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

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.

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 :rolleyes:

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.

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.

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.

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.

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.

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).

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.

I am classed as obese on the BMI as am only 5ft. I also took on a lot of fluid which was the problem. I didn't want any pain relief I wanted to be able to use the TENS Machine throughout, but was induced and the labour was very intense. As it was they couldn't get the Epi needle in and they wanted to try a surgical needle which they couldn't find. I would do the same again not plan to have an Epi as I was very pleased (the stars were aligned) that in the end I didn't have it. I planned not to have one not for the actual needle but because of the extras that goes with it - saline in the back of the hand, catheter (?) and not been able to move until it's worn off.

Is the article referring to putting in the epidural in advance (so the plumbing is installed and drugs can be delivered that way if needed), or anaethetizing all obese women as a matter of course?
One might be worth considering, the other seems insane!

Is this the same journalist that wrote the stupid front page article last weekend (which was posted on BB). If so my suggestion would be to use "The Age" for lining the cats litter tray from now on....

I am "obese". I had an epidural with my first birth due to pre-eclampsia complications. It went in fine and worked properly. Only problem was trying to sit still during contractions while they put it in... obviously not a 'weight issue'.

My second birth I sailed thru in 45 minutes with no pain relief at all!

Personally, I would not let someone stick a big needle in my spine JUST for the 'what if' situations. Its this kind of scare mongering generalisation that makes some women fear birth and panic into compromising their wishes before even having the first contraction.

My sister was 'forced' into having a c/s because she was too overweight to deliver normally. She was very young and inexperienced at the time (and it was a long time ago) and she has regretted it ever since.

Ok. and if this post sounds inflammatory and aggresive, well, thats just the kind of day I'm having. Blame it on the hormones.... Im really a nice person... really. ;)

I am someone who rolls my eyes at these kinds of articles.
I am Obese. I am a very large chick.
I understand that yes, it CAN cause complications. It CAN have bad effects on pregnancy and birth, but I really think anything like this should be decided on case by case. I have fantastic pregnancies. I have a better birth with DS than I could have imagined. Did I have ANY problems in labour? NO not one. I had no problems being monitored. I had no problems with any drugs. I had a problem with them putting a cannula in, but that is because I have small veins. I had this problem when I was a size 12, it's no different.

I had gas only last birth. I am hoping that this time, my birthing experience can be as good if not better than my first one. I am VERY confident in my BIG body. I just don't see why because of weight, us large people are shoved into a bracket where we are a massive risk.
I am perfectly healthy, and the only 'problem' with me according to my caqre providers in my weight. If I did happen to have complications, and needed an epi, I'd have it in a heartbeat. If I HAD to have a c sect, I'd have it. I just beleive in being able to be given a go first.

I will be saying NO to an epi, unless I NEED it.
I have the utmost confidence in my body though, and I just know I can do it again:)

Sorry might have gon off track, but when are care providers going to stop looking at a number to determine your risk, and start looking at your entire history before deciding it? Case by case I say;)


Oh and myson... I think my post is more aggresive than yours haha.


ETA: by the way... I had a 36+ hour labour, which 32 hours of was at home. Yes, it was tiring, but I was in no way ridiculousy exhausted afterwards, and even got up and walked over to have a shower. ;)

I am a size 22, weighing at about 100kg and 155cm tall, i have delivered 5 happy, healthy babies, i had no labour complications and no drugs. My only plan during labour was that i did not want an epi, i used mind over matter, visulising the baby moving down, it still hurt like hell, but it helped me remain calm.

I do understand that they worry that a womans size can hinder an epi, especially if it is needed in an emergency, but to suggest that larger women have one to advoid problems trying to get one in if needed later, is just absurd.

My sister is half my size and after watching me give birth 5 times, asked for an epi, unfortunatley for her it slowed down her labour and she ended up needing a c sec.

So large women are more than capable of delivering babies with out any complications and without the need for an epi.

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.

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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.

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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.

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.

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.

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!!

In terms of the studies (google for them, there are a bunch) the reasoning behind this article are as follows....

Obese women tend to have longer labours. That does NOT mean they are "complicated", that means that in a hospital an Ob who is twitchy to get to golf/bed/the bar will regard a normal labour for an obese woman to be a protracted one by HIS standards and then augment, CAUSING complications. The reasons for longer labours are twofold. The first reason is that having a lot of excess bodyfat tends to interfere with calcium levels in cells, and your uterine muscles (in fact all muscles) NEED calcium to contract in a strong and organised way. That doesn't mean you can't labour perfectly well, it just means you might take a while to efface and dilate, and in and of itself that is not a problem at all. The second reason is that while the cervix is dilating and the baby descending everything in the pelvis needs to get out of the way. SOME obese women have a lot of fat around their organs (although they are far less likely to than obese men) and this fat also needs to move out of the way to let the baby out. This can mean the late first, transition and early 2nd stage is a little longer for obese women too. Again, not a problem so long as mum is well-supported and allowed to rest properly between contractions.

The reason epidurals can be harder to site in obese people (obese men having spinal pain relief for injury or surgery present the same challenge) is because THE NEEDLES AREN'T LONG ENOUGH! The epidural needle is about 4inches long and has a stop on it - they insert it into the epidural space and then place the stop against the skin to stop it going deeper. If your epidural space is more than 3 inches from your skin the needle can be too short. MOST major hospitals should have needles long enough as that is hardly bloody rocket science!

I have obese friends and was about 101kg at delivery (though 181cm so not quite obese) and i have read an awful lot on this. In my view i would suggest the following for obese women:

1) During pregnancy stay active and eat well - fat around the vital organs and in the pelvic cavity is MUCH less common in physically fit individuals, and exercise is the key to keeping your bodyfat under your skin and not around your guts.
2) Have a doula or a good midwife as constant support - you might have a long labour, but your body is EVERY BIT as capable of birthing your babies as any other woman - it can be hard to remember that after several days of tiring contractions, so make sure you have really top notch emotional and practical support for your WHOLE labour experience (oftentimes you will be sent home from hospital until you're dilating and if you arrive at 4cm after 58 hours of labour it might be too LATE for the support of your ob or hospital midwife to make a difference, those early hours are valuable working time for your cervix and baby, and good support then will be invaluable - i do not subscribe to labour only being "real" when dilation hits a 4 - labour is labour as soon as you're having to work to meet the contractions, and you need support from then on).
2) Take calcium supplements during pregnancy and birth - 1000mg/day during the last month and 1000mg every 3-4 hours during labour is what my german midwife friend prescribes for her larger mamas. This will also help minimise your pain as the better tone you have and the more organised your uterus is the less "work" there will be for you to do - it will flow like a well-oiled machine.
3) Avoid spinal anaesthesia. I know this is flying in the face of him up above with the article, but really as someone else pointed out, if your labour will be long anyway, WHY would you counteract gravity and sacrifice the tone of your pelvic muscles? Obese women, like ALL women, should stay upright during contractions, ESPECIALLY once dilation is happening.
4) USE YOUR RESTS - between contractions rest as much as possible. Stay upright but resist the urge to march about trying to speed things up - a little walk every few hours is fine, but climbing up and down the stairs between every contraction for 10 hours will just exhaust you. Eat and drink for as long as you feel interested, your body will appreciate it as will your baby. An active labour needn't be an exhausting one and the more relaxed you can stay the more your body can use its energy to labour.
5) Use gravity during the 2nd stage. The birth stool, supported squats, hands and knees and so on are your friends! With bigger mamas especially lying on your back can really shut the pelvis, making it much harder work for you and babe to get to birthing. So stay upright, and have a doula, DH, DP, Midwife, bar or rope to hang from while you push.
6) Remember this bit of good news; one study i read suggested that positional problems in undrugged obese women with protracted labours are REALLY rare - your baby is very unlikely to "get stuck" due to a positional problem during labour because all that prelabour means s/he has a lot of time to get tucked up into a little ball of birthable joy.

Bx

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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.

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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.

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".

Hi ladies, I`ve had four natural births only one of them i had an Epi,the rest i had no pain relief,but my 5th birth i needed a c-section due to medical reasons. There is no reason why a larger lady can`t give birth in the manner she chooses,I refuse to be bullied about the birth choice i make, unless it effects myself & bub. I don`t understand why us larger women are sometimes treated so differently to a slimmer person,but during my pg`s i have found that most Dr`s & midwifes aren`t that friendly towards us plumper girls.No wonder we leave hospital only a few hours after giving birth.it seems like no one really gives a toss,I`ve never stayed more than 10 hours in hossy after my births except when i had my c section,then i sighned myself out on day three.Just didnt like the some of the nurses attitudes.:rolleyes:

Tenar- I wouln`t read to much into the article you read,sounds like a scare tactic,to me!!!! :wtf:

Actually I talked to my ob about this today.

She said that in her opinion the comments might be sensible of very obese women (BMI over 45), who are giving birth in the crowded public system. The rationale being that it is better to plan to have an epi given by an expert, during the daytime, than to have a registrar doctor trying to get a tricky thing right in the middle of the night if you really need one then.

Given the reports in the press about the state of public hospitals in Melbourne at the moment, and the fact that epis seem to be harder to get right for obese people in general, the ob's comments actually make sense to me.

This is why that whole BMI thing is a load of crap!!!!

It is so not an indication of your health and how much fat you actually carry.

I am not skinny, I am actually quite healthy, I am a size 14-16 (mainly because of my massive assets up top) and usually carry no weight around my middle section. I mainly carry weight on my legs and arms. I also have muscles (which we all know weigh more than fat). My midwife doesnt weigh me as she thinks I am looking great but according to that BMI thing I am obese! WTF!

I think that anaethetists are jsut trying to make mroe money by scaring women into booking in epi's and I dont buy it at all.

Thanks to all the women who have told us about their positive experiences (whilst still being classed as obese even though I am sure you are not). It is very good to hear that you could still have great labours without needing epi's or without having problems having one if you wanted it. :)

I have NEVER heard this much BS. Actually, that is not true, this kind of BS comes up all the time.
Yes, it is more complicated to anaesthetise an obese woman. This is why they should AVOID and epi. As epis increase the risk of things going wrong and a general anaesthetic and c/s becoming necessary.
Your BMI is not an accurate indication of whether or not you are obese and high risk. It is however and easy way to "measure". But there are so many factors involved. Like your fitness level, your body fat percentage, your muscle mass, your general health, your attitude and mindset and last but not least your environment.

I have been told by a close family friend who's an anaesthetist to try and avoid an epi if at all possible because you can twist it however much you want: no epi means less risk than having an epi. It's a simple fact. Epis reduce pain, not risk.

I am obese judging by the BMI and I was when I fell pregnant with DD. I managed not to put on too much weight during my pregnancy and ended up having a beautiful complication free all natural water birth at a birth centre (link to birth story in my siggie, if you want to read it).
I was 85kg when falling pregnant the first time andgained around 12 kg during my pregnancy. I am 171cm tall.

Saša

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?!!!