Caring for Three Generations at a Time: Clinical Perinatal Care of Individuals With Obesity

• Duration: 60 Mins
• Credits: 1 CERP, 1 R-CERP, 0.1 Midwifery CEU
• Handout: Yes

Abstract:

Obesity affects more than 35% of women ages 20-39 in the United States. This presentation will summarize recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, health care access, food quality and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Obesity is an adaptation to an unhealthy environment more than poor individual eating choices. The female fetus forms her lifetime complement of ova during pregnancy; therefore, the effects of obesity may affect three generations in one pregnancy.

Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical actions for midwives at national, state and community levels to reduce population disparities in racism, education, employment; reduce pollution from obesogenic chemicals and improvement of food quality and distribution policies will be reviewed.

Learning Objectives: