Passive Descent in Obese Nulliparous Gravidae

Obesity rates in reproductive aged women in the United States are rising. It is now
universally accepted that obesity is associated with many adverse pregnancy outcomes and
post-operative complications following cesarean section. Recent studies have also shown an
increased rate of cesarean section in obese women, adding to the already elevated rate of
complications and adverse outcomes. Given the increased a priori risk for obese patients, it
is vital that the investigators reexamine management practices routinely used for normal
weight women in this specific high-risk population. Passive descent has been shown to
increase the spontaneous vaginal delivery rate in non-obese women; however, high quality
studies have never been performed in obese women. the investigators hypothesize that passive
descent could improve the spontaneous vaginal delivery rate in nulliparous, obese women with
regional anesthesia. This study will randomize women to passive descent for ninety minutes
or active pushing upon entry into the second stage. Further, given that passive descent is
widely accepted in the midwifery literature and clinical practice, the investigators
anticipate that a high-quality study in the physician literature could increase the dialogue
between practitioners and lead to development of best practices in this high-risk
population.