obesity and bpi

[mel1972]

I've heard about a new study showing that maternal obesity and the child's weight are the main factors behind BPI. According to this article the increase in obesity in the western societies (specially refering to the US and fast food, etc.) has brought a general increase in the number of BPI injuries worlwide. I'm actually overweight myself: 123 and should be 114, but it's not considered obesity. My baby was also born very big, 9 pounds.

[Kath]

I was never over weight and had small weight gains... I had three large babies... and I was smoking...
OK don't beat me I was encouraged to smoke because my three children were so large and my weight gains small. When they were born they believed the placenta was a filter... It was old school stuff.
I had two SD deliveries... I am OBPI and was 11 lb. 14 oz... my last baby was 9 lb. and I only gained 17 lbs... I was under weight after the birth of two of my children...

My friends who did not smoke gained 30/40 lbs and had small babies.
Kath

[katep]

Some of the latest stuff has suggested that SD is not directly a result of size, but more a result of shoulder-to-head-size ratio. Typically, the shoulder/chest girth is smaller than the head girth (because the shoulders can partially collapse). Head size is not sensitive to insulin and blood sugar levels, the shoulders are. So moms with high blood sugar (diabetes or gestational diabetes) tend to have babies with proportionally bigger shoulders than head. So instead of the head dilating through the birth canal and the shoulders following easily behind them, the shoulders are more likely to be tight in the canal, too. The shoulders need to rotate and maneuver in order to not get stuck, so large shoulders are a risk for SD. Also, the head doesn't grow as much as the shoulders in the final weeks of pregnancy, so post-dates are a risk for the same reason.

I only gained 19lbs with 9lb 14oz Joshua. BUT I also had nearly all my midwife appointments first thing in the morning (before work) and I typically don't eat breakfast. So all my blood sugar tests were essentially fasting blood sugar. If I manage to get pregnant again, I'm going to go ahead and get a digital blood sugar meter and test throughout the day.

Kate

[Tanya in NY]

Blood sugar levels when tested in pregnancy should be done when fasting and doing the 1 hour glucola test. This is accurate then. If you fail the 1 hour glucola, then you should do a 3 hour glucola test which is also fasting. If you fail the 3 hour glucola test, then you have gestational diabetes. If your provider was only testing your glucose as a random check in the office, then this is lack of care. If you have a questionable 3 hour glucola, then I suggest a repeat one at around 32 weeks of gestation (usually it's done at about 28 weeks).

Being obese has been listed as a risk factor for BPI (it's even listed on the ubpn website under the prevention program and causation). It is a risk FACTOR though, not the only one though. When you are obese, it is typically more difficult to estimate the fetal weight and to have an accurate ultrasound for fetal weight. Keep in mind that the Leopold's manuever done by your provider to estimate the fetal weight is just an estimate...it is only as good as the provider's experience. Same with the ultrasound as an ultrasound can be 1-2 lbs. off either underestimating or overestimating the baby's weight. Some technicians and providers are better at it than others, but it is truly more difficult to estimate weight if the mother is obese. This is just a fact. I know this as it was difficult to estimate both my children's weight and I was obese, along with I am a labor and delivery nurse and see this phenomenon happen often. But, that said, there are still women who are average or underweight who have baby's that are big, average, and small.

The blame for a BPI truly falls on the shoulders of the provider who caused the injury I believe. There are risk factors, but this is the job of the provider to look for these risk factors and do everything possible to elimate or decrease these factors. It is also their job to get women off their back when delivering. I delivered my 9lb.12oz. son with a shoulder dystocia that was readily relieved and no injury, but my daughter with ROBPI was only 8lb.3oz. and she suffers the consequences of the midwife pulling in a panic instead of using proper manuevers to relieve this dystocia.

I'm sorry, I feel like I'm rambling. Please forgive me. I just felt compelled to write what I've seen in my experiences as a L&D nurse and Mom.

Tanya in NY

[admin]

personally, I think it is a bunch of garbage and another way for the dr's and insurance companies to continue to try put the blame on the mother rather than on the practioner.