C-Section or Vaginal Birth? Do Plus-Sized Women Have a Choice?

In the past, C-section births were considered necessary for pregnant, plus-sized women. But is this still the case today? Most experts agree that, while vaginal births can be riskier for overweight women, C-section births can also pose some serious health problems for both pregnant women and their baby.

Assessing the Risk�Pros and Cons
A C-section is still considered a good option for plus-sized women because of the lengthy duration of vaginal births, and the size of their babies.

A study conducted in 2004 found that plus-sized women tend to have longer active labors (that is, the time it takes to dilate from 4 cm to 10 cm). For average-sized women, active labor took 6.2 hrs, while in plus-sized women the process took an average of 7.2 to 7.9 hours. Overweight women included in the same study tended to stall between four to six centimeters, while medically obese women tended to stall at under 7 cm. In cases of induced labor, a separate study found that plus-sized women needed more medication in order to start the birth process.

Additionally, plus-sized women, who make up over half of all pregnant women, usually have larger babies. Because of this, there is a greater risk to a baby during vaginal birth, including shoulder dislocation (when the shoulders get stuck in the birth canal). This can lead to nerve changes in the baby or vaginal tears for mom. This seems to make C-sections the more practical route.

Doctors also usually prefer cesarean sections if the woman has had a previous C-section due to a lack of progress as opposed to due to a breech, in which case a C-section is not always the preferred route.

But C-sections can pose their own risks. Hernias due to a weakened abdominal wall are one hazard, while dangers to the baby include respiratory problems, bleeding and infection. Midwives state that C-sections increase the risk of a hysterectomy either at present or in future, while they increase the risk of maternal death two-fold.

Some doctors believe that the probability of having a C-section can be lowered by closely monitoring the baby, and by controlling the pregnant woman�s weight gain. Controlling weight gain to a healthy rate of 15-20 lbs. lowers a plus-sized woman�s chance of having a C-section. Eating healthy and exercising can also help reach this goal.

Other Complications: Plus-Sized Women and Pain Killers
Other dangers associated with childbirth and plus-sized women include problems correctly administering epidurals, because the spine on a larger woman is often harder to locate with a needle.

A study found that the general medical opinion is that plus-sized women should be given an epidural upon their arrival to the hospital to prevent the need for an emergency anesthetic, in case a C-section is later deemed necessary.

If plus-sized women don�t have an epidural, they require a general anesthetic to assist with breathing. Inserting a tube in the woman�s lungs can be even riskier than correctly placing an epidural. Other complications from inserting a breathing tube for a general anesthesia include blood clots.

However a study found no link between a pregnant woman�s size (weight, height, Body Mass Index, Body Surface Area) and her risk of developing epidural fever. Epidural fever occurs in 25% of pregnancies. Size also doesn�t affect how long an epidural lasts.

Doctors emphasize that while being overweight can lead to more complications during labor, most plus-sized women have a healthy delivery, whether vaginal or C-section. Experts suggest plus-sized women express their specific concerns right away with their doctors to ensure their pregnancy and childbirth experiences are positive, healthy ones.

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