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Massage Today
May, 2011, Vol. 11, Issue 05

Obesity and Childbirth

By Elaine Stillerman, LMT

It's a sad fact that Americans are growing fatter every year as obesity rates are increasing faster than originally estimated. I am not referring to a few extra pounds or the pleasantly plump silhouette, but rather the serious health risks involved in carrying excessive weight.

More than one in four Americans (72.5 million) were obese in 2009 and nine states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) reported 30 percent of their population was obese in 2009. In 2007, there were only three states that made that unfortunate claim. The highest rate was 34.4 percent in Mississippi. (Only Colorado and Washington, D.C. had obesity rates under 20 percent.)

The medical costs of obesity are estimated to be $150 billion a year. Obese people are more likely to die from heart disease, stroke, diabetes, and cancer than thinner people. The American Institute for Cancer Research projects there will be more than 103,000 cases of cancer caused by obesity in 2010. Forty-nine percent are expected to be endometrial cancer, 35 percent esophageal cancer, and 28 percent will develop pancreatic cancer. Nearly 112,000 deaths are caused by the complications of obesity every year.

The reason is simple enough: not enough exercise and too much of the wrong kinds of food. This epidemic is affecting our children too: one out of three children in the United States is now overweight or obese. This puts them at a higher risk for developing heart disease, diabetes, and cancer during their lifetimes. One-third of children born at the beginning of this millennium are expected to develop diabetes and the current generation is expected to have a shorter life span than their parents due to obesity rates. In addition, girls as young as seven or eight are developing breasts and reaching puberty much earlier, in part due to increasing rates of childhood obesity. I wrote for a PBS-TV show years back, and we did a segment on childhood obesity. I learned that for most six year olds in this country, the only 'vegetables' they ate were French fries.

And for pregnant women who are overweight or obese, the risks to them and their babies are of great concern. Obesity contributes to the increase in Cesarean section, more birth defects, and more maternal and neonatal deaths. Cesarean section rates increase tremendously the fatter the woman is. The National Institutes of Health reports that women with a 30-35 body mass index (with 20 BMI being the equivalent of a woman 5'6" weighing 124 lbs) have 25 percent more C-sections on average, 35-40 BMI equates to a 33 percent increase in C-sections, and over 40 BMI results in a 43 percent increase in surgical deliveries. (Body mass index is a calculation of body fat based upon an adult's height and weight. A BMI of less than 18.5 percent is considered underweight; 18.5-24.9 percent is considered average; 25-29.9 percent is considered overweight; an index of 30 percent or more is considered obese.)

In addition, obese women have few choices where or how to have their babies. For most, natural childbirth is not an option. Their heightened risk factors disqualify them from having home births or opting to have their babies in birthing centers. So a hospital birth is their only option. Hospitals have also had to adapt to the increase in maternal weight by purchasing longer surgical instruments, larger beds and gurneys, and increasingly more sophisticated fetal testing machines.

The birth experience for many of these women (and their babies) is far from ideal. Local anesthesia is difficult to administer because the additional bulk makes it nearly impossible to feel the spine and find the right place for an epidural, so general anesthesia has to be given. Doctors also find themselves in awkward, uncomfortable positions since they often have to stand on stools or platforms to reach over the patient's abdomen.

And the babies don't fare well. Babies of obese mothers are almost three times likely to die within the first month and obese women are almost twice as likely to have a stillbirth, which is the death of the baby after 20 weeks gestation. In New York State, between 2003-2005, 2 out of 3 maternal deaths were attributed to obesity.

Within New York City, a consortium of hospitals is considering creating specialized centers just for obese maternity cases. The maternity care the patients would receive would also include nutritional counseling and weight loss programs and would be staffed with sufficient medical personnel to handle emergency C-sections and intensive neonatal care. The cost of caring for these women and their babies can reach more than $200,000 as compared with $13,000 for a normal delivery.

From a massage point of view, these women are considered high risk for pregnancy and labor complications. And if they already have diabetes, signs of hypertension or blood clots, excessive swelling, thrombophlebitis, or cardiovascular disease, massage may have to be ruled out entirely.

Although the costs of obesity and its sequelae are staggering and add an unnecessary burden to health care costs, the bottom line isn't the bottom line. And it certainly isn't about fat-bashing. It's the health and survival of these women and their children that has to be of paramount concern. Making smart food choices and learning to eat nutritionally sound meals are small prices to pay for a long, happy, and healthy life with your child.

Resources

  1. Gardner A, "Study: US obesity rate will hit 42 percent", CNNHealth.com, November 4, 2010.
  2. Grady D, "First Signs of Puberty Seen in Younger Girls," The New York Times, August 9, 2010.
  3. Grady D, "Obesity Rates Keep Rising, Troubling Health Officials", The New York Times, August 4, 2010.
  4. Hagan C, "News From Center for Disease Control and Prevention", CNNHealth.com, August 5, 2010.
  5. Hartocollis A, "Growing Obesity Increases Perils of Childbearing", The New York Times, June 5, 2010.
  6. National Institutes of Health, "Health Weight, Healthy Child", NIH Medline Plus, Spring/Summer, 2010.
  7. Stillerman E, Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork, St. Louis, Mosby, 2008.

Click here for previous articles by Elaine Stillerman, LMT.

 

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