"Being in labor can be as physically demanding as running a marathon," Dr. Dickerson says. That's why women who are overweight and less physically fit tend to experience longer, harder labors and have higher rates of c-sections.
Postdelivery recovery also can be more taxing. "Overweight women are at greater risk of infection following a cesarean because their stomachs hang over the incision site, keeping it moist and prone to bacteria, and fat itself is more prone to infection," says Cornelia van der Ziel, MD, coauthor of Big, Beautiful, and Pregnant. For this reason, some doctors perform vertical incisions on obese women instead of the lower horizontal or bikini cut.