Abortion? You’re too fat to have one.

Anonymous writes:

I am 36 years old, married with children. I am also fat. I am 5’6″ and I weigh about 250lb.

In April I found out I was pregnant. This was not planned and was totally unexpected. For a myriad of reasons we decided not to continue with the pregnancy.
At that point, I thought the hardest part was over. How wrong I was.

I live in a rural area with a relatively small population. I wasn’t sure if my pregnancy was 5 weeks along or 9 weeks along as I had only had very light bleeding for what I thought had been my last period. However once I found out I was pregnant, I thought perhaps that had been implantation spotting and not an actual period. Hence I had no idea how far along I was. I didn’t want to go to the doctor because a/ my doctor is Muslim and I didn’t want to run the risk of s/he refusing to refer me for a termination and b/ my doctor works at a community clinic that we are quite involved with personally and professionally and I have reservations about the extent of confidentiality. Usually I see that doctor only for mundane illness and I see another doctor in another town about anything personal. However I was unable to get into see that other doctor for two weeks and I couldn’t wait that long.

I went to the local women’s health referral service and got the contact details for abortion providers. I found out that I would not be able to get a termination done in my own town (which was ok by me) and that I would have to travel to the city, over 3 hours away. I would have to have someone with me, the ability to pay for the procedure etc etc. I am lucky enough that I had all that but I wondered how other women who don’t have transport, money and support people would cope?

I chose a clinic and rang to make an appointment. I was booked in for 2 days later and the receptionist started asking me her battery of questions. After about ten questions about things like how far along I was etc, she asked me my height. Alarm bells immediately started ringing and I felt sick to the stomach. Surely this wasn’t heading where I thought it was? Unfortunately, it was headed exactly there. Her next question was about my weight. I was honest, I told her my weight was 250lb. She went quiet and I started to shake. She then told me that my BMI was 41 and that the anaethetist at the clinic would only administer anaesthetic to women with BMIs of 40 and under. I wasn’t willing to go without the anaesthetic and I know my voice was shaking when I told her that. I coulnd’t believe they were telling me I was too fat to have an abortion. I felt sick with anger. How dare they? I have had two surgeries under general anaesthetic in the last 18 months and neither time has either anaethetist said anything about my weight. I wondered how much of a difference one point on the BMI scale could really make to the skill needed to administer an anasethstic? I asked the receptionist what exactly I was meant to do now? She consulted with someone else in the office and then asked if she could call me back in ten minutes. I agreed and hung up the phone. I then burst into hot angry tears. I was furious. So not only are fat women not meant to be attractive to men and not meant to have sex, and not be able to get pregnant, when we do get pregnant we are apparently putting our baby at risk because we are fat and if we don’t want to continue with the pregnancy, we can’t get abortions either because we are fat. I ranted and raved to my husband, who was as apalled as I was, until the phone rang ten minutes later. The clinic receptionist informed me that the other anaethetist who worked at the clinic was willing to perform terminations on women with BMI up to 43 and so I would be able to have my abortion after all. But I would have to change the day I was booked in as he only worked particular days. This meant my husband had to renegotiate time off work and we also had to rearrange childcare for our other children. But I was booked in.

I was still fuming about it 3 days later when I went to the clinic. After having to leave home at the crack of dawn, travel 3 1/2 hours and walk through a group of anti-choice protestors, I was seen by a junior clinican (female) who took my history and did what I assume was meant to be the ‘counselling’ part of the pre-termination consultation. She never once mentioned my weight. Then I had to see the doctor who would do the termination. In the 5 minutes I was with him, he must have mentioned I am ‘quite overweight’ at least 5 times. He mentioned it in relation to the ultrasound he did to try and see how far along I was ( I didnt have to see the screen and the sound was turned down) and he mentioned it in regard to prescribing me the contraceptive Pill. He refused to give me the combination pill that I had been on prior to my last pregnancy because of my weight and would only give me the mini pill. After that, I was taken into a room to put a robe on and wait to see the anaethetist. He came in, took my blood pressure (which was fine), commented on my facial piercing and assured me all would be fine. No mention of my weight at all – which is probably just as well because by that point I probably would have lost it.

The actual termination went smoothly and I recovered physically quite quickly. Emotionally I still find it difficult from time to time but I feel we did the right thing for us at the time.

It was a week later that my husband discovered online that if a woman weighs over 70kg that one mini pill a day may not be enough to prevent pregnancy. I was horrified. Here I was, just having had a termination and taking birth control to prevent another pregnancy and it was highly possible that the abortion clinic doctor had prescribed me a pill that was going to be ineffective because of my weight on the grounds that I was too fat for the combination pill? It was beyond belief. I was able to get into see my alternate doctor two days later (by some stroke of luck) and he was happy to prescribe the combination pill for me. He knows my history and he knows my blood pressure is fine. He has never made an issue of my weight, which is why I continue to be his patient.

I am still incredibly angry that such a difficult decision (for me/us) was made even harder because of one point on the BMI scale. I am still incredibly angry that women who have a BMI over 43 who seek a termination at that well regarded clinic, are going to be turned away. It makes me so angry I don’t even know where to begin to address the issue because not only am I so angry I could spit, I also don’t want to broadcast to the world at large that we chose to terminate the pregnancy. I think that is our business and has nothing to do with other people. But how to raise awareness about the issues fat women face in this area without compromising my own privacy? I have yet to work that out.

ETA: Sorry for 2 posts today, but I rescued this one from the spam folder after I did the first post. I thought this one was too important to let go until next week.

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31 Comments

  1. My heart goes out to you and your husband, along with a healthy dose of rage at what you had to go through at the hands of the doctor who performed the procedure.

    Reply
  2. J.S.

     /  July 16, 2009

    I am so saddened that you had to go through this horror.

    I doubt that these doctors would use BMI to control women’s access to weight loss surgery they way they are using it to control women’s access to abortion.

    Reply
  3. Piffle

     /  July 16, 2009

    What a stupid rule, particularly if you’ve had anethesia already. And even I know that some hormonal contraception isn’t right for fat women due to dosing problems. Gah.

    Frankly, if I hadn’t finished my family and gotten my tubes tied, I’d go for one of the new IUDs, they seem to be just about perfect.

    Reply
  4. Kristin

     /  July 16, 2009

    You should write to RH Reality Check (http://www.rhrealitycheck.org/) about the situation with the Clinic name and ask that they publicize it anonymously. Or Feministing (http://www.feministing.com) and ask the same thing. Both those places are likely to be able to send your story on to people with influence who can maybe work to get the BMI rule changed?

    Reply
  5. Anna

     /  July 16, 2009

    That is MESSED UP.

    Abortion is hard enough, with social stigma and beliefs and everything else, and they felt they had to make it harder by going ‘OH, btw, our dude/lady for this precedure is an idiot and would you mind going without?’ It especially infuriates me they didn´t look for another person until after you told them you wouldn´t do it without going under.

    I don´t know your specific situation, but you made the right choice for you and our family, and I am furious at those doctors.

    Reply
  6. I am so sorry you had to go through that. How horrible! And the thing about the mini-pill is insane. I went a year having to take that b/c of a too small blood pressure cuff. I’d never had high blood pressure, but all the sudden it was crazy high when I went to the clinic so the Dr. refused to give me my regular pill. Turns out I’ve never had another high reading. I’m glad that a nice guy at a health fair told me about the too small cuff thing. Funny, he wasn’t even a DOCTOR.

    Reply
  7. MargB

     /  July 17, 2009

    I have no words, but my heart goes out to you. As if making the decision to have an abortion and the process and aftermath weren’t enough.

    You described the Catch 22 that many overweight women are put in very well.

    Reply
  8. lilacsigil

     /  July 17, 2009

    I’m so sorry you had to go through this. Anaesthesia does carry slightly higher risk for fatter people, but it’s the anaesthetist’s job to manage that risk, not to bar people from healthcare. Wouldn’t it be easy to be a doctor if you could refuse to treat everyone who was sick? Or even refuse to treat anyone (elderly, child, pregnant, fat, thin, any other health condition) who might have a slightly raised risk of complications?

    Reply
  9. Hildy

     /  July 27, 2009

    In defense of the doctor:

    Anaesthesia carries a significantly higher risk for the morbidly obese. A doctor who is not a board certified anesthesiologist may be willing to perform anaesthesia on a low risk patient, but not on a high risk patient. Even a board certified anesthesiologist might balk at managing a high risk airway without the appropriate support, which is unlikely to be available at a freestanding termination centre, but may be available at the place you had the other procedures done.

    Everything’s just harder in the obese, and you don’t do yourself any favors by pretending it isn’t. Even if you reject the idea of losing weight, don’t trivialise the problems; get appropriate treatment — the best treatment you can get — wherever possible.

    Reply
  10. vesta44

     /  July 27, 2009

    Hildy – the problem with that is that most doctors/anesthesiologists don’t have a problem with “morbidly obese” patients when it comes to putting them out for WLS. They just have a problem when it comes to any other kind of surgery that might actually help a patient instead of causing more problems than it supposedly cures (and if you don’t believe that WLS causes more problems, just take a look at the complications list at the Yahoo group, OSSG-gone_wrong, it will scare the bejeebers right out of you).
    I’m in the DEATHFATZ category, and I’ve had 5 instances where I’ve had to be knocked out (wisdom teeth removed, tubal ligation, gallbladder removed, hernia repair, and VBG) and only once did a doctor tell me I needed to lose weight first (and I went over his head to the surgeon and anesthesiologist and they disagreed with him). So that significantly higher risk you’re talking about can apply to a lot more people than just the “morbidly obese” – it can apply to thin people with heart disease or asthma or diabetes or any other disease. A lot of the risk involved in anaesthesia depends on the person’s overall health, and weight isn’t always a good indicator of that.

    Reply
    • cecil

       /  October 4, 2011

      But those WLS aren’t happening in freestanding clinics that don’t have an immediate support available; they’re happening in hospitals or specific centers that are fully equipped with the staff and equipment that can be very necessary to manage an emergency in a high risk patient. Larger patients respond differently to general anesthetic; its not simply a matter of increasing dosage because anesthetic is fat soluble and thus the amount and distribution of body fat can have huge (and less predicable) implications on the intensity and duration of the effects of the anesthetic.
      To compound the problem, should a complication occur, managing a respiratory or cardiac emergency in an obese patient may require resources beyond those of the clinics. An ER doc spoke on the jez thread as to these issues; it’s not a matter of “just get bigger tables!” but instead the fact that managing these complications can be significantly more difficult and require an individual with more training and experience than those who may be on staff. The doc spoke as to the issues in establishing emergency airways in obese patients, and mentioned the increased technical difficulty of many of these procedures: even intubation can become significantly more difficult. This increased difficulty means that many procedures are really best carried out in a hospital where the staff regularly see and perform similar procedures.
      The clinic is just really weighing risks here. Obese patients happen to be a demographic with a higher risk of complications for anesthetic (which tends to be the more dangerous part of most procedures), and, to compound the problem, are harder to manage when said complications arise. Would it be great if all clinics had the resources necessary to compensate for those risks? Absolutely. Unfortunately, not all clinics can afford the staff and equipment necessary to do so, and in those cases, treating a patient beyond the guidelines of the scope of practice they can safely provide not only puts that patient in danger but their entire operation as well.
      It’s easy to say, oh, it’s just one BMI point, but at a certain point, they have to draw the line. They aren’t refusing to give her an abortion, just the general anesthetic (a combination of local anesthetic and a sedative, which is very commonly used, was probably still an option), and that is not based on a “oh you’re fat and ugly and lazy so you deserve to be punished,” but instead on medical fact. The high risk diabetic patient or patient with heart disease you referred to? Also probably referred to a clinic with the back up support necessary to manage general anesthetic in high risk patients.

      Reply
      • vesta44

         /  October 5, 2011

        I’m letting your comment through so that I can let you know that you’re not exactly right with what you’re saying. 30 years ago, I had an abortion. I was 5′ 8″ tall and weighed 325 lbs, and never at any point did the physician or the anesthesiologist say anything to me about any difficulties they might have with the procedure because I was DEATHFATZ. And my BMI was significantly over 40. But that was back before all the hysteria about the so-called “obesity epidemic” and how being fat is killing people right and left. So evidently doctors and anesthesiologists in clinics 30 years ago knew how to deal with fat patients, but they’ve lost those skills in the intervening years.

        Reply
  11. I got pregnant 2x on the pill. I have had PCOS for 41 years – both times I was much younger and VERY thin so it was my hormonal imbalance that canceled out the pill.

    Now I am overweight and STILL doctors try to give me the pill to “fix” my PCOS. Thank GOD I found a doctor who gets it! and put me on the right meds.

    I just had major surgery and at no time was I told I was TOO FAT. I hope you report these people to the AMA.

    Reply
  12. Vesta44:

    I agree entirely; however WLS does not occur in the outpatient-style low-risk-only setting that termination of pregnancy does. Every doctor has their own appetite for risk, and it’s hard enough to get doctors to participate in abortions that forcing them to accept more risk than they want may drive them away.

    For example, I will do certain procedures under sedation on ASA I/II patients, whereas for an ASA III+ patient I would refer for the procedure to be done in an operating theatre with full general anaesthetic. This is because the place where I work has the facilities to manage low-risk patients, but not high-risk patients.

    BMI 30-40 puts you into ASA II, BMI 40+ puts you into ASA III.

    http://my.clevelandclinic.org/services/Anesthesia/hic_ASA_Physical_Classification_System.aspx

    It may also be that the doctor’s insurance doesn’t cover ASA III+ patients in that particular location.

    I have often thought about providing termination services as a career, but I would take the same approach as this castigated anaesthetist: BMI 40+, go to a big hospital.

    Reply
    • vesta44

       /  July 31, 2009

      Hildy – I weighed 325 lbs when I had both of my abortions, and my size was never an issue with either of the doctors or anesthesiologists. So I’m thinking it’s an issue of fat-phobia combined with inexperience with fat patients (and if you refuse to work with fat patients, you’re never going to get that needed experience). I’m firmly of the opinion that fat women are entitled to the exact same care that thin and “average”-sized women get, and doctors need to figure out how to work with all sizes of women, not just the ones that are aesthetically pleasing to society.

      Reply
      • Fat women cannot get the exact same care. It’s physically impossible, and not just that, it is dangerous and unethical.

        Here’s an example: I tried to tap a knee on someone who was >400lbs. None of the needles we had was long enough. We tried multiple times. A thin patient would not have had that experience.

        You have to consider every patient as a whole person, and do what’s best for them. This involves assessing what risks they have and managing appropriately.

        Reply
  13. The anaesthesiologist keeps you alive during your surgical procedure. If you’re higher risk, that IS something to worry about. An M. D. anaesthesiologist is better to have than a nurse-aneasthetist, too, IMHO. I am pleased to see that some of the techs do take things seriously, because if they operated on high-risk patients and LOST them . . . well, it’s not a pretty thought at all. Be glad that they send you to a full-fledged hospital.

    Reply
  14. Hildy, I am not sure you get it. I am morbidly obese. I also have no *actual* health problems. No high blood pressure, no diabetes, no CVD involvement of any sort, excellent lipid panels, no history of weight-related illness (or any serious illness), no apnea, good exercise tolerance. I am energetic and healthy, just large, and if you saw my chart without the weight number, you would not be able to distinguish me from an ASA I patient. Do you not see that placing me in ASA III solely because of my weight, when I have no actual health problems requiring management, is the result of assumptions about weight’s relationship to health that are not, in fact, accurate?

    Reply
  15. likeabeam

     /  August 4, 2011

    The craziest part is that BMI isn’t a medical tool – it was invented by insurance companies and is not an entirely accurate measure of the aspects of a person’s health which it is designed to assess.

    Reply
  16. vesta44

     /  October 3, 2011

    For those who are commenting after reading this on Jezebel – if you’re going to be a fat-phobic fuck, your comment won’t see the light of day. I’m not going to allow comments that are derogatory to the OP or anyone else who has written in with stories about mismanaged medical care. If you’re thin and have never had a problem with a doctor misdiagnosing you because of your size or refusing to even treat a problem because of your size, then you have no idea what fat people face when they try to get medical care. And if you think losing weight is all a matter of calories in/calories out, then I suggest you do some research, and make sure what you read ISN’T paid for by the diet industry or pharmaceutical companies who have a vested interest in keeping people coming back for another new diet (that won’t work) or another new diet pill (that has horrendous side effects and doesn’t work). If you think fat people like being called names, hated, and reviled on a daily basis, you have another think coming. And I’ll tell you this – You can’t hate yourself thin, and no one else can hate you thin.

    Reply
  17. Anna

     /  October 3, 2011

    I am so sorry for this experience. That is a pretty tough thing to go through without bigots and inexperienced people making your life harder.

    I’m glad to hear you recovered well. All the best to you, your partner and your family.

    Reply
  18. So glad you were able to do the best for yourself and your family, despite unnecessary obstacles put in your way. I’m glad that you were able to find professionals who haven’t lost their way when it comes to fat people.

    Those who have should be ashamed of themselves.

    Reply
  19. Thank you so much for sharing your story. I’m not sure if comments go back directly to the author, but I wanted to reach out to her.

    I’m a sociologist interested in fat stigma and I’m currently working on a project about fat stigma specifically related to abortion and reproductive health care. If the author (or anyone reading this) is interested in chatting with me about the project, I’d love to talk to others about it. It wouldn’t be for my research at all, I’m just trying to get my head around the concepts and I think hearing about other experiences might inform my research in a really helpful way. You can reach me at natalie dot ingraham @ucsf.edu.

    Reply
  20. This is fucking disgusting. I am so sorry you had to go through this, anon. I’m glad you had a supportive husband and a supportive secondary physician. This is an incredibly important story to share. Thank you for doing so. <3

    Reply
  21. I’m really sorry.

    Even if there were issues related to weight that put you at a greater risk, they could have been handled a hell of a lot better. Having an abortion is a hard decision anyway, without all of the added stress you had to go through.

    While I understand what’s been said here in relation to the health risks in morbidly obese people, I think it’s ignoring the point that there are healthy and unhealthy people regardless of their weight.

    Health should be determined taking all factors into account, not just weight.

    Again, I’m really sorry for your experience, and I’m glad you got the treatment you needed.

    Reply
  22. I’m 5’2 and I weigh 159 lbs and my previous doctor put every one of my joint issues down to my weight. My current doctor did some damn tests and found out I have arthritis. I’m 19, and I’ve been having joint problems since I was 15 and slim, but my last doctor refused to believe I didn’t exercise because of the pain.

    The way fat people are bullied by society most certainly has an effect on what care doctors provide.

    Reply
  23. Neka smith

     /  January 24, 2012

    Im going through the exact same thing right and I don’t know what else to do right now. But cry because I can’t afford anOther child right now and I don’t want my child to suffer

    Reply
    • Shana

       /  January 26, 2012

      I am also going through the same thing. I was told I was 5 lbs. over their weight limit to perform a termination. I found a clinic who can take me in. I go Saturday. I am incredibly scared that they will humiliate me in the same way. Since I was told by the other office that I was too heavy, I have sunk into a new low for myself. I already have struggles with my weight. I have yo-yo’ed my entire life. My husband and I, too, cannot afford another child, and this decision was incredibly difficult and thought out. To have a woman on the other end of my phone tell me I was too heavy hurt and scared me. I have never heard of such a thing, and have never been so humiliated.

      Reply
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