Wednesday, August 13, 2008

Obesity and Waterbirth: A Match Made in Heaven?

When I first started this blog (before I enabled comments), I got emails with questions on various plus-sized pregnancy and parenting topics. I will try to respond to them periodically as I have time.

First up is whether waterbirth is contraindicated in obese women. One woman wrote:
I have recently discovered that there are some care providers that are telling women that if their BMI is too high that they risk out of having a waterbirth.

This is not the first time I have encountered this question. I have heard similar questions from others over the years, wanting to know if waterbirth is okay in women of size, whether waterbirth was restricted from women of size across the board in all facilities, or whether there was real research justifying weight-based restrictions in waterbirth.

The answer is a little complex and will take me several blog entries to adequately answer.

But yes, there are some birthplaces where women of size are risked out of waterbirth (or even laboring in water) entirely. However, this is not an across-the-board policy. Policies vary greatly from facility to facility.

In many birthplaces, women of size are "permitted" to labor in water, and in some they can actually push the baby out in water too. In fact, many women of size have given birth in water just fine. You'll find many such waterbirth stories on my
website in the BBW Birth Stories FAQs.

Are these restrictions against waterbirth in women of size justified? In my opinion, no, they are not. Barbara Harper, a leading waterbirth expert, also agrees. More on that in a future post.
In fact, for a variety of reasons, many people feel that waterbirth is the perfect choice for women of size. I agree wholeheartedly. Frankly, waterbirth is uniquely well-suited to women of size, as well as being one of the COOLEST experiences ever. I would urge women of size to explore the possibility and consider it for their own labors whenever appropriate.

Disclaimer: Of course, I have to admit I am biased in the matter. I labored in water for 3 of my 4 births (including one hospital labor), and my last child was actually born into the water. My waterbirth was by far my best birth, and I found being in the water TREMENDOUSLY helpful. I have heard from many other fat women who feel similarly about their waterbirths.

So I am a INCREDIBLE fan of waterbirth, particularly for women of size. But even had I not had personal experience with it, waterbirth makes simple common sense for healthy women of size. Restricting access by BMI is an incredibly short-sighted rule on the part of hospitals and birthing centers, and it needs to be changed.

Rest assured, if you are interested in waterbirth, there ARE birthplaces where fat women can labor (and birth) in water, if they choose to.....including hospitals, birth centers, and of course at home. But you have to choose your place of birth carefully and ask a lot of questions if you want the waterbirth option.

I look forward to the day when waterbirth is universally available to all women, regardless of size.

P.S. The photo above is of labor in water in a "morbidly obese" woman, just before crowning (just before the head appears). The baby was born safely into water shortly after this picture was taken.

Coming Soon: Why Waterbirth Is So Great For Fat Women


Iwanttodeletemyblog said...

Wait.. that is a picture BEFORE the head comes out? That isn't a head at the bottom? I thought it was already halfway out!

Anonymous said...

Just to back up the whole "not universally risked out". I currently weight 433lbs pregnant with my third child. With my second, at 410lbs I was offered and would have gotten into the tub had I not had a horrible cough/cold and just wanted a tiny bit of stadol and some cough syrup to get some sleep.

My provider is a midwife who deliver in a hospital. They are very progressive and understanding and open to a mother's needs/wants.

Anonymous said...

2 water labors here, one of those was actually a water birth. And definitely the way to go! I am convinced that my water-born baby would have ended up being born via c-section if we hadn't been in the water--it was the only way I would have been able to move into the positions I needed to be in so that she could come out.

Well-Rounded Mama said...

Christa, yup, that IS a picture of just before the head comes out.

Just before a baby crowns, the head tends to distend the vulva and perineum. So in effect, you ARE seeing the head, but simply through the mother's tissues. Sometimes the effect is more pronounced than others, sometimes it happens so quickly you don't really notice it. It's all variable.

The photographer did not get a shot of the baby actually coming out in this birth. She got it JUST beforehand instead. Not always easy to time your photos perfectly in birth! But still, it's a good waterbirth photo.

Nic, I think it's FABULOUS that you have such supportive providers. I'm glad you have the option of laboring in the tub and that your hospital does not employ BMI restrictions, as so many do.

I hope you will take a moment to submit your birth stories to my website. Although I have a few birth stories of women around 400 lbs., I don't have many, and a lot of these women would love to see more stories of women of their own size giving birth too. I know it's a request I get frequently through my website.

There is a form you have to fill out to use with the story. Check the BBW Birth Stories Submissions FAQ on my site,, for more info. It does take a while for the story to appear on the site, but it does eventually get there and I'd love to see your stories there too!

Anonymous, glad to hear from another mom who had a waterbirth. I agree; birthing in water helps you be SO much more mobile and responsive to the baby's positioning needs in order to negotiate its way out. My next entry in this waterbirth series covers exactly that topic. Thanks for sharing!

Anonymous said...

So what justifications do care providers actually give for risking out fat women for waterbirth?

Well-Rounded Mama said...

Linda, that's a coming-soon entry in my series on waterbirth. Rather than having one gigantic long entry, I broke it up into smaller posts.

Check out the next two posts in the series for more information!

Breana said...

Thank you so much! I was so worried I wouldn't be able to water-birth before I read your blog. I was crying after reading all those obesity is bad for pregnancy articles. I weigh 276lbs. Then I cried with relief after reading your blog. Thank you so much!