Thursday, August 4, 2011

Automatic Cesarean Section for Everyone with BMI Over 40?

People don't always fully believe it when I tell them about the tendency of many doctors to just schedule an automatic cesarean for "morbidly obese" women these days, but it's really true in some practices.

Of course, it's important to point out that not all care providers do that......but quite a few do, and more and more providers are starting to feel the pressure to do so.

Here's yet another example.

This is from My OB Said What?!?, in the comments section of the entry, "Because of Your Weight, We'll Just Schedule Your Cesarean."
When an anonymous survey was conducted, 100% of the OBs at this hospital (yes, every last blinkin’ one of them) admitted that they would schedule a c-section automatically if a woman’s BMI was over 30 and there were any other risk factors, or BMI over 40 with no other problems!!!
As a woman with a BMI over 40, I find this trend offensive and troubling in the extreme.  I know it's not routine everywhere, but this is becoming the "standard of care" in many places, and woe to the caregiver who doesn't do it, or who dares to try and support one of these women for a natural birth. 

I'm hearing now about care providers who are being hassled for daring to attend "morbidly obese" women at all (instead of sending them to the high-risk Bariatric Obstetrics practices), or even for not automatically sectioning those they do see.  Really.

I know there are still good doctors and midwives out there who don't practice this way (and thank goodness for them!), but the birth politics around obesity in some areas are becoming so extreme that even the good care providers are feeling pressure to not attend women of size for normal birth. 

This is a very ominous and deeply troubling trend.   If this trend becomes firmly established as the "standard of care," it will be very difficult for the good providers to fight against it because it opens them up to increased legal vulnerability. 

If that happens, heaven help women of size.

Where is the outcry against such things?  Where are the birth professionals willing to stand up for women of size and speak out against this?   How can we reverse this trend?


Janie said...

this breaks my heart. all these beautiful fat women being cut open, feeling once again that their body is a failure (when its NOT) and missing out on what could be the most empowering experience of THEIR ENTIRE LIFE!

Janie said...

and hasn't BMI been debunked over and over as an indication of health anyway?

Lillian said...

As someone that had a very successful VBAC, this tread alarms me. I had my second baby on his due date with less than 3 hours of labor. Today, I would have only been able to have that baby naturally because he was born in less than 45 minutes after I arrived at the hospital.

Bethany B said...

As a woman with a BMI over 40, who has had several c-sections and a few vaginal births, I can honestly say that C-sections are SO MUCH harder for a woman of size.

The size complicates all aspects of surgery, from sedation to being moved from the operating table to the gurney. These surgeries are truly humiliating for women of size. I'm just sick that this could be considered the standard of care.

Anonymous said...

First of all, by speaking out, speaking out, speaking OUT. I have been "morbidly obese" for most of my life and I had three babies at home. Yes, at home, in my own bed. My longest labor was just over 12 hours. I am not Superwoman; I'm not even particularly athletic. (For people who may not know this already, FAT AND ATHLETIC ARE NOT ANTONYMS.) And I did it. I was flying so high after the first birth that I said I wanted to do it again before my daughter was entirely de-gooped. My husband called me a goddess of birth. It was hard, it hurt, but my body is made for having babies! Even though I don't look like the women in the textbooks!

Here is an interesting note: I didn't know I was pregnant with the first one until I was 16 weeks along. I was exercising at Curves most mornings. They had a little doohickey you held on to that was supposed to send a mild charge through your body and display your body fat percentage. Mine kept going up and I could't figure out why; I was doing Weight Watchers at the same time, losing weight (the baby was fine, don't worry!), growing muscle, etc.

My bad, wicked, evil body fat of laziness and stupidity and needing an OB to save me from myself was the baby.

Jenny Islander

Megs said...

I have a BMI of 42. I have birthed 4 children vaginally, including breech twins. I cannot imagine how different I would be as a person if I hadn't been "allowed" to have those births. Each one was an empowering experience, a learning experience, each had their own contributing to my growth. To miss out on all that because of a few rolls of fat and some numbers?? Hell no!

convertedcatlady said...

This idea terrifies me. I can't believe that people are so biased that they would actually put a mother in more risk by exposing her to a dangerous surgery just because of size.

Anonymous said...

Eeek! This is really horrifying! c-sections are one of my biggest fears. I've had two very healthy, uncomplicated, vaginal births, despite weighing about 400lbs. We do plan on having another child, or two, later on. I can't imagine being told I had no choice but to have a c-section.

Janeen said...

I left a hospital I went to for my VBAC because I was told that due to my BMI, I would have to have a cesarean automatically. They're concern, that with all of the fat on my stomach, if they had to go in to save the baby, the extra five minutes it would take to get in there would surely mean her death and I wouldn't want that, now would I? I canceled the rest of my appointments with that OB and went to another hospital. Now, by this time, I was past 33 weeks. I had been in South Korea until almost 30 weeks. So, we didn't have much time left and the second OB, while he would have recommended a repeat cesarean, at least figured that if he did NOT give me a chance to have a vaginal birth, I would just hire a midwife and have a homebirth and he felt that was even more dangerous. What he didn't know was that yup, that's exactly what I would have done and I even had actually hired the midwife later on as a monatrice.

It's sad but the treatment of fat/obese women is only getting worse, NOT better. My mother I don't think EVER got any mistreatment for being an obese woman and being pregnant and her BMI was probably close to 50, like mine. She was obese when she had both my sister and I. And they were both vaginal births in a small hospital in a rural town. Never once did I hear her tell me anything about any negative treatment she went through during her pregnancies due to size. She did mention she had lost weight with one of us and she mentioned that one of us was such a massive kicker that a plate she had on her stomach was knocked off but that's the extent of it. I was born weighing 8 lbs, 15 oz and my younger sister was born weighing I think 8 lbs, 2 oz.

What I find really sad is that there are those who villianize obese mothers, even those in the natural birthing communities. I saw this shortly after I became pregnant with my younger daughter and it hurt greatly. The comments that followed an FB posting of an article on how obese women in the UK were not allowed to have midwives but had to be sent to an OB instead were absolutely horrible. If it wasn't for this site, I don't know what I would have done.

Karla said...

As a Big Mama, I am so incredibly thankful for my OB. My son was supposed to be a repeat C-section (3rd baby), but ended up being a surprise VBAC. My entire labor and delivery was 3 hours, and my doctor told me it would be faster and easier to just push my son out. Our area does not technically allow VBACs, but upon learning I was pregnant this time, my doc said "We have to schedule you for a C-section, but I won't be mad at you if you say 'no' to one." He basically said he would support me if I chose to VBAC, and he has said this twice now. Not once has anyone said anything to me about my weight (5'4", 286lbs). Here's hoping for a repeat of last time!!

Zion Lights said...

Being over a certain weight is not the same as being unhealthy. Afrucan women tend to be bigger, and yet they manage with little intervention!
Great post.