Are caesareans more complicated if I'm overweight?

Deborah Taylor

Consultant obstetrician and gynaecologist.

A caesarean section is usually a brief operation, whatever your weight. And it's unlikely that any problems will occur if you have one. Hopefully, soon after you're taken into the operating theatre, you'll be meeting your baby.

However, if you have a BMI of over 40, there are a few complications that are more likely to affect you during a caesarean. You should be given the chance to discuss these potential problems with a senior anaesthetist or obstetrician.

Anaesthetic problems

There are two sorts of anaesthetic:
  • Regional, which means you stay awake and a part of your body is numbed during the operation.
  • General, which means you fall asleep during the operation.
Both regional and general anaesthetics require you to have a drip, usually in your arm or hand. If you are carrying extra weight it can be more difficult for the anaesthetist to find a vein to put the drip in.

If you stay awake for your caesarean, you will have a regional anaesthetic. This will be either a spinal anaesthetic (a single injection in your back) or an epidural (a small tube in your back). Both work very well and will numb the bottom half of your body.

If you are overweight, it is harder for the anaesthetist to find the right spot in your spine to insert the anaesthetic. So it may take longer to set up the spinal or epidural.

The only time you'll need a general anaesthetic is if your baby needs to be born urgently, or if it's too tricky for the anaesthetist to do a regional anaesthetic.

Your caesarean should ideally take place during daytime hours, when more staff are likely to be around.

Surgical problems

If you have a lot of fat round your tummy it can make it harder for the surgeon to have a clear view while she's performing the surgery. Your surgeon may need to make a longer cut so she can reach your uterus (womb) more easily.

This is unlikely to cause you any problems later on.

Problems after surgery

After any surgery there's a small risk that you could develop a blood clot or deep vein thrombosis (DVT). This risk is increased if you are overweight. But you can reduce your chances of developing DVT by:
  • Moving around as soon as possible after your surgery. If you can’t get out of bed you'll be shown leg exercises to keep your blood circulating properly.
  • Drinking plenty of liquids.
  • Taking blood-thinning drugs if prescribed by your doctor.
  • Wearing elastic support stockings.
After your caesarean, you are more prone to a wound infection if your BMI is 30 or higher. To reduce your risk of infection, your surgeon will carefully insert extra stitches into your cut. This helps to reduce any build-up of fluid, as this is what spreads the bacteria. These extra stitches, along with a dose of antibiotics, will help to keep your wound free from infection.

You can help to guard against infection too. Change your dressing regularly and dry your wound thoroughly after a bath or shower. If the area is a bit too tender for you to dab, you can use a cool hair dryer to make sure it's completely dry.

You also have an increased chance of developing a chest infection after surgery if you're overweight. Moving around will help to prevent infection. To help you with this, you may see a physiotherapist while you're recovering in hospital. She will show you chest exercises that can help to fend off a chest infection.

Last reviewed: February 2014

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