Jennifer writes:
During my first pregnancy, I got regular checkups from my in-network provider, a group medical practice, as well as from a midwife. The visits with the various doctors at the practice were punctuated with uncomfortable silences and long looks. Finally, when I was about four months along, one of them said hesitantly, “Well, I don’t know if anybody has raised this as a concern, but you’re . . . well, you’re obese.”
What I wanted to say was, “Gosh, I never knew that! No wonder my clothes have to be so big! Thank you for clearing up this mystery, doctor!” What I said was, “Yes, I’m aware of that.”
“Well, we were worried that you would get upset if we raised the subject.”
“No, that’s fine.”
So she went down the laundry list of Awful Awful Things, such as blood pressure (always normal), blood sugar (ditto), hauling around the baby weight on overstressed joints (I told her that my weight had actually gone down just before I conceived), and so on and so on and doobie doobie doobie. She started looking a little unnerved as the fat lady just sat there giving assorted variations of, “Yes, I know, and as you can see from my chart, I’m perfectly okay.”
So on the next visit, another member of the practice flipped through the last doctor’s notes and said, “I see that you’ve been made aware of our concerns about your obesity.” I nodded and smiled and he went on to tell me solemnly that I was so fat inside (or as he put it, I had so much “excess tissue”) that I could never have a baby without medical assistance, so my planned homebirth would just have to be canceled, and he looked forward to working with me if I got him on rotation in the labor and delivery suite at the hospital.
And I took a copy of his notes to the midwife, who–gasp, shock–did an internal exam and said that Doctor Doom was full of shit. I had a good set of abs under my flab due to the crunches I had been doing faithfully for years, I had a classic gynecoid pelvis, my tissue health was excellent (I had been taking high-powered vitamins recommended by my midwife and eating well), and she even had me do a Kegel around her fingers to prove that I did not have a flabby incompetent twat. In her opinion, I was not likely to have a problem even if my baby was twins.
I had that baby at home, after a four and a half hour labor. In fact, I had all of my babies at home. They’re fine, I’m fine, and Doctor Doom has never retracted his ridiculous assertion. Not that I see him for anything if I have a choice!
I live in a midwife-unfriendly state and I don’t want to cause her any trouble, even indirectly. So just sign me,
Big Fat Mama of Three
First, Do No Harm 
Tanz
/ May 11, 2010Even your midwife was wrong here; there was no need to give you an internal exam, or check out the strength of your abdominal muscles, etc. I’m obese. I had twins 5 years ago, vaginal birth, no issues during pregnancy (carried to term). I am still obese, pregnant again with twins, and only mildly high BP. I don’t, and never did have, good abs. I’m not, and never have been, a ‘good fattie’. Weight has little bearing on pregnancy and birth.
The wellrounded mama
/ May 11, 2010Ah, yes, the infamous fat vagina theory!! The idea is that fat women are so “padded” on the inside as well as the outside that the baby will never get out without assistance.
There is virtually no research on this topic (and what there is is supportive of it being nonsense), but it gets taught religiously to every generation of docs (and some midwives, sad to say) and many believe it fervently.
That’s one reason why many women of size have better, easier births at home (with size-friendly midwives, who “get” that this is a lot of nonsense). Many docs have been too brainwashed into the fat vagina mindset and can’t take a step outside that paradigm at all, and it influences all their choices (from inducing early to get a smaller baby, to recommending a planned cesarean, to having a very low threshold for cesarean during labor, or to recommending dieting to lose weight “down there” between or even during pregnancy).
I’ll be blogging about this topic soon. Hope you will share you story there too. Thanks for documenting it.
lora
/ May 11, 2010Thank you, thank you, thank you. I am going throught this right now, not just with doctors but also with midwives. At this point my husband and I are prepping for a home birth on our own because we just can’t get anyone in our area to provide care, even though I’m very healthy. I previously had a healthy pregnancy and natural childbirth but the hospital experience is not something I care to repeat. Already I’ve been told that it’s a good thing that I’ve proved my ability to have a child vaginally otherwise I would automatically be sent in for a cesarean and that I can’t have this baby at home because it would be hard for someone to move me if they needed to. My husband laughed at that midwife and told her that if that’s her only concern, no problem, he can move me. No, we won’t be seeing her or anyone from her practise again.
mand
/ May 19, 2010Came here from Spilt Milk, and just about to blog linking to this. The myth i believed (it’s in my past) was that not weight but type 1 diabetes meant early induction was necessary. I so wish i’d known then that the health professionals simply don’t know what they’re talking about… well, some do, but you can’t take it for granted any more than you can assume some stranger you met on the bus knows what she’s talking about. ;0) Well done spreading the word.
Guillermo Wilkinson
/ May 29, 2010fathealth.wordpress.com’s done it again. Incredible read.
Jackie
/ July 21, 2010I so hate this infantilizing attitude some doctors had towards fat patients. It’s like, “We don’t want to upset the baby by telling them we realize they’re fat!” I mean, if patients become upset at a doctor pointing out their fat before discussing their actual health issues, you know maybe that might be a lesson.
I love your sarcasm Jennifer, and if I were in your position I would have totally gone with it, because it’s so darn irritating to be treated like your behavior is that of a naughty child. I know this all too well, from having Asperger’s Syndrome, and going through a Special Ed program that didn’t work for me at all, which is where I developed my talent for sarcasm.
I would have told the doctors, “Look, first off I am not a tempermental child, I am a fat adult. I would hope you would be professional enough to realize the difference, and stop acting as if you have to walk on eggshells because you don’t want to have to deal with a tantrum.
Secondly, I know I’m fat. Do you know how I know I’m fat, I have TV shows telling me I’m fat, strangers on the street telling me I’m fat, and now my doctors telling me I’m fat. Please, would you explain this ridiculous notion to me that fat people are somehow unaware of the size of their body, given everyone else’s inability to look past it?
Now, please do some research into Health at Every Size and Fat Acceptance? I hope that you realize that fat people are not children in adult bodies, or hapless and too dumb to realize the state of their size. Fat people put up with discrimination every day, and dispite it still manage to love themselves despite the reality that genetics determine body size, not activity, not food intake, genetics. I will not be needing your help any further. I really hope you realize how insulting and unprofessional it is of your staff to regard patients, as if they are small children. Perhaps this means you are unable to deal with adults on an adult level, maybe you should consider becoming a pediatrician?”
I probably wouldn’t get that all out at once, but that’s what I’d like to tell them. It’s like the doctors might as well have walked in and started quacking, with the way they’re acting frightened that the scary fat person might protest if they point out they’re fat. I have no patience for adults, who behave like a frightened 1 year old almost wetting their pants, when confronted with a possibly difficult situation. It’s like they’re going “Um…I-I-I *looking like they’re about to cry* I think you’re fat, please don’t yell at me!” I guess they must think nobody would attack someone who seems to have that much emotional fragility. They were worried you’d get upset if they brought it up, being a doctor means having to bring up things patients wouldn’t want to hear. If you feel frightened by telling a patient they’re fat, then don’t be a doctor. Find an occupation that is willing to accomadate you and your oversensitivity.
Honestly I don’t know if I would have just laughed at them to begin with, and said “Are you afwaid the big bad fat woman will get angwy because you said she’s fat?” If they want to act like a pack of frightened toddlers, then that’s how they’ll be treated.
Amber
/ October 11, 2010I’m so happy to read these posts. I have dealt with doctors being concerned about my weight with three pregnancies. Their “concern” is humiliating, and non-productive. They never ask how they can support me, offer referrals to nutritionists, or screen for an eating disordered history. Each time, I get so upset I just cry until the appointment is over. I feel like a punching bag. I’m just glad to know there are other women out there. I feel less alone. I would change doctors, but this is the third group I’ve been with, and there’s always a doctor willing to be abusive. The irony is, I always begin pregnancies at a healthy weight, but end up gaining so much I eventually get attacked. I don’t know why I gain so much, and I would do anything to gain less, if only to avoid these interactions. I always feel like a helpless child being scolded. It really sucks the joy out of pregnancy.