Management of Labor and Delivery to Reduce Risk for Cesarean Birth in Women with Obesity

Purpose of reviewThis review provides readers with current management guidelines for labor and birth for individuals with obesity and includes a summary of methods for lowering the risk for cesarean birth. The goal of this review was to examine the evidence for women with obesity having uncomplicated labor courses and to apply the concept of metabolically healthy obesity to cesarean birth reduction.Recent findingsOne-fifth to one-third of those in labor will have a pregnancy complicated by obesity. A variety of adipokines produced in excess adipose tissue counteract the normal physiology of labor and increase systemic inflammation. Those with obesity but without co-morbid diseases such as diabetes and hypertension have high rates of uncomplicated pregnancy and birth and lower cesarean section rates, particularly if they are younger and multiparous.Optimal labor outcomes begin during antenatal care with guidance in appropriate weight gain and regular physical activity. Antenatal education tailored to the obesity class and metabolic health of the client should prepare those at risk for the possibility of early induction of labor, longer labors, and cesarean birth. Individuals with metabolically healthy obesity can safely give birth in low-risk units, particularly if multiparous. A team approach to cesarean reduction is needed, with all providers understanding physiologic support of birth including admission in active labor, physical activity during labor, intermittent auscultation, and patience with the length of labor. Those with obesity deserve labor and birth management that begins with a wholistic health assessment followed by a thoughtful application of national guidelines to reduce risks for cesarean birth while preserving optimal perinatal outcomes.

Automated summary

This review provides management guidelines for labor and birth for individuals with obesity and emphasizes methods for reducing cesarean birth risk. Research shows that a significant percentage of people in labor have obesity-related complications, which can be attributed to excessive adipose tissue producing adipokines that disrupt normal labor physiology and increase inflammation. However, individuals with obesity but without other comorbidities have high rates of uncomplicated pregnancies and lower cesarean section rates, especially if they are younger and have had previous children.