Abstract

Existing literature has established that laboring people with obesity have poorer intrapartum outcomes compared to their lower weight counterparts, including elevated c-section rates which increase with increasing BMI. People with obesity are at increased risk for complications related to surgical birth so optimizing chances for vaginal delivery is of utmost importance yet professional guidelines about labor management are lacking. Research has established that people with obesity have longer times in labor especially early labor, need more labor stimulating medications and have physiologic changes that alter the labor process compared to lower weight people. Literature on the impact of midwifery care on this population is lacking. This study compared intrapartum outcomes for primiparous patients with obesity among three provider groups: Nurse Midwives (CNM), OB/GYNs (OB) and Family Practice physicians (FP) practicing at one medium-volume hospital in the American southwest. Induction rates, cesarean outcomes and time in stages of labor were examined. There were no significant differences in cesarean rates although midwives had a lower cesarean rate (20%) compared to OBs (30%) and induced fewer patients (52% vs 75%). In OB patients, there was a significant (p=0.003) association between induction of labor and cesarean delivery while outcomes were equivalent for CNM patients. Labor times were not significantly different. In CNM patients, the mean rate of physiologic interventions was the same (2.5 interventions) between those experiencing vaginal and cesarean delivery. This study highlights the importance of reducing non-medically indicated induction of labor in people with obesity, demonstrates potential contributions of the midwifery model of care in this population, while highlighting the need to increase support of physiologic labor across all provider groups.

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Level of Degree

Doctoral

First Committee Member

Dr. Noelle Borders

Keywords

obesity, labor, midwife, BMI, pregnancy

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