"Dealing with an obese woman is not the same as dealing with a normal sized woman," says Dr. Shoshana Haberman, the center's director of perinatal services.

Since the center began seeing more obese women, Haberman's unit updated its equipment. It purchased bigger beds, replaced examining tables with sturdier ones and purchased a 3D-enabled ultrasound unit. The center also acquired different vaginal tools, such as larger speculums and longer ring forceps.


Many of the protocols changed as well. Traditionally, anatomical ultrasound is done at 20 to 22 weeks. At the facility, an anatomical survey using the transvaginal approach is done between 14 to 16 weeks of pregnancy. The earlier ultrasound exam is more beneficial in the case of an obese patient because the fetus is still low in the uterus and less obstructed by abdominal fat.
Haberman says insurance companies don't cover the earlier anatomical survey but Maimonides still does it because it benefits the patient.

"An early anatomical survey is not the mainstream in the United States," she says. "The bottom line is you can see a lot of anatomical features earlier than the 20 to 22 week sonograms."

Facilities should have the proper resources to take care of obese patients, such as expert anesthesiologists and an adequate surgical intensive unit, in case of complications, says Haberman.

"[An obese patient] needs a different approach that's more focused and more careful," she says.

Maimonides Medical Center shares the protocols it put in place with four other New York City hospitals. Along with Haberman's institution, Beth Israel Medical Center, Montefiore Medical Center, Bronx-Lebanon Hospital Center and Mount Sinai Medical Center are all a part of a consortium working to lessen the risks the obstetrics teams encounter on the labor floor. The institutions' malpractice insurer, United Hospital Fund, supports the group.

"The reason this is a great collaboration is because we do 25,000 deliveries between us a year, so we can collect a lot of data very quickly on things that we try, to see if it works or not," says Mount Sinai's Brodman.

The sharing of information through such a consortium is unprecedented, since hospitals and staff involved tend to be competitive. However, the representatives from these facilities all respect each other and have been meeting together for the last three or four years, Brodman explains.

"The first step was to come up with ideas on how to improve safety on the labor floor," he says.

This proved to be a complex task, since each institution handles the issue differently.

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