The Impact of Obesity on Both Sides of Maternal Healthcare

An opinion piece in the New York Times highlighted a serious maternal health topic we’ve covered before — obesity and its’ impact on maternal-fetal health. 
In this op-ed piece, Claire A. Putnam, MD a California OB-GYN, writes about her struggle to provide care for an increasingly overweight patient population. As Putnam said, “Obese pregnant patients are more likely to have elevated blood pressure, gestational diabetes and babies with birth complications. They are more likely to need cesareans… [and] have serious complications from the surgery, such as infections, hernias or life-threatening bleeding.” Putnam described taking care of a 24-year-old, 300-pound preeclamptic patient as her labor turned dangerous:

“She was having seizures from the swelling and elevated blood pressures. Her baby’s heart rate dropped from 100 beats per minute to 70 to 40, and then the signal was lost — the monitor had come off. As we worked to treat her seizure, we moved her to the operating room. We needed to sedate her, but struggled to find a vein. We needed to intubate her, but her airway was obstructed from the obesity and the swelling. Just moving her onto the operating table required an additional team: the table was too narrow and the straps too small.”

As I read Putnam’s piece, I remembered similar nights spent with obese patients during my own career as a labor and delivery nurse. Let me be clear, I don’t pass judgment on my heavier patients — heck, I (like 69% of Americans) carry some extra weight myself and know it impacts my health. During the years I worked one-on-one with patients of every body type I knew that many overweight patients were perfectly healthy, but many were not. Obesity is among the most significant contributors to poor maternal health here in the US. In addition to adding stress to a pregnant woman’s body, it deeply impacts healthcare providers’ ability to take care of patients in ways that support the best outcomes. I recalled many patients whom I couldn’t assess properly when fetal heart and contraction monitoring equipment couldn’t do its’ job because of a patient’s excess weight. I remembered all the patients with complicated vaginal deliveries, c-sections and recoveries who may not have suffered those complications had they been normal weight. And I remembered the obese patient whose inability to move herself ended my career as a hospital labor nurse.

She was young, no more than 20, but weighed over 350 pounds and her excess weight contributed to compounding complications and interventions. She’d developed gestational diabetes that required daily insulin injections and during labor she needed two IV sites — one for insulin and another for other medications. Her veins were impossible to visualize or feel through her skin (due to obesity) and starting her IVs required multiple needle pokes. Because of concerns about her diabetes’ impact on her baby, the patient was induced. With contractions more painful than she could manage, she requested an epidural. Because she was obese, the anesthetist had to make several attempts (requiring many extra needle pokes) before she was able to access the right area of her spine.

Once the epidural kicked in, the patient was numb, which meant when she needed to shift to a new position, she needed help to move. Working as a team with three other nurses, we grabbed the “draw sheet” placed under our patient to help with repositioning and, on the count of three, hoisted the mother up in bed. That’s when a sharp pain in my shoulder almost caused me to drop my patient.

It took months for my shoulder to recover and I never returned to the hospital to do patient care. This mother certainly wasn’t the first obese patient I’d taken care of and over the course of 20 years I’d watched our patient population became increasingly overweight. I’d left countless shifts with aches and pains caused by lifting, turning and supporting our heaviest patients and I know this trend is occurring on every maternity ward in the country. I also know that the toll of all this excess weight not only adversely impacts our patients’ bodies, but also the bodies of their healthcare providers.

The Centers for Disease Control (CDC) says:

• Rates of musculoskeletal injuries from overexertion in healthcare occupations are among the highest of all U.S. industries
• The overexertion injury rate for hospital workers is twice the [national] average (76 per 10,000)
• The single greatest risk factor for overexertion injuries in healthcare workers is manual lifting, moving and repositioning of patients
• Most manual patient lifting is performed by nurses and support staff

In addition, the CDC associates rising obesity rates and the physical demands it places on caregivers in an aging workforce (average age of U.S. registered nurses is 44 years) with our country’s serious nursing shortage, projected to reach 260,000 unfilled nursing positions by 2025.

Dozens of my colleagues have abandoned nursing careers under similar circumstances as my own or taken long medical leaves, had surgeries or suffered chronic pain as a result of the hard manual labor our jobs require. While some hospitals implement policies that make manual lifting safer, in most hospitals, nurses will continue to lift “old school.” Like me, when lifting my 350-pound patient, they’ll grab a few coworkers, take hold of the draw sheet and on a count of three, potentially end their careers.

Every Mother Counts is committed to improving the health of mothers in America and other parts of the world. In the next few months, we will continue to examine the many factors, including obesity, that place the US at 60th in the world in terms of maternal health outcomes.