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The rising number of obese pregnant women in the U.S. may be contributing to a record-high number of cesarean section births, as well as more birth defects and motherly and infant deaths, the  New York Times reports. According to the Centers for Disease Control and Prevention, about one in five women are considered obese  having a body mass index of at least 30 at the start of their pregnancy.

Women with a BMI of 35 of higher are considered very obese and are three to four times more likely to deliver their first infant via c-section than women of normal weight, according to a study by the National Institutes of Health’s Consortium on Safe Labor and other health insurance programs.
Data show that obese women are more likely to develop conditions like high blood pressure, diabetes, hemorrhage and blood clots during pregnancy and childbirth, according to the Times. Studies also have indicated infants born to obese women are nearly three times more likely to die within the first month than infants born to women of normal weight. Obese women also are nearly two times more likely to deliver a stillborn infant, the Times reports. According to the New York state-sponsored Safe Motherhood Initiative, two out of three maternal deaths in the state from 2003 to 2005 were associated with maternal obesity.

Howard Minkoff, chair of obstetrics at Brooklyn’s Maimonides Medical Center, said that doctors must weigh concerns surrounding c-sections which have risks similar to surgery against the risks of vaginal delivery in obese women, which can include difficulty monitoring fetal distress and failure to progress during labor.

As the nation’s obesity rate continues to grow, hospitals “have been forced to adjust” to accommodate the needs of obese pregnant women, the Times reports. Medical facilities are purchasing more sophisticated fetal testing equipment, longer surgical instruments and larger beds. They are also counseling women about losing weight or undergoing bariatric surgery before becoming pregnant, as well as conducting sensitivity training for hospital staff members.