The Big Picture | Fit Pregnancy

The Big Picture

How Obesity Impacts Health Care

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There have been some really big changes in the land of obstetrics in the last decade and much of it comes from the fact that mothers and babies are getting bigger. A reader wrote in complaining that my blogs encouraging women to eat right, exercise and keep their weight under control were prejudiced against fat women. She said she gained 80 pounds with her pregnancy, was overweight to start with and still delivered a healthy, normal baby. I'm happy she had a positive experience. I'm sorry though that she'd interpret my advice for healthy diets and exercise as an insult or form of prejudice. That actually kind of breaks my heart. It's tough love time, ladies. This week is going to be one of my "Tell it like it is" blogs because its time we got a handle on all the ways obesity impacts pregnancy. Honey, it's not all about you.

A study came out in April's New England Journal of Medicine connecting obesity with increased need for medical care in pregnancy. Turns out, just as we suspected, obese women have a tougher time of it when pregnant than those who maintain a normal weight. Their hearts work overtime pumping blood to a big body and a growing baby, thus driving their blood pressure up. Their blood sugar goes haywire and they develop gestational diabetes and Grande-sized babies who also tend to have blood sugar and respiratory problems. They have more C-sections, require more specialists, have more premature babies who need more intensive care and have a tougher time healing from their deliveries. These poor women have a lot of extra physical and emotional stress to deal with in addition to the normal stresses every pregnant woman experiences. That's no way to start the already tough job of mothering. Honey, you need a break, not more burdens.

This trend of obesity affects more than just the pregnant woman and her baby. Far more health care dollars are spent on obese pregnant women and their babies than non-obese, and that impacts insurance premiums and the price of prenatal care for one and all. Women with C-sections and complications stay in the hospital longer before and after delivery. The hospital does not necessarily make more money though, because payment for obstetric patients is generally a package price. They make the same amount if that patient stays seven days or three. That also means that hospital bed won't be available for other laboring women. Sometimes, they have to be diverted to other hospitals and use a doctor they don't know. That's a sorry situation all around.

It's tough on nurses too. We have a very physical job: lifting, pushing, massaging, repositioning and anything else it takes to help a laboring woman get the job done. Ten years ago, women didn't weigh as much as they do now. The leg we'd hold for hours while mom pushed didn't weigh as much. The gurney we'd pull to the operating room for an emergency c-section was a lot easier to run with. If our patient can't turn herself because of an epidural, we do it for her. It's a lot easier to turn a 180-pound woman than a 250-pound woman. We get frustrated at how often obese women end up with C-sections because they have a harder time pushing babies out. To put it as kindly as I can, there's extra weight "down there" too and too often babies get stuck. We're sad that our bigger mothers have to spend so much more time in the hospital because of all the complications. It breaks our hearts when a mother who's had a difficult C-section and delivered a baby who can't keep his blood sugar stable (thanks to gestational diabetes) have to be separated—Mom in a recovery bed and baby in the NICU. The worst thing is how common these situations are. A whole lot of our patients are overweight and hospitals are now coming up with adaptive measures to deal with this as the new normal.

My advice to keep healthy while pregnant isn't because I'm prejudiced against fat women. I've been struggling with the same stubborn 15 pounds forever. I had a tough time keeping my weight down during my own pregnancies and was a little heavier starting out with each one. I get it. It's really hard to eat right and get enough exercise these days. And still...if you want a healthy pregnancy, safe childbirth and a normal, healthy baby—you have to do the best you can.

Remember, your child will learn from you. If you teach your child there's no time to shop, cook and eat a healthy dinner, he'll learn that healthy eating isn't important. If you don't make exercise part of your lifestyle, your child won't either. Then your child will join the ranks of the heaviest generation of children the world has ever seen. This week, the American Pediatric Association announced new guidelines for cholesterol screening of at-risk children starting at age 8 because so many obese children are developing heart disease —the #1 killer in America.

I want you to stay healthy, have an easy delivery and teach your children that your health is what you make it. If my blogs touch a nerve, I suspect it's because you know, deep down, you could do better. I know it's hard. Motherhood isn't for wimps. Every day is a new chance to do the right thing, eat the right foods and get enough exercise. If you're starting out heavier than you'd like, talk to your midwife or doctor about it. Believe me, they're not going to judge you. They'll admire your honesty, your desire to make important and healthy choices and they'll be your ally. Now, go do your best. I'm done scolding.

Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.

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