Hi girls.
A co worker said today that large woman are known to have problems dilating during labor.
Can someone explain to be why this is?
TIA :)
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Hi girls.
A co worker said today that large woman are known to have problems dilating during labor.
Can someone explain to be why this is?
TIA :)
Sent from my GT-S5830 using Tapatalk 2
sounds like crap to me but who knows?
I would think its crap too unless someone else can come in and shed some light.
Seems there is some merit to it.
http://journals.lww.com/greenjournal...ty_and.10.aspx
Maternal Prepregnancy Overweight and Obesity and the Pattern of Labor Progression in Term Nulliparous Women
Vahratian, Anjel PhD, MPH*â€*; Zhang, Jun PhD, MDâ€*; Troendle, James F. PhDâ€*; Savitz, David A. PhD‡¶; Siega-Riz, Anna Maria PhD*§¶
Abstract
OBJECTIVE: To examine the effect of maternal overweight and obesity on labor progression.
METHODS: We analyzed data from 612 nulliparous women with a term pregnancy that participated in the Pregnancy, Infection, and Nutrition Study from 1995 to 2002. The median duration of labor by each centimeter of cervical dilation was computed for normal-weight (body mass index [BMI] 19.8–26.0 kg/m2), overweight (BMI 26.1–29.0 kg/m2), and obese (BMI > 29.0 kg/m2) women and used as a measurement of labor progression.
RESULTS: After adjusting for maternal height, labor induction, membrane rupture, oxytocin use, epidural analgesia, net maternal weight gain, and fetal size, the median duration of labor from 4 to 10 cm was significantly longer for both overweight and obese women, compared with normal-weight women (7.5, 7.9, and 6.2 hours, respectively). For overweight women, the prolongation was concentrated around 4–6 cm, whereas for obese women, their labor was significantly slower before 7 cm.
CONCLUSION: Labor progression in overweight and obese women was significantly slower than that of normal-weight women before 6 cm of cervical dilation. Given that nearly one half of women of childbearing age are either overweight or obese, it is critical to consider differences in labor progression by maternal prepregnancy BMI before additional interventions are performed.
Wow, fair enough then!
Applies to induction as well?
Obstetrics & Gynecology:
March 2004 - Volume 103 - Issue 3 - pp 452-456
Original Research
The Association of Maternal Weight With Cesarean Risk, Labor Duration, and Cervical Dilation Rate During Labor Induction
Nuthalapaty, Francis S. MD; Rouse, Dwight J. MD, MSPH; Owen, John MD
Abstract
OBJECTIVE: To assess the relationship among maternal weight and cesarean delivery, cervical dilation rate, and labor duration.
METHODS: We used a secondary analysis of 509 term women who were previously enrolled in a prospective observational study of a labor induction protocol in which standardized criteria were used for labor management. A variety of analyses were performed, both unadjusted and adjusted. P < .05 was considered significant.
RESULTS: The mean ± standard deviation weight of women who underwent a cesarean (97 ± 29 kg) was significantly higher than that of women who were delivered vaginally (87 ± 22 kg, P < .001). In a logistic regression model of nulliparas who comprised 71% of the study population, after adjustment for the confounding effects of infant birth weight, maternal age, initial cervical dilation, and diabetes, for each 10-kg increase in maternal weight, the odds ratio for cesarean delivery was significantly increased (odds ratio 1.17; 95% confidence interval 1.04, 1.28). In a linear regression model also limited to nulliparas and after adjusting for the same confounders, the rate of cervical dilation was inversely associated with maternal weight: for each 10-kg increment, the rate of dilation was decreased by 0.04 cm/h (P = .05). Similarly, labor duration was positively associated with maternal weight: for each 10-kg increment, an increase in the oxytocin to delivery interval of 0.3 hours was observed in nulliparas (P = .02). Neither lower rates of oxytocin administration to heavier women nor diminished uterine responsiveness (as reflected in measured Montevideo units) accounted for the slower labor progress.
CONCLUSION: In nulliparous women undergoing labor induction, maternal weight was associated with a higher cesarean risk and longer labor and was inversely proportional to the cervical dilation rate.
LEVEL OF EVIDENCE: II-2
no. Im thinking there is truth in it. I am thinking perhaps it relates to hormones taking longer to work because of larger distribution of fat which slows absorption/distribution....but....Im not sure if this is the case.
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snap!
thanks M. Just what I was looking for :)
I wonder why though?
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Also I wonder if large women are less active???
Either because they are pressure into more monitoring because they are over weight (sort of chicken or the egg debate)
Or if larger women are just less active full stop.....
I am obese and had no issues, quite the opposite in fact.
Also in regards to being less active I walked around, moved around etc etc.
I do think it's obviously different for each person but to me labor IS different for each person (no matter their weight or size)
Sent from my iPhone, more than likely while I should be doing something else!
I was induced twice.With both labors I had spontaneous contractions but didn't dilate until I was induced. FWIW I was also active during the labor.
i was hoping a mid or doula could shed some light on what they know. I am hoping with my next birth (whenever that may be) I can avoid the non dilation issue.
ETA the study M provided above does state that overweight/obese women dilated slower but no reason given other than oxytocin not being an issue..hmmm. Thanks for the info M provided:-)
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LOL as a 40kg overweight nullip with 6.5 active stage followed by primip precipitate labour < 3hrs from first cx - I dread to think about a non overweight one then.
yeah fatty-mcfat-fats with their fat vaginas cant possibly give birth quickly. what horse ****.
It's not saying that. General trends can never predict the lengths of individual labours. All there is, is an association. Seems on average obese women labour for longer, but there are other papers out there showing stage 2 is similar length, and that obese women pushing put the same out of pressure out as other women. It's just stage 1 that differs.:
All I can say is if my being obese slowed down my labour then thank goodness I wasn't a skinny girl!! I certainly was the exception to prove the rule with my second and third births.
don't forget their fat stupid cervixes that don't dilate the right way! :/ Even if there is a trend (I'd want to see a big sample size of physiological births (very unlikely to happen)), it still stinks of blaming and pathologising women's bodies :/:
Interesting, do you think maybe it has to do with muscle tone or strength? contractions are less effective at shortening muscle fibres to dilate cervix?
sent from my watzamajig so may not make sense....
Want to know why I think it's horse****? It is because it uses the BMI! The BMI is a flawed measurement of weight and you have 'obese' women who are really probably not obese at all and it skews the results of the study pretty damn quickly.
And this;
Is also making the study flawed because they are creating a situation where the rate of surgical birth outcomes are immediately greater than normal.:
labor induction protocol in which standardized criteria were used for labor management
And do you know what else makes it a totally ****ed up study? Does anyone know what 'nulliparious' means? It means a woman who has NEVER given birth before. So they have done this study on women who are having their first baby, INDUCED them for the purposes of controlling the outcome of the study and then said 'oh yeah, these fat women having their first births ended up with more surgical births'. Really Einstein? Statisically speaking, premip women who have an induction of labour are more likely to end up with a surgical birth than a woman who is a multipara. OF COURSE their study is going to show that these nulliparious women have a higher c/s rate and because the study is about obese women, then that must be the reason right? Not the fact that they are inducing premips.
Oh and inductions. Biggest mistake right there. If they genuinely wanted to do a study and find out if obese women labour longer than smaller women, then they should NOT have included births that were induced, used any form of analgesia (which would include epidurals). You can only get an accurate result if you are studying completely unhindered births.
Bad studies like this only make it harder for larger women to birth how they want. They are not given the options that other women would have. Assumptions are automatically made just because of studies like those ones.
You guys might like to read this paper:
http://edoc.hu-berlin.de/oa/degruyter/jpm.2009.110.pdf
Other clinical evidence is in harmony with the potential for obesity to compromise the intensity or efficiency of uterine contractility. Onset of labor may be delayed by obesity, and dysfunctional labor may be abetted. Obese women have been observed to have longer-term gestations, and more post-dates pregnancies than thinner women w4, 22x. Also, in a prior analysis of labor duration, Vahratian et al. studied rates of dilatation in a data base of 612 nulliparas and found active phase labor (defined as 4–10 cm dilatation) was significantly longer in overweight and obese women, after adjusting for birth weight w24x. Zhang et al. w27x showed in a clinical study that obese women had a higher risk of cesarean, related primarily to abnormal progress in the first stage of labor.
Until recently, there has been no biologic basis to explain why simply being obese would affect labor, but accumulating evidence supports the association of
obesity with impaired uterine contractility. In one study, myometrial tissue obtained at cesarean from obese women was shown in vitro to contract with less force (as indicated by lower calcium fluxes) than those from normal weight subjects w27x.
The basis for this contractile inhibition may reside in some of the biochemical changes induced by obesity. For example, leptin, a protein with diverse metabolic and
regulatory functions, is produced in increased amounts in obese individuals. Moynihan et al. demonstrated that leptin strongly inhibited myometrial contractility in vitro w12x. Cholesterol, also increased in obesity, has similar inhibitory effects on myometrial activity and calcium signaling w21, 28x. We conclude that obesity may interfere with the progress of labor, resulting in dysfunctional patterns of dilatation. The mechanism for such an effect may be mediated through diminished uterine contractility in the active phase of labor, a consequence of increased levels of leptin, cholesterol, or other metabolic features of the obese state. Obesity should be added to the list of possible causes of abnormal labor progression.
The effect of obesity doesn't seem to reach to second stage (where similar pressure is exerted by all women regardless of obesity status): http://journals.lww.com/greenjournal...tage_of.3.aspx
And if you want to see how they have "tried" to isolate the effect of obesity from other complications in pregnancy / labour, see here:
http://www.ncbi.nlm.nih.gov/pubmed/16108107
That's scientist mcfatty, over and out for the evening ;).
Which study was this? I agree bad studies suck, but the error usually lies in people interpreting the studies to say things they don't mean, rather than bad design. It was encouraging to read in the conclusions of some of these studies that obesity should be taken into consideration when labour stalls and hence DON'T take further interventions because this particular labour may be usual / within normal for an obese mother.:
Both of them! Neither of the first two studies linked were sound and both had glaringly obvious flaws. It is easy to predetermine the outcome of your study when you are manipulating so many of the variables. The only way something like this could ever be proven would be to study every single birth that every woman has and for every single birth to be a 100% normal, physiological birth with absolutely no medical interference. But that will never happen, so there will never be a study that can accurately say conclusively one way or the other that obese women take longer. There may be some merit in the last study you linked to that said it was a biological issue, but even then, are there any studies that are following up these women once they become multiparas? I would love to see what the subsequent births of these women were like.
These studies just make it seem like we are pushing the proverbial poo uphill when we are fighting for the right to give birth the way we want to. I am an 'obese' person who gave birth 4 times. I personally had quite quick labours. But for any women who is on the large side who is having her first baby is going to have a medicalised birth dictated to her because of the findings of these studies. Even though all the women in the studies were induced, the findings are going to be applied carte blanche to all women before she even goes into labour. Women are going to be induced if they are overweight to avoid something that didn't even exist in the first place.
They control it so much in order to isolate the effect of obesity under certain conditions. Otherwise there are so many free variables you can't say anything. Given the number of inductions in this world, it isn't meaningless to study the effect of obesity under induction conditions.
Am I right that obese women feel threatened by this, that it will force them into more interventions or less faith in their inherent ability to birth?
I've just slipped into the obese category :redface: and I read this not to improve my "body faith", but to know what might happen and what I could do or say to avoid those excess interventions. So I guess I understand a part of the emotion in this thread, but some of it still baffles me a little. Maybe that's the AND and I just numb myself because I don't want to deal with other people's critical opinion of my weight? Meh, bed. :)
Definitely! But we forget that induction is not how the body is naturally supposed to labour. That's where the problem is. If left alone, these women could have had births that were just as effective. Maybe not short, but then maybe not long either. But physiologically, if a woman is left alone to birth, she births how she is meant to birth. I have had spontaneous births, and I have had one induced birth with syncto. Trust me, it is NOT how a woman is meant to do it. Your body is forced to do something it doesn't want to do.:
hmmm. okayyyyy. lol.
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Why? can't anyone objectively look at a study and comment on it and think it's complete rubbish? I'll tell you one thing, it's a lot less rubbish than just believing that it is true.:
What would anyone do if they went into their Doctors appointment and he said to them 'ýou're overweight/obese. There has been some research that suggests you might have a longer labour because of your weight, so we should just induce you. No one wants a long labour do they?''. Would anyone seriously think that was appropriate? would anyone have an induction based on that? Probably. And that's why we have a ****ed maternal health system where women are objects and everyone knows what is 'best' for the woman except for the woman herself.
And hell yes I'm a bit ranty about it! Someone has to be. For a while there BB was a place where women still believed that they had some bodily autonomy and that if they had a vagina, then they could give birth but lately it's gone all mainstream where women should just do what they are told like good girls.
:leap: yep, trillian!
I don't see anywhere in this thread where anyone said that. It's kinda frustrating we can't discuss an issue without so much emotion getting in the way.:
I had a long labour. I'm 'morbidly obese'. My Mum had a long labour, she was on the borderline of being underweight.
These studies might have some merit in the medical world and it would be fantastic if it meant that medical professionals allowed larger people more time and thus avoiding intervention, but there is no way that's ever going to happen.
:
ACtually that's what the first study said. That we could consider allowing obese women more time to labor in first stage because it appears to be part of normal variation for them. Same with stage 2 - the studies actually came down on the side of the obese women and said they could push as well as everyone else and didn't need any intervention just because of their weight.
I don't just mean in this thread. It's an overall thing happening.
Unfortunately the reality is that women don't get 'time'' in labour. They get things sped up. How many times have you read a birth story where a woman was told by her care providers ''your labour has been going on for hours now, lets just give it a few more and see how it goes''. no. most of the time she gets arm, or she gets syncto. Even though the outcome of those studies might suggest that if given time, a woman will labour just as well, it doesn't translate into the current practice of hospital obstetrics.
I don't believe that I have let emotion get in the way of a good discussion. I simply have strong views and I will voice them. If that is what you call emotion, then so be it. But I choose to think critically and not just accept that because a study found something to be 'true' that it has to be unchallenged.
As one of the health care providers you speak about 'Trillian' I would like to give you a different perspective. As I can speak for every midwife, ob etc. this ofcourse is my opinion and what the protocol is in my department.
Women 'do' get time in labour and when we have to intervene it is usually at the very last moment. Why do we intervene, because studies and previous situations have shown that not every woman will labour 'just as well' as you put it. As a mother of two, I do understand the emotion and determination to birth your babies but I can also see from the other side and to them, it is to ensure your baby arrives as safely and healthy as it can. The demands and physical response to labour doesnt just affect the mother but baby too. And while, you are right, that many women can birth their perfect babies on their own in another couple of hours without the need for ARM and drugs many dont and we are able to help them take home their babies without even considering the alternative of what could have happened. But, what if you insisted that we let you go a couple more hours and see how you go and something did happen to affect both you and your baby? Then a review is conducted and the questions are asked of 'why wasnt any intervention done?, why didnt you act sooner?...' We are human beings, some of us mothers aswell, and we dont just 'turn off' when our shift is over. If a birth doesnt go to plan we dont just go 'oh well' and move on to the next patient, it stays with us and we torment ourselves by going through every minute wondering if we had done this would everything have been different.
I dont post alot on BB but I felt the 'other side' had to have atleast my view. BB is very useful with regard to so much information given to mothers about birthing their babies, bfeeding, raising them... It is great to have mothers who are so informed and know what they have/ want to do in labour but the babies dont and neither does a woman's cervix. I dont mean to offend with that comment but we are all different, agreed? And so is our anatomy, with tilted pelvises, undiagnosed bicornate uteruses, scar tissue affecting dilation of the cervix and yes, obesity does impact labour/birth in some experiences. To ignore that is to be uninformed and at the end of the day, birth is truly a miracle no matter how your baby arrives.
hey- just to point out I was asking a question for myself not doing the whole fat women don't dilate thing...I relate to this information and wanted to know if there was any substance to it.:
Fair enough to rant but maybe start another thread if you want to turn this into a 'doing what the doctor says' thing.
I have had babies. I am empowered to have a intervention free birth AND I am entitled to ask a question that enables me to do that. Thankyou.
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LittleB, do you really think I would be that obtuse to ignore that there are very real issues that can and do impact on the outcome of a birth? Of course there are instances where there are underlying issues which can prevent things from going ahead normally. But in cases where there are absolutely no indicators that things are going wrong, then a woman should ideally be left as she is. You say that it comes down the 'what if's'', but isn't that the ultimate right of the woman over her bodily autonomy to refuse?
As someone who works in the business, LittleB, can you tell my why then are there so many instances of 'failure to progress' after what could be considered a short time? Normal physiological birth can take up to 24 hours, so why are women deemed as not progressing after less than half that time? Would you agree that sometimes it does come down to 'failure to wait'? Sometimes it is hard for those in the business to be objective, especially if they are staunch followers of the medical model of care. They need to have things progress a certain way, they put women on time limits. What if these women in the studies do end up with surgical births and are led to believe that it is somehow their fault because they are obese? The impact that the outcome of a first birth can have on a women is mind blowing. So many women swallow hook line and sinker what they are told if their births do end up in surgery and it affects every single birth choice they make for their next birth. What if the outcome wasn't so much the result of their size, but rather the mode of their birth? surely you have to agree as someone who works in this area that statistically speaking, women who have inductions are more likely to have further interventions, sometimes resulting in surgery?
I honestly don't think we are going to see things from the same perspective. You see a medical model that works well and gets babies born at any cost. I see shattered and bewildered women who are left with more questions than answers.
ETA - Delphmoon, thanks for clarifying.
Why are the intervention rates so high in Australia if they are all medically necessary? Is it something we as Australian women lack, for the intervention rates to be so necessarily high?
Well we are one of the fattest countries in the world ;) it's probably all those fat vaginas.:
Fat vaginas have trouble getting pregnant too!
:
:
Abit off topic girls don't you think? TBH I'm not finding any of this helpful so please.....:
This isn't about fat vaginas, or having trouble TTC....
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I'd love to know where abouts you work so I can head there if I ever need to have a baby in hospital! :) The hospitals where I live have a very different approach.:
I thought this thread was about a request for information. Aren't we all about being informed? Making informed, well researched decisions? I don't actually see anyone making a "fat vagina" argument in a negative way. We don't need to turn every thread into a rant about how doctors intervene too much and remove birth choices.