Plus Size Birth: Nursing
Considerations& Implications
J E N M C L E L L A N
OverviewWhat It's Like To Be Plus Size &
Pregnant
Address Your Personal Bias
Size-Friendly Care Providers
Larger Equipment
Labor
Birth
Postpartum
WhatIt's Like To
Be Plus Size&
Pregnant
“In agreement with most other studies, no significant increase in cesarean
sections or operative forceps delivery was noted in [the obese group]”
1978
TodayBMI > 35 = 47.4% Cesarean Birth
BMI > 50 = 80% Cesarean Birth
American Journal of Obstetrics and Gynecology, 1978
The Institute of Medicine, 2009
Planned Vaginal Delivery or Planned Cesarean Delivery in Women with Extreme Obesity, 2011
Physicians Build Less Rapport with Obese Patients, Obesity Research Journal, 2013
Perceived Weight Discrimination and Obesity, Angelina R. Sutin, Antonio Terracciano, 2013
Step Into Our Shoes...M Y L A S T P R E G N A N C Y , I W A S T O L D T H I N G S L I K E -
S O W H E N D O Y O U W A N T T O S C H E D U L E Y O U R C - S E C T I O N F O R ?
I D O N ' T D E L I V E R V A G I N A L L Y F O R F A T W O M E N S U C C E S S F U L L Y E V E R ,
S O L E T ' S J U S T G E T I T O U T O F T H E W A Y A N D S C H E D U L E N O W .
A T E V E R Y A P P O I N T M E N T , I W A S C H E C K E D F O R O N E - H O U R G L U C O S E
T E S T , E V E N T H O U G H E V E R Y T I M E I T C A M E B A C K G R E A T .
High Risk Assumptions
M Y C A R E P R O V I D E R A C T U A L L Y S A I D - Y O U R B O D Y I S N ' T T H E O N L Y
T H I N G G E T T I N G F A T T E R . Y O U R V A G I N A I S G E T T I N G F A T , T O O .
A N D T H E R E W O N ' T B E R O O M T O P U S H O U T Y O U R B I G B A B Y ,
B E C A U S E F A T W O M E N H A V E B I G B A B I E S .
Fat Vagina Theory
O F T E N , I F E E L H E A L T H C A R E P R O V I D E R S " D O N ' T S E E " P L U S - S I Z E D
B O D I E S A S I N D I V I D U A L S A N D A R E J U S T F O C U S E D O N A N U M B E R O N T H E
S C A L E .
Focus Only On BMI
Video
Address Your Personal Bias1. Do I make assumptions based only on weight regarding aperson’s character, intelligence, professional success, healthstatus, or lifestyle behaviors? 2. Am I comfortable working with people of all shapes andsizes? 3. Am I sensitive to the needs and concerns of obeseindividuals?
Work On Your BiasYouTube Video: Weight Bias In Health Care Weight Bias and Discrimination: A Challenge for HealthcareProviders (obesityaction.org) Health At Every Size (haescommunity.com)
Frompreconception to
postpartum,women need
access to positiveand supportiveinformation to
promote healthydecision making.
Increased Risks
Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: apopulation-based study to inform prepregnancy weight loss counseling. Obstet Gynecol. 2015;125(1):133–143.
Flip the Script
1 5 % R I S K F O R G E S T A T I O N A L D I A B E T E S .
Gestational Diabetes
8 5 % C H A N C E Y O U W O N ' T D E V E L O P G E S T A T I O N A L D I A B E T E S !
L E T ' S T A L K A B O U T H O W T O B E P R O A C T I V E W I T H Y O U R H E A L T H .
Flip Gestational Diabetes
LanguageMatters
Patients don't like to be calledobese!Have realistic conversationsabout preconception weightloss.Address topics like weightgain during pregnancy, testing2x for Gestational Diabetes,and a difference in fundalheight measurements from aplace of compassion.
Empower women to be proactive with their health!
3 Keys For AHealthy Plus
Size PregnancyNutritionPhysical ActivitySize-Friendly HealthcareProvider
Size Friendly Care ProviderCompassionate
Aware of personal biases
Provides individualized care
No high risk classification based
only upon BMI
Doesn't make assumptions about
nutrition/physical activity
Treats patients with dignity
Larger EquipmentArmless Chairs
Blood Pressure Cuff
Urine Catch Basin
Speculum
Scale
Gown
FetalMonitoring
Washcloth/Baby Blanket
Belly Band
Positions
Folded Blanket
Wireless Monitoring
Intermittent Auscultation
LaborFetal Monitoring
Induction
Longer Labor
Labor Positions
- Exercise & Peanut Balls
Epidural
BirthBirth
- Labor Bed
- Hold Legs
C-Section
- Panniculus Retractor
- Wound Vacuum
- Longer Operating Time/Increased
Risks
- Emotional Obstacles
PostpartumFundal Massage
C-section Recovery Tips
- T-Shirt Strips
- Hairdryer (Cold)
Walking Support
Breastfeeding
- One day longer to reach full milk
supply
- Positioning
- Connect with an IBCLC
Postpartum Depression
We all wanthealthy moms
& healthybabies.
Let's worktogether!