Washington Pediatric Hospital’s Weigh Smart Program

The Baltimore City Community College PTA Class of 2019 invites one to join us even as we celebrate our 6th Annual Fitness Can Be Fun Games. We are thrilled to instruct you the Six Steps to raised health: strength, mental health, diet, flexibility, stamina, and balance while doing offers, dance, and other fun activities ideal for the entire family. Proceeds from Steps to 6-cess will benefit Mt. Washington Pediatric Hospital’s Weigh Smart program. This scheduled program provides physical, psychological, and nutritional support to children and their caregivers thru group and individualized programming which promotes healthy lifestyle options and prevention of childhood weight problems.

Unfortunately, despite a glaring insufficient evidence, soft tissue dystocia is an idea that continues to be taught and broadly believed. Barau 2006 argued that although there is no hard proof of soft tissues dystocia, it must exist because there is an increase in cesareans due to prolonged labor in obese women in comparison to average-sized women with similarly-sized infants.

However, I will point out again a higher level of malpositioned infants among women of size may possibly also describe their longer labors and increased rate of cesareans due to labor dystocia. Babies who face their moms’ tummies (occiput posterior) don’t fit as easily through the pelvis, present with a larger head diameter, and experience long often, slow, hard labors.

Research clearly demonstrates posterior infants have much longer and slower labors and have a higher cesarean rate than anterior infants. And anecdotally, women of size do seem to have more malpositions often, especially occiput posterior, many of which lead to cesareans. Many of these excess fat women have been told that they had cesareans because of their “fat vagina” or “too small” pelvis.

  • Tons of equipment
  • Raises energy and metabolism
  • 15 MPH maximum acceleration
  • Too little exercise

Yet if you read their stories carefully, they had all the signs or symptoms of the malpositioned baby instead. The main element was getting a well-positioned baby, not losing weight or reducing maternal pelvic body fat. Another problem with the concept of the “fat vagina” is the inconsistency with which this analysis is applied. 275 lb. girl (like my pal from ICAN) is told that her vagina is “too unwanted fat” and prevented her baby from escaping ., then it follows a 350 lb.

Yet we know that women of this size can and do have vaginal births. I’ve birth stories on my website of vaginal births to women at 300, 350, and 400 lbs. If excess fat vaginas truly prevented vaginal birth as much as some providers think they are doing, there would be NO vaginal birthers above a certain size.

In my estimation, the real concern behind an increased rate of “dystocia” cesareans in women of size is most likely fetal position, not fats vaginas. However, because doctors are trained at fault weight problems as the go-to analysis when they don’t have another description, soft tissue dystocia gets blamed for “blocking” the baby’s way out.

But that’s just lazy thinking, not actual proof of soft tissue dystocia. What About Shoulder Dystocia? This fear seems borne out by studies that have shown higher rates of make dystocia in “obese” women. Yet many of these studies did not control for other factors, like macrosomia, diabetes, forceps/vacuum extractor, or induction, which increase the risk for make dystocia, and the majority of which occur at higher rates in women of size. It is important to note that other studies have found that obesity is not a risk factor for make dystocia when these other factors are controlled for.

Furthermore, it isn’t extra fat crowding the vaginal walls that triggers make dystocia. Rather, shoulder dystocia is caused by obstruction by the bony pelvis, not smooth tissues. A complex interplay of factors results in shoulder dystocia, including fetal position, maternal mobility and position, pelvic form, induction, operative delivery, diabetes, and macrosomia. But justified or not, dread that “extra” gentle tissue may cause make dystocia is a large contributor to the high planned cesarean rate and early induction rate in women of size.