is it true that obese women "should" have epis?

[tenar]

I read a letter in The Age today, written by an anaethsetist, that said the following:

- obese women are more likely to have birth complications (this I believe)
- obese women are harder to anaesthetise, especially in a rush
- therefore it is recommended that all obese women have a planned epi (or maybe other kinds of pain relief) during birth, to avoid a situation where it goes wrong in an emergency.

Now this kinda freaks me out a bit. I am obese according to BMI definition, though I'm also moderately fit and very healthy. I absolutely do not want to plan to have pain relief during my labour, though I can understand that I might change my mind about it, depending on how things do.

I would be horrified if I was told I have to have pain relief that I don't want, just because I'm overweight. I am not afraid of labour pain and I'm going to do a CalmBirth course to help me prepare better for the labour, and I defintely want to give it a go with minimal interventions.

Does anyone here know more about this?

Are there any other overweight women here? Did you have pain relief, and what sort, or did you not? I'd really like to learn about other people's experiences here.

[Trillian]

Do you think maybe that considering it was an Anaesthetist who said this, someone who gets PAID to give epidurals would have a vested interest in spruiking this kind of bulls***? It is NOT true in the slightest! Not even about larger women having trouble giving birth. I haven't ever been able to comprehend why they think larger women have more trouble giving birth? Our backsides may be fat but our vaginas aren't. Some say it's due to not being able to aptly monitor the baby because we have soooo much fat in the way - so it's not a problem for US, again it's a problem for THEM and how hard we fat women make THEIR lives

Simply having an epidural in the first place is what dramatically increases your chances of having your birth go downhill, not your weight.

I too am 'obese' according to the stupid BMI and I have had 4 babies - not one single epidural and mostly only gas for pain relief. I didnt have any complications due to my size. I did have a retained placenta after my 3rd birth that required a GA to remove it and there were no troubles at all with my *emergency* anaesthesia. Scarmongering and bullsh** at it's very best. He should win an award for that if there were a prize for this kind of thing.

[AnyDream]

Well I weighed well over 100kg when I gave birth to my second DD1 (planned CS) and it took next to no time for the REGISTRAR anaesthetist to get my spinal in. I've had vaccinations that've taken longer. I'm tall and obviously carry my weight well since the only time I was weighed during my entire PG was when they weighed me to calculate dosage (pre-op). They didn't blink an eyelid and it was soooo not an issue.

So I'd say this guy just has a high opinion of himself and the godliness of his interventionist medical practices, rather than any substantive reason for this suggested practice. Essentially he's saying that he finds it difficult to deal with a challenging anaesthetic when time is of the essence - or maybe he doesn't like getting called out in the middle of the night to deal with difficult situations that are beyond the skills of more junior staff.

[visitor1]

I have to date had 2 complication free births, so whilst there *may* been complications with over weight women, so far so good for me. Not so much a complication, but i know monitoring (external) has always been a problem for me, to the point where they have told me in mot in labour purely because they couldnt detect contractions.

Obese women are harder to anaesthetise, especially in a rush....i agree to a point. My hospital said they do find it harder the bigger you are, as there is more fatty tissue to get through and finding the right spot becomes more difficult.

It is recommended that all obese women have a planned epi (or maybe other kinds of pain relief) during birth, to avoid a situation where it goes wrong in an emergency.

My TBH i think its worth having a back up JIC that was to happen. I have never planned to have drugs (but have resorted to gas both times), depending on the kind of emergency i guess your in would affect the drug of choice. Ive always said no to epi, i fear spinals...so for me gas and peth are my hard core drugs....but if i needed something more...then my baby is worth it and id take whatever.

With DD1 i had peth but it was used to in early labour to make me sleep and then just gas for the main action....DD2 i only used gas for about 1 hour (of the 3 hours i was at the hospital). This time i plan to go it drug free but have no worries if i wish to use gas again. If needed id go for a spinal in the event of c/s.

[tenar]

Thank you all, this is reassuring.

I understand the idea that it might, in some situations, become a very good idea to have an epi, depending on how the labour goes and how I deal with it. I'm not one to get very intensely committed to an idea of a "perfect birth" - anything that leaves me and baby healthy is good enough!

But I'm very much planning to not plan for any intervention, and in fact to resist suggestions for interventions that might not be necessary. Which is why the stuff I was reading earlier was worrying me.

[Trillian]

Oh of course, if you are looking down the barrel of a very long and tiring labour, then they do have their place and you are smart enough to know that, as is every other woman, but his suggestion that they should be given as routine to EVERY obese woman is just ludicrous.

[satya]

I fell into the obese category but am at the lower end of it - size 14 bottom half size 18 top half. My BMI was not high enough to be considered a risk.

I actually wanted an epidural but I was never offered one. At the second midwife appointment I was told that the hospital doesn't do them routinely and it would only be given if it was necessary. I birthed at a public hospital.

I had a long labour - 15 hours 1st stage & almost 2 hours 2nd stage plus a day of prelabour. I told them when I arrived at hossy that I wanted an epi but the subject just never came up in the labour room & I completely forgot about it. I was 6cms dilated when I got to hossy & needed gas straight away.

I think I had 2 or maybe 3 shots of peth & something for nausea. In the end I had to have some Syntocyn to get the labour going a bit faster as after all those hours it started to recede & then it was stirrups, snip snip & out he got vacced. The intervention was by no means a bad experience. I was just so glad to get my little man out safely after all that time.

If I was to go through birth again I think I'd be pushing for an epi because by the time I got to pushing I was completely exhausted and I'm sure that was partially due to my weight (as well as the long labour).

[Mum0809]

I am obese. I had an epidural that didn't work, I don't know why it didn't work, I wasn't really with it, it may have been due to my weight, or anaethsetist not wide awake being 3.30am, or me having 2 fractured vertabraes but I don't think it would have gone any differently if it was a planned epidural. I really wish I hadn't had it I think it made things alot worst because they wouldn't let me get of the bed. I think the CalmBirth course is a great idea.

[Toomanytoomany]

If obese women have more complications during labour, I don't see how encouraging them to be immobile and supine is going to benefit them.

I'd want to see some evidence before I chose to make an *informed* decision about that kind of thing.

[Jacqui]

If obese women have more complications during labour, I don't see how encouraging them to be immobile and supine is going to benefit them.

I'd want to see some evidence before I chose to make an *informed* decision about that kind of thing.

I have been morbidly obese in technical terms for all 3 of my births. Epidurals never once entered into my birth plan or delivery room. I was 120 with baby 1, 130 with baby 2, and possible 150 with baby 3.

With baby 3 delivery I chose to stand up and let gravity help. The delivered on the bed. All deliveries were fine. I agree with the above quote. Encouraging "obese" women to have epidurals is in my opinion a farce.

IN my opinion as an Obese person, this is a very negative approach to something positive.

[rhyb]

I was 105kg with DS (making me obese at only 175cm tall) and no issues I had Aiden with out an epi. It was never even mentioned to me.

[tan32]

I am too classed as obese, i have had 3 wonderful labours. my longest labour of 4 hours consisted of me having an epidural and laying down due to pre eclampsia and this i feel was my hardest labour. I was at my lightest with bub number 1.

My two other labours were natural labours with no pain relief at all, I stood with my second and had him in 45 minutes, and i knelt on the bed with my third and had him in 50 minutes.

[Bumperstump Cummerbund]

My sister was 105 when she gave birth, and the week beforehand her anaesthetist told her if she gained any more weight he wouldn't be ABLE to give her an epidural!

You'd think they'd at least have the same story!!

[Midwife Melissa]

I read a letter in The Age today, written by an anaethsetist, that said the following:

- obese women are more likely to have birth complications (this I believe)
- obese women are harder to anaesthetise, especially in a rush
- therefore it is recommended that all obese women have a planned epi (or maybe other kinds of pain relief) during birth, to avoid a situation where it goes wrong in an emergency.

Maybe this anaesthetist is trying to justify another use for his/her services, thereby ensure his / her income stream?

Do your own research and come to your own conclusions. I'm waiting for the day when TENS, Calmbirth, waterbirth etc are promoted as much as epidurals are, for pain relief in labour.

[Kmn]

I think that the anaesthetist is just writing based on what they see, and trying to reduce the distress of their patients.
The patients (obese and otherwise) who get through labor with heat, cuddles, TENS, gas and peth are not patients who are on the radar of an anaesthetist. The patients they see are the ones who are not coping and are distressed. And their job is to minimise additional distress to the patient.

So if you were an anaesthetist who kept seeing distressed, large women who were difficult to help, you might also develop this view, based upon a very biased sample.

There's no shortage of work for anaesthetists, they don't need to create extra!

Maybe the advice that should be given to large women is "It will be harder to get an epi in if you need one, so if you aren't managing with the gas/heat/etc then let us know earlier rather than later".

[dust]

im obese never had any epi or tear.. not a single stitch. ive also never used any pain meds as im a control freak and the thought of my head spining from gas doesnt float my boat!

sorry but the generalisation in any sense is complete BS! Im obese would have been easy 110 at 169cm at both births. No pain meds, No epis, No forceps or salad scoops, No tear, full public service midwife only, birthed squatting & birthed on birth bean bag & very quick births (including all stages)

there was never a suggestion of epi, gas or otherwise.. one crazy midwife who wanted 2 get my personal details check my BP etc kept on going on about water injections in my back.. which ive never heard of b4 but after a internal stopped insisting as i was 8cm dilated.. no crap! i go to the hospital to deliver not to have a chat over tea.. grr

i hate that despite my perfect record of wonderful births & healthy babies that im classified as "high risk" its like telling cathy freeman she may have won gold at running but no she cant run 4 ****.. WTF?!!!