Im actually a nursing student that is hoping to get into OB eventually, but I was wondering if your would share your opinions or experiences regarding a situation that is bothering me lately.
My friend has a 7 year old and a 9 month old, and is currently pregnant (due late november) with twins. Her first birth wasn't complicated although she had gestational diabetes. The second was concieved with medical assistance and the birth was also uncomplicated, and had no GD. She had epidurals with both and both were lady partsl deliveries.
The problem is that my friends weight has gone from just over 300#'s with the first baby to now just over 400#'s, and she is having a heck of a time finding a anesthesiologist that is comfortable giving her care. From what I understand, its risky for obese women to have any kind of anesthesia.
I feel so bad for her! Her OBGYN sent her 2 hours away to a bigger hospital today, and the doctor chose to tell her a story of a pt that DIED from complications. Isn't that heartbreaking?
I guess what Im wondering is what the normal procedure is for this scenario where you work? Since she has had 2 normal, lady partsl births wouldn't going drug free on a natural delivery be your best case scenario? I mean, I know they have to prepare for the worst by fiting her with specific equipment, but she said that nobody has even mentioned a natural birth to her..
Also, do you see this often where you work? Do you see complications often? Are the anesthesiologists attitudes regarding the saftey of obese pt's generally the same? Is an epidural less dangerous then full on anesthesia?
Thanks in advance for any help you can offer! I know this is my friend Im talking about, so its a bit personal, but I'm curious about this from a clinical standpoint as well. It concerns me that the population continues to gain weight (myself included) and that Dr's are feeling the heat from liability issues and could potentially refuse to treat.
One important reason the doctors are looking into anesthesia rather than a natural birth is that most twins end up being C/S. At our hospital, if they are planned to be lady partsl births, we deliver them in the OR because when the first delivers, the second often ends up turning and being breech or transverse. Breech can be delivered lady partslly, but most doctors feel it's safer to do a C/S. If transverse, they have no choice but to do a C/S, and it needs to be done quickly - not always time to start an epidural if it wasn't placed already.
On obese women it is harder to place an epidural - harder to feel the landmarks, more tissue to go through to get the correct space in the spine. It takes longer and there is more chance of ending up in the wrong place. Might not be able to get a good epidural in an emergency.
We had a 400+ pound woman deliver recently. She did very well, but she made the doctor nervous because of the risks. It is harder for obese women to deliver naturally because, as one nurse said, "if they're fluffy on the outside, they are also fluffy on the inside," making the delivery a bit rougher. Her doctor discussed all the risks of both and strongly encouraged a C/S, which is what she had. With twins, her doctor would have insisted on a C/S.
I'm sorry your friend has to go though stress to find good care during a time that should be exciting and happy. Hope she finds a skilled anesthesiologist and doctor who feel comfortable with her care.
Specializes in Nurse Leader specializing in Labor & Delivery.
harder for obese women to deliver naturally because, as one nurse said, "if they're fluffy on the outside, they are also fluffy on the inside," making the delivery a bit rougher.
Ugh. Please don't call obese patients "fluffy."
That said, that's totally true, about being obese on the inside, as well.
beachmom
220 Posts
One important reason the doctors are looking into anesthesia rather than a natural birth is that most twins end up being C/S. At our hospital, if they are planned to be lady partsl births, we deliver them in the OR because when the first delivers, the second often ends up turning and being breech or transverse. Breech can be delivered lady partslly, but most doctors feel it's safer to do a C/S. If transverse, they have no choice but to do a C/S, and it needs to be done quickly - not always time to start an epidural if it wasn't placed already.
On obese women it is harder to place an epidural - harder to feel the landmarks, more tissue to go through to get the correct space in the spine. It takes longer and there is more chance of ending up in the wrong place. Might not be able to get a good epidural in an emergency.
We had a 400+ pound woman deliver recently. She did very well, but she made the doctor nervous because of the risks. It is harder for obese women to deliver naturally because, as one nurse said, "if they're fluffy on the outside, they are also fluffy on the inside," making the delivery a bit rougher. Her doctor discussed all the risks of both and strongly encouraged a C/S, which is what she had. With twins, her doctor would have insisted on a C/S.
I'm sorry your friend has to go though stress to find good care during a time that should be exciting and happy. Hope she finds a skilled anesthesiologist and doctor who feel comfortable with her care.