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The United States has become the epicenter of an obesity pandemic. Research has shown that more than half of all women in the United Sates are overweight or obese.Not surprisingly, this epidemic spills into the pregnant population. The prevalence of obesity among pregnant women has more than doubled in the last twenty years. This dramatic increase makes obesity in pregnancy a public health issue because it contributes to many complications for mother and baby and often results in adverse pregnancy outcomes.  Complications experienced during the antepartum period are markedly increased when the laboring woman is obese. Many researchers feel obesity in pregnancy is the greatest future challenge facing perinatal maternity services today.

This program was implemented at a 316-bed community hospital centrally located in Southwestern Illinois. This acute care facility is one of three delivering hospitals in the county. It provides 26 obstetrical beds, 10 labor and delivery beds, and 20 nursery beds. Approximately 1600 deliveries occur annually. Concerns related to obesity in pregnancy within our hospital included a lack of education for obese pregnant patients.  The average BMI at our institution is between 62% and 70% based on one year of data collection.   The need to plan and implement special care during the prenatal and antepartum period with implementation of a new program for obese pregnant patients with a BMI over 30 was identified.        A task force was developed and literature review revealed very little on programs for obese pregnant patients but numerous studies specified the need for these programs. A guide developed by the task force was given to all patients with BMI over 30 at their first prenatal visit. This included risks of obesity, evidence based information on obesity in pregnancy and a BMI chart with recommended weight gain. It also listed the specific plan of care the patients would receive upon admission to labor and delivery. All patients were given a dietician referral. This education was standard protocol for all physicians practicing at this institution. Education for implementation was provided to the staff by the Obstetric Nurse Clinician.        

A standardized plan of care was implemented upon admission to labor and delivery on patients that met the BMI criteria. It included more inclusive lab tests, EKG, pulse oximetry during labor, more frequent vital signs, semi fowlers positioning at all times with patients never allowed on their backs.  An accurate weight was obtained upon admission so medications could be accurately calculated and appropriate equipment utilized. Patients received one-on-one nursing care when possible and two nurses were present for delivery.  Special scales and beds were purchased to accommodate excessive weight. Internal fetal scalp and uterine pressure monitoring was utilized when possible.  An anesthesia consultation was provided in labor to discuss risks of anesthesia for obese patients. All patients were placed on a 2000 calorie diet with dietician consultation after delivery.  Outcomes were evaluated through randomized retrospective chart review post delivery. The results are revealing a decrease in fetal distress, emergency cesarean section and an increase in Apgar scores.