What happens if I’m overweight during labour and birth?

Being overweight while pregnant means you have some additional challenges, over and above the usual excitement of looking forward to your new baby. There are some extra things for you and your health team to consider, as you prepare for birth.

Being overweight (BMI 25.0 to 29.9kg/m2) or obese (BMI over 30kg/m2) means that you may experience a longer first stage of labour. But a high BMI will not impact the length of your second stage of labour (giving birth). Being overweight while pregnant increases the chance of complications or needing a medical intervention during the birth.

Where can I have my baby?

Not every hospital can cater to the needs of an obese woman in labour. Hospitals have different ‘levels’, which determine what level of care they can give. Overweight women can go to hospitals that are level 3 and above when in labour, and obese women can go to level 4 and above. This is because an overweight or obese woman may need specialist care or equipment (for example, hoists or limb lifters). They also may need anaesthetists or surgeons familiar with the potential medical complications that can occur during labour.

Generally, home births are not recommended for obese pregnant women, due to the potentially complex medical situations that can arise. But it is important that you speak to your doctor or midwife before deciding where you want to give birth.

What complications or interventions might happen?

If you have obesity, there are complications and interventions that your health team will watch out for while you are giving birth, including:

• Shoulder dystocia — this occurs during birth when the baby’s head passes through the birth canal but one shoulder gets stuck behind the mother’s pelvic bone. When a woman with obesity has a large baby, there is more chance the baby’s shoulder will get caught. If this happens, the doctors and midwives will help the mother position herself better to push the baby out.
• Heavy bleeding (primary postpartum haemorrhage — PPH) — losing 500ml or more of blood in the first 24 hours after the birth. There is a higher risk of PPH among women with obesity. This is sometimes caused by shoulder dystocia.
• Induced labour — this is when your labour is induced by using medicine. Obesity is a risk factor that increases the likelihood your labour will be induced.
• Birth interventions — medical techniques to help during the birth, such as caesarean sections and vacuum birth, are more likely to be needed for women with a high BMI.
• Anaesthetic complications — women with obesity are more likely to have complications associated with epidural pain relief during labour, and difficulty with intubation (a preparation for general anaesthetic).

Are there any extra concerns for the baby?

Babies born to mothers with a high BMI are more likely to have a birthweight of 4kg or more. These babies also have a higher chance of diabetes or becoming obese themselves as they get older. There are things you can do to protect your child from becoming overweight — speak with your doctor or dietitian.

Babies born to mothers with obesity may have low blood sugar levels. They tend to have lower Apgar scores (a measure of newborn health). They are also more likely to need some time in the neonatal intensive care unit (NICU).

Women with obesity may also have difficulty breastfeeding their babies. You may find that positioning your baby and latching on to the breast may be more difficult. But there are strategies that can help you breastfeed. These include using nipple shields, and carefully positioning extra pillows or other supports.

If you are having difficulty initiating breastfeeding, ask your midwife to refer you to a lactation consultant to get the breastfeeding support you need.

For breastfeeding help, you can also call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse.

What precautions may your doctor/midwife take during labour?

Your doctor or midwife will monitor your baby to make sure that they are doing well.

Your doctor or midwife may check your baby’s position during labour by ultrasound, or they may prefer to use continuous monitoring. Sometimes, it can be difficult for the doctor or midwife to monitor the heart rate of the baby of a woman who is very overweight. If this is the case, your doctor may monitor your baby’s heart rate internally, rather than externally.

An external check involves placing a device on your abdomen. Internal monitoring involves placing a device through your vagina and directly onto your baby’s skin. Monitoring is safe and will not harm your baby.

What can I do to prepare for my baby’s birth?

If you are overweight or obese and are pregnant, it is important to keep a healthy lifestyle. Try to eat healthily, including a balanced diet of many vegetables, some grains, meats and dairy. Eat junk food only occasionally. It is also important to keep moving by exercising frequently. Speak to your doctor or dietitian before making any lifestyle changes.

While it can be very challenging to change old habits, any improvement can help you have a more comfortable pregnancy and easier birth. This will also improve the your baby’s health.

It’s also important to feel psychologically well in the lead-up to birth. Depression can lead to weight gain. Getting professional counselling can help guide you to your weight goal and improve your mental wellbeing.

Who can I speak to?

For more information and trusted guidance, speak to your:

• doctor
• obstetrician
• midwife
• dietitian

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