The majority of people with a high BMI will have a straightforward delivery, however if your BMI is more than 25 then you and your baby are at a higher risk of complications including:
Anaesthetists are specialist doctors responsible for providing anaesthesia and pain management. They make sure that you are pain free and comfortable.
On the labour ward anaesthetists are responsible for providing some forms of pain relief during labour, including epidurals. Anaesthetists also provide “the anaesthetic” during surgical procedures, such as Caesarean sections, deliveries in theatre and procedures when there is ongoing bleeding or damage after you have delivered your baby. The main types of anaesthetic are discussed later in this leaflet and include epidurals, spinal anaesthetics, and general anaesthetics. Roughly 60% of women who come to the labour ward will have an interaction with an anaesthetist. An anaesthetist is present on the labour ward at all times.
You may be offered an appointment to see an anaesthetist before going into labour to discuss options to minimise your risks. This is particularly true if your BMI is more than 40.
If you have a high BMI you may want to speak to the anaesthetist when you arrive on the labour ward about your options for pain relief and any concerns you have. Please let your midwife know and the anaesthetist will speak to you as soon as they can. Sometimes there will be a delay if the anaesthetist is busy in theatre. The anaesthetic team is here to help keep you safe and we are always happy to answer any questions you have.
Anaesthetists are there to help facilitate the safe delivery of your baby. Everyone is entitled to all forms of pain relief and we will modify our anaesthetic plan to maximise the safety for you and your baby.
An epidural is a procedure where an anaesthetist inserts a thin plastic tube between the bones of your back so that the nerves that supply the womb, cervix and vagina can be blocked by an infusion of painkillers. An epidural is the most effective form of pain relief that we have during labour. Epidurals are safe, but do have some risks. These are explained at: Epidural advice and information - Labour Pains. You will have the opportunity to discuss an epidural with the anaesthetist before it is inserted.
Having a high BMI can mean that it takes longer time to put in and get an epidural working effectively. One way to help make the insertion more straightforward is to have an epidural placed early on in labour, when you are more relaxed and your contractions are not as strong.
An anaesthetist may examine your back in clinic or in the early stages of labour to assess how difficult an epidural might be. Sometimes we will use ultrasound to help find the correct space in your back. If an anaesthetist cannot manage to place an epidural, they will discuss other safe and effective forms of pain relief.
An epidural that is working well can also be used to provide the anaesthetic if you need to go to theatre for delivery of your baby or after your baby is born.
If you are booked for an elective cesarean section, an anaesthetist will talk to you on the day about your anaesthetic for theatre. This will most likely be a spinal anaesthetic, which is very similar to an epidural as it is also an injection between the bones of your back that makes you go numb from the chest downwards. The difference between an epidural and a spinal anaesthetic is that the spinal needle is much narrower and goes into a slightly deeper space in your back. A much smaller, one-off dose of anaesthetic will result in complete pain relief and leg weakness for between two and three hours. A spinal anaesthetic means that you will be awake when your baby is born and is safe for you and your baby.
Like an epidural, it can take longer to insert a spinal anaesthetic if you have a high BMI. Your anaesthetist may decide to put an epidural and a spinal in at the same time, which can be useful if your surgery is likely to be longer (for example if you have had more than one previous Caesarean section).
For both planned and emergency Caesarean sections the anaesthetist will need to make sure that your lower chest and abdomen (tummy) are numb so that you won’t feel pain during the operation. If you need to go to theatre for emergency delivery of your baby, this can happen very quickly if you already have an epidural in place. If you do not have an epidural it may take longer to place a spinal or epidural anaesthetic and this delay could result in harm to your baby. To avoid this risk we suggest you consider an epidural early in labour that can be sited without time pressures.
Rarely, the safest option may be a general anaesthetic if:
Unfortunately you will be asleep when your baby is born and your partner cannot be present.
Common risks of a general anaesthetic include feeling or being sick, a sore throat, and damage to your teeth. People who have a general anaesthetic tend to need more pain relief after their operation than those who have had an epidural or spinal anaesthetic. There are some rare but serious risks of general anaesthetics, particularly difficulty inserting a breathing tube, and unfortunately these are increased by both pregnancy and a higher BMI.
The anaesthetic team will try to avoid general anaesthetics unless absolutely necessary and having an epidural is one of the ways that the risk of requiring a general anaesthetic can be reduced.
It can be difficult to place a drip (cannula) in patients with a high BMI. It may take more time than usual and we may use an ultrasound to guide the placement of the cannula (a thin plastic tube for giving medications). If you often have difficulties with people finding veins to take your blood from, this can be done at the same time as the cannula.
The anaesthetist on labour ward may come to see you early in your labour to ask some questions about your birth plan and your general health. This is to allow the team to plan for any complications that may arise and adapt our anaesthetic techniques for the benefit of you and your baby.
Women with a high BMI are at increased risk of blood clots, and you are likely to be shown how to give blood thinning injections to reduce this risk.
If you would like any further information about anaesthetists on the labour ward, or would like an appointment where you can speak to an anaesthetist at Bradford Teaching Hospitals NHS Foundation Trust please ask your midwife or obstetrician to refer you to the anaesthetic clinic, or contact the labour ward on 01274 542200.
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Bradford Teaching Hospitals NHS Foundation Trust is a smoke-free organisation. You are not permitted to smoke or in use e-cigarettes in any of the hospital buildings or grounds.
