Caring for the Bariatric Obstetric Patient
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S20, June 2012
How to Cite
Panzarella, M. (2012), Caring for the Bariatric Obstetric Patient. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S20. doi: 10.1111/j.1552-6909.2012.01359_23.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- Class 1 obesity/obese;
- Class 11 obesity/severe obesity;
- Class 111;
- obesity/morbid obesity;
- body mass index;
- process guidelines
Purpose for the Program
Body mass index 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 childbearing age. Among women aged 20 to 44 years, 24.5% are overweight, 12.7% are obese (body mass index 30%-34.9%), and 10.3% are severely or morbidly obese (body mass index greater than 35%), with the highest rate among non-Hispanic black women. Obesity places women of childbearing age and pregnant women at increased risk of diabetes, hypertension, sleep apnea, arthritis, chronic back pain, coronary heart disease, infertility, and depression. Additional intrapartum and postpartum risks include increased cesarean birth, gestational diabetes, preeclampsia, eclampsia, HELLP syndrome, prolonged labor, dystocia of labor, inadequate pain control, thromboembolic event, hemorrhage, bowel obstruction, wound infections, seizures or stroke, and pneumonia.
In an effort to appropriately care for pregnant women with higher body mass indexes, our institution initiated an evidence-based systematized approach to care.
Implementation, Outcomes, and Evaluation
Key elements of the evidence-based approach included a review of standards of care, a CINAHL and MEDLINE literature search, attendance at the national Association of Women's Health, Obstetric and Neonatal Nurses 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 guideline is expected to enhance the care team's ability to provide safe, effective, and efficient care to pregnant women with higher body mass index. Data collection and outcomes evaluations are ongoing with changes being made as relevant.
Implications for Nursing Practice
The implications for nursing practice include an evidence-based systematized approach to care for patients with higher body mass index during the antepartum, intrapartum, postpartum, and recovery periods and the utilization of the multidisciplinary team to provide safe, effective, and efficient care to pregnant women with a higher body mass index presenting in the labor and delivery department.