The growing number of obese pregnant women in the U.S. may be contributing to a record-high number of cesarean section births, as well as more birth defects and maternal and infant deaths, the New York Times reports. According to the Centers for Disease Control and Prevention, about one in five women are considered obese — having a body mass index of at least 30 — at the start of their pregnancy. Women with a BMI of 35 of higher are considered very obese and are three to four times more likely to deliver their first infant via c-section than women of normal weight, according to a study by the National Institutes of Health’s Consortium on Safe Labor.
Data show that obese women are more likely to develop conditions like high blood pressure, diabetes, hemorrhage and blood clots during pregnancy and childbirth, according to the Times. Studies also have indicated infants born to obese women are nearly three times more likely to die within the first month than infants born to women of normal weight. Obese women also are nearly two times more likely to deliver a stillborn infant, the Times reports. According to the New York state-sponsored Safe Motherhood Initiative, two out of three maternal deaths in the state from 2003 to 2005 were associated with maternal obesity.
Howard Minkoff, chair of obstetrics at Brooklyn’s Maimonides Medical Center, said that doctors must weigh concerns surrounding c-sections — which have risks similar to surgery — against the risks of vaginal delivery in obese women, which can include difficulty monitoring fetal distress and failure to progress during labor.
As the nation’s obesity rate continues to grow, hospitals “have been forced to adjust” to accommodate the needs of obese pregnant women, the Times reports. Medical facilities are purchasing more sophisticated fetal testing equipment, longer surgical instruments and larger beds. They are also counseling women about losing weight or undergoing bariatric surgery before becoming pregnant, as well as conducting sensitivity training for hospital staff members.
The issue has become “so acute” in New York City that five hospitals — Beth Israel Medical Center, Mount Sinai Medical Center, Maimonides, Montefiore Medical Center and Bronx-Lebanon Hospital Center — have teamed up to determine how best to approach obesity during pregnancy, the Times reports. The consortium is funded by the United Hospital Fund and the hospitals’ malpractice insurer (Hartocollis, New York Times, 6/6).
Mass. Public Health Specialists Studying C-Section Rates at Area Hospitals
Meanwhile, public health specialists are studying disparities in c-section rates among Massachusetts hospitals, trying to determine why some areas have higher rates than others, the Boston Globe reports. The research so far shows that five community hospitals had the highest proportion of c-sections, with Holy Family Hospital having the highest rate at 47.4%. Five other community hospitals had the lowest rates, while teaching hospitals with high-level neonatal intensive care units had rates that were closer to the state average of 34.4%, the Globe reports.
Lauren Smith, medical director of the state Department of Public Health, said, “There are a complex array of factors that contribute in each individual case to whether or not a woman delivers vaginally or via cesarean.” She added that “some of those factors are at the hospital level, such as how do they organize the staffing of their labor and delivery units, what are the resources that might be available, … is it a teaching facility, are there residents or attending (physicians), how many delivery rooms or operating rooms do they have” (Cooney, Boston Globe, 6/7).
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