose weight.
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If you have had a caesarean section you will most likely be offered medication to reduce the risk of thromboembolism (blood clots)
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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 This fact sheet is available for download as a pdf in: English, Arabic, Chinese, Serbian, Somali, Tigrigna, Turkish, Vietnamese
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Last updated Feb 2008
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