Purpose for the program:

Across the country, Body Mass Index (BMI) has been increasing at epidemic proportions in the United States and internationally, with no states reaching the Healthy People 2010 obesity goal of 15% or lower.  This same trend holds true in women of child-bearing age; among women age 20-44, 24.5% are overweight, 12.7% are obese (BMI 30-34.9%), and 10.3% are severely or morbidly obese (BMI above 35%), with the highest rate among non-Hispanic black women.  Obesity places women of child bearing age and pregnant women at increased risk for diabetes, hypertension, sleep apnea, arthritis, chronic back pain, coronary heart disease, infertility and depression.  Additional intrapartum and postpartum risks include increased need for cesarean section, gestational diabetes,  preeclampsia, eclampsia, HELLP, prolonged labor, dystocia of labor, inadequate pain control, thromboembolic event, hemorrhage, bowel obstruction, wound infections, seizures or stroke, and pneumonia. 

Proposed change:

In an effort to appropriately care for pregnant women with higher BMIs, our institution initiated an evidence-based systematized approach to care. 

Implementation, outcomes and evaluation:

Key elements of the evidence-based approach include a review of standards of care, a literature search in CINAHL and MEDLINE, attendance at the national AWHONN conference, and a multidisciplinary team assessment of internal resources.  As a result, a process guideline was developed and is being implemented.  The guideline includes definitions, quality and safety standards, risk considerations, equipment and supply needs, clinical considerations, and psychosocial considerations.  The guidelines are expected to enhance the care team’s ability to provide safe, effective, and efficient care to pregnant women with higher BMI.  Data collection and outcomes evaluation is ongoing with changes being made as relevant.

Implications for nursing practice: Includes evidence based systematized approach to care for patients with higher BMI during the antepartum, intrapartum, postpartum and recovery continuum.  Also the utilization of the multidisciplinary team to provide safe, effective, and efficient care to pregnant women presenting in Labor and Delivery with a higher BMI.

Keywords: Bariatric; Class 1 Obesity/Obese; Class 11 Obesity/Severe Obesity; Class 111 Obesity/Morbid Obesity; Body Mass Index; Process Guidelines