ABSTRACT
Women with a high BMI in labour still need the routine care that any woman in labour requires. However, there are a few extra considerations:
Due to the greater risk, these women should give birth under consultant-led care.
Obesity itself is not an indication for induction of labour.
Early assessment by the anaesthetist and obstetrician (prior to labour preferably) is optimal.
If requested, the insertion of an epidural by a senior anaesthetist earlier in the labour is preferable. However, the benefits of encouraging mobility to promote normal labour and reduce the risks of thrombosis should also be considered.
Equipment, including beds and birthing balls, blood pressure cuffs, etc., should be capable of accommodating the woman's weight.
One-to-one continuous care is vital.
Manual handling and health and safety issues must be considered. Use elastic support stockings if mobility is restricted.
Venous access if BMI is over 40.
Active management of the third stage is advocated.
Continuous monitoring may be required but can be difficult; there may be a case for the use of a fetal scalp electrode (FSE).
Remember: Women with a high BMI may have been on heparin during the antenatal period and so are at a higher risk of haemorrhage.
There is an increased risk of shoulder dystocia, so consider adopting alternative positions for the birth where possible (CMACE/RCOG 2010; Rees et al. 2008).
