Thursday, March 26, 2009

The battle of the bulge...

Living in the South seems to go hand in hand with obesity. We can't seem to get enough of sweet tea, fried foods, and lots of sweets! I have noticed that in my personal social circle and in my midwifery practice that people are getting bigger--unfortunately, it's not muscle mass they are gaining it's body fat. It is estimated that nearly two-thirds of Americans are considered overweight and one in three are obese, meaning they have a body mass index of 30 or greater. Since more and more Americans are obese we (as midwives) are now beginning to see the effects of obesity on the childbearing woman. Compared with normal-weight women, obese women have a greater risk of developing complications during pregnancy. Their babies are also more likely to be admitted to neonatal intensive care units. I have spent today(during my spare time:) researching the complications of obesity in women's health and childbirth.

To begin with, I found that obesity contributes to infertility. Research has shown that women who were severely obese were 43% less likely to achieve pregnancy than normal-weight women or women who were considered overweight but not obese. While your ovaries are trying to behave and cycle normally, the steady input of estrone (a type of estrogen created from fat cells) will interfere blunting the peaks and valleys of the ovary's function, which ultimately interferes with ovulation and can cause infertility.

Secondly, I found out that women who are obese are more likely to have C-Sections. There are several reasons why obesity increases the chance of a C-section. One of these is a longer labor time. A University of North Carolina at Chapel Hill study showed larger women have naturally longer active labors – defined as the time going from 4 centimeters to 10 – between one and one and a half hours longer. The study goes on to say that many of these women, if allowed to continue to progress, can have successful vaginal births, but many physicians are unaware of this study, so women who could probably deliver vaginally instead end up on the operating table because they exceed the usual time limits for labor. Another reason for C-sections is that larger women also often have larger babies, either because of gestational diabetes, genetic reasons or because of weight gain during pregnancy, and larger babies are more difficult to deliver vaginally.

Thirdly, I found that obesity is linked to neural tube defects. The most common neural tube defect is spina bifida, which is the leading cause of childhood paralysis. The research suggests a doubling of risk for babies born to obese women, compared with those born to normal-weight women. And while folic acid supplementation helps protect against this birth defect, obese women who get enough folic acid are still twice as likely as normal-weight women who also get enough to deliver babies with neural tube defects.

Lastly, I found that obesity is obviously correlated to hypertension and gestaional diabetes during pregnancy.

I now realize that I must make more of an effort in taking a direct approach in assessing my clients healthcare risk. Even though I find myself at times uncomfortable with discussing the topic of obesity, I must do what's best for the wellbeing of my mothers.

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