plus size birth: nursing considerations & implications · nursing considerations &...

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!