If you're obese during your pregnancy, you're probably well aware of all the potential and added complications. During your baby's development, there are risks associated with the size and growth rate of the fetus at every stage. You'll also be at a higher risk for complications such as preeclampsia and hypertension during gestation. However, if you've become pregnant before you could reach a healthy weight, don't start dieting now. You should certainly focus on eating healthy, but don't sacrifice your nutrition in an effort to reach a normal BMI. Once you've accepted your weight, the complications could still arise, but you'll be less stressed. One common misconception about being overweight and pregnant is that the epidural will be less effective should you choose to have one. Luckily, this is untrue.

Once the epidural has been successfully inserted into the spine, the medication will affect patients of all sizes in the same way. If you're overweight, the medication will not be any less strong than in a woman who weighs less. However, there is a good chance your anesthesiologist will have a hard time inserting the needle all the way into the spine because of the body fat protecting it. It could take her longer to locate the right area, but it's not like she'll give up if it's difficult. If you're worried about it, you should consider calling ahead before you go into labor and finding out if there are any nurses with particular expertise in dealing with women who are overweight. Some nurses are better at finding the right spot for needles and anesthesia than others. He or she might also be able to use a longer needle to get through the fatty tissue and reach the spine just as easily as in a person who is of a normal weight.

Though being healthy before you become pregnant is preferable, it's okay to accept the fact that you're overweight once you found out that you've conceived. If you still do a healthy pregnancy diet and get the recommended amount of exercise for your pregnancy, you might even end up losing weight during gestation. Talk to your doctor about any special needs you might have but don't worry about the epidural if you're thinking of getting one for delivery.

Source: Laura Vricella et al: Impact of morbid obesity on epidural anesthesia complications in labor. American Journal of Obstetrics and Gynecology Volume 205 Issue 4 pp. 3701–3706 October 2011