Marg writes:
I am currently 22 weeks pregnant and probably in the best health I have been in years. Unfortunately instead of enjoying it I’m finding myself for the first time wanting to skip medical appointments because I am totally fed up with dealing with the worst fat-prejudice I have ever encountered in my life.
Except it’s not just fat prejudice (although this is how it is expressed in my case). I have discovered it’s more the systematic bullying of nearly every pregnant woman I’ve met, no matter her age, weight, overall health or whatever by the medical profession.
You see there is no perfect ideal pregnant patient. We’re all doing something wrong.
In my case, I tick a lot of high-risk factors – I’m overweight, over 35, became pregnant through IVF and have a mother who died of a diabetes-related illness. About the only risk factor I don’t tick is being of indigenous descent. So I totally get that the doctors want to keep a close-eye on me during my pregnancy and this is fine. It’s just the way they do it.
During my 16-week appointment the doctor said (and I swear I’m not making this up although I may have got the words a little wrong): “Your blood pressure is good, your kidney function is normal, you have good iron levels, low cholesterol and normal insulin levels BUT you are carrying too much weight to have a healthy pregnancy.”
As evidenced by what???
If he had just said: “All your medical tests have come back fine but I still want to keep a close eye on you because of your high risk factors” it would have been fine. It would have been better than fine.
Instead I get “It’s really important that you don’t gain any more weight during this pregnancy. I don’t want you coming back in a month another four kilos heavier.”
So are you are saying that I shouldn’t report for medical check-ups if I’ve gained any more weight?
It’s actually really really important that I get regular check-ups – whether I gain, lose or maintain my weight – especially given my high-risk factors. We need to ensure that if my blood pressure soars or that develop gestational diabetes – both very common conditions that can affect pregnant women of all ages and weight – they are caught early and treated appropriately, both for my health and the baby’s. In fact all pregnant women should be encouraged to have these check-ups. I met a 21-year-old within the ‘healthy’ weight range who delivered a 10 pound baby because her doctor didn’t think she was at risk of gestational diabetes. Which shows that you can never tell just by looking at the outside.
So I keep returning for my check-ups because I am interested in keeping an eye on my health, whatever my weight is that week.
I vent my frustration to my other pregnant friends and discover I am not alone in dealing with insensitive doctors. One friend who had a higher than average risk of Downs Syndrome was being hounded by her hospital to have a diagnostic test that carried with it a 1/200 risk of causing a spontaneous miscarriage. She had worked for 3 years with severely disabled children and knew what she was saying when she told them “I don’t want the test as there is no way I’d abort the child even if it is disabled”. In the end the phone calls only stopped when she sent them a legal letter via her GP who explained that she had “informed consent” regarding this decision.
Another friend, who had twice been hospitalised for mastitis (severe infection of the breasts) was told off by the breast-feeding police for her decision to go straight to formula-feeding with her third. Didn’t she realise that she was putting her newborn’s development at risk? The fact that she had every medical reason not to breast feed (how healthy is pus- and blood-filled breast milk anyway for a bub?) and that she thought it more important to be a healthy mum able to care for all three kids at home was of course irrelevant.
And so on. There are 100s of stories each worse than the first, but us overweight pregnant women come with a ready-made condition to be bullied with. The dietitian cross-examines me over a glass of apple juice I had at breakfast (the first one in nearly a year I might add). Don’t I know what harm I could be doing to the baby?
Probably not as much as the harm you are doing, madam. You see there is one pregnancy statistic that all the studies around the world have confirmed time and time again. While gestational diabetes and high blood pressure are definite risks, if they are caught early and managed properly there is little or no impact on the developing baby. But stress, anxiety or depression during pregnancy all carry with them a very high risk of impacting negatively on the development of an unborn child. So why do so many doctors and nurses and other medical professionals act in a way that increases the likelihood of this happening through their bullying of pregnant patients?
First, Do No Harm 
Nicole
/ October 14, 2009Oh, I’m sorry that you’re having to go through this. Rest assured that whatever they say, you *can* continue to have a healthy pregnancy, regardless of weight. I have been lucky enough to have two amazing, wonderful, totally normal pregnancies resulting in vaginal births of average-sized kids. I got a very mild case of GD with my first pregnancy (diet and exercise controlled and not until 37 weeks) but didn’t with my second, and my babies were 3.5kg and 3.8kg respectively. In neither case did my doctors hassle me about my weight, and I think that made a big difference in how I was able to handle my pregnancies.
Hang in there and know that fat women have been having healthy babies for millennia! Just look at the Venus of Willendorf: http://tr.im/BOuF We’re a fertility symbol, for heaven’s sake!
A Random Claire
/ October 14, 2009I am currently pregnant too (and over 35, and got that way through IUI)! Luckily for me my doctors have been a little better than yours, although there is one nurse who I swear is disappointed when I go in and she can find nothing “wrong” with me other than my weight. I’m thinking she just wants me to be the bad pregnancy bogeyman for younger, skinnier moms.
When finding that future child did have a higher risk of having Down’s than was “normal” for my age I did have the amnio my doctor offered, because I wanted to, not because they pressured me into it. Luckily both I and future boybaby are both in tiptop health and survived the procedure with little complication – I found going to a good perinatal clinic reassuring (and lucky that I have health insurance and can afford to pay what insurance will not, but that is another rant) as their particular rate of miscarriage is somewhat lower due to the practice the doctors get.
(Also, I plan to breastfeed if I can, but since all other females in my family line have had little to no success, I am perfectly willing to switch to bottle feeding if I can’t, and any breastfeeding police that hassle me will be smacked around the head by my F-cup-and-growing breasts 😉
JeninCanada
/ October 15, 2009We’ll probably never hear from the woman who posted this, but then again we might so I shall ask “But stress, anxiety or depression during pregnancy all carry with them a very high risk of impacting negatively on the development of an unborn child.” Source please? I’ve never heard that before and I’d like to read more. 🙂 Good luck with the rest of your pregnancy and delivery especially!
MargB
/ October 15, 2009Ask and ye: shall receive:
Stress During Pregnancy Has Detrimental Effect On Offspring
The Hebrew University of Jerusalem (2008, October 29). Stress During Pregnancy Has Detrimental Effect On Offspring. ScienceDaily. Retrieved October 15, 2009, from http://www.sciencedaily.com /releases/2008/10/081027140724.htm
Depression During Pregnancy Can Double Risk Of Preterm Delivery
Kaiser Permanente (2008, October 27). Depression During Pregnancy Can Double Risk Of Preterm Delivery. ScienceDaily. Retrieved October 15, 2009, from http://www.sciencedaily.com /releases/2008/10/081023100804.htm
Babies Born To Women With Anxiety Or Depression Are More Likely To Sleep Poorly
American Academy of Sleep Medicine (2009, April 5). Babies Born To Women With Anxiety Or Depression Are More Likely To Sleep Poorly. ScienceDaily. Retrieved October 15, 2009, from http://www.sciencedaily.com /releases/2009/04/090401101743.htm
Postpartum Anxiety Delays Puberty In Offspring
The Endocrine Society (2009, June 14). Postpartum Anxiety Delays Puberty In Offspring. ScienceDaily. Retrieved October 15, 2009, from http://www.sciencedaily.com /releases/2009/06/090610124424.htm
tanz33
/ October 15, 2009Fat preggy women, take heed: there are some non-horror stories out there!
I was approximately 130 kilos (about 300 pounds, give or take) when I became pregnant with my twins almost 5 years ago. I was shocked when I asked my GP about possible complications and was told that, while I had a slightly elevated chance of gestational diabetes or high blood pressure, there was no reason why I wouldn’t have a normal pregnancy and birth. And he was right (there were some complications near the end but they were related to the multiple birth, not my size, and that was made clear to me by the health professionals involved). I had a vaginal birth.
I’m about the same size and pregnant again. While on one hand I am sure I’ll be fine, on the other I am still a little worried about what kind of reception I will get from my midwife when I turn up for my first (8 week) check.
What really gets me though is the way women who have fertility issues are told to loose weight. I got pregnant the first time with no problem, and the second time without even trying. And I really doubt I am the only obese woman out there with that same experience.
Sal
/ October 15, 2009When I became pregnant for the first time, back in 1975, I weighed all of 160 pounds, but my doctor cautioned me, that on account of my weight, I should not drink fruit juice because it had too many calories, and I would get the vitamins I needed from pre-natal vitamins!
Well, that doctor died a few weeks into my pregnancy, and his associate who took over my care, was fat himself. He never said a word about my weight, and mentioned how easy my pregnancy was. He was also my obstetrician for my second pregnancy, which also went well.
I feel sorry for pregnant women whose doctors hound them about their weight. I wasn’t very fat at all back then, but my first doctor was ready to give me a hard time.
Zobo
/ October 15, 2009Thank you for posting this. I am 12 weeks 5days and having to fight my midwives every step of the way to be considered on my general health rather than “omg your fat fat and you were stupid to get pregnant this fat.”
I have PCOS, I’m fat but I am in pretty good health, except that I spent the last 6 months recovering from a major injury that left me unable to walk more than 100 yrds. If that was there concern I could understand it, but not once have I been asked about my excersise history.
I refused to let them do my BMI because its c*** and unreliable. You’d have thought I told them I was smoking 20 a day. I refused to go to the nutritionist, because I’ve been for PCOS and I seem to understand more than they do, plus they tell you your lying which is unhelpful. This was met with raised eyebrows and a comment that I needed to make sure I understood the consequences of my choices.
I told them that as someone recovering from an eating disorder I didn’t want to be told how much I weigh and to be treated on the basis of my other indicators of health, and that I didn’t want to discuss this. Both times with 2 seperate proffessionals I was told “well ok…. BUT your other health indicators might show you as healthy and you can’t be healthy if your fat!”
So far I’ve had 2 appointments and left both angry enough to be stressed and crying 3 hours later. It’s ridiculous. They have told me that unless I consent to BMI they won’t “allow” me a home birth as they won’t know if I’m too fat and that I’ll HAVE to have a caesaerean. This is so much b***s***. In the UK I am legally entitled to give birth at home, so long as I have made informed consent and they have to support me. And fat women can give birth, obv.
I feel a little better knowing I’m not the only person fighting like this.
Patsy Nevins
/ October 15, 2009Best wishes to all the expectant mothers out there. Please be assured that the vast majority of fat women have no more difficulty having babies than thin women do. (BTW, in my childbearing years, I had a nine-pound boy & several other women I knew from La Leche League had babies over ten pounds without complications or any sign of gestational diabetes; we happened to be fortunate to have our babies during a brief window of time when women were being encouraged to eat well & told that gaining 35-40 pounds was healthy for mother & baby. My mother, who was a fat woman, had six babies ranging from 9 to 12 pounds at birth, no complications, no sign of diabetes, nor in most of us since birth ( I have two brothers who were told that they had Type II, given pills, but it magically disappeared, so apparently were misdiagnosed); my mother lived to be 85 & all of us are now between 60 & 77.
I do recall being furious during my first prenatal exam for my second pregnancy because I glimpsed my chart, & the young Family Practice resident labeled me, under possible complications, as ‘obese’, at 5’6″, 156, when this was the weight to which I returned as a young woman after dieting, before too much dieting & compulsive exercise, as well as pregnancy, aging, & menopause, gradually helped me fill out to my genetic blueprint. I was very healthy, fit, & active, as I am now at around 200 pounds, & my only ‘health issue’ was being born with cerebral palsy.
I wish that they could understand that variation in body size is not a disease & that, indeed, women who carry some body fat generally do better at the childbearing business.
JeninCanada
/ October 15, 2009MargB: Thank you! 🙂
Dykestra's Algorithm
/ October 16, 2009“It’s really important that you don’t gain any more weight during this pregnancy. I don’t want you coming back in a month another four kilos heavier.”
Uh, I’m pretty sure that’s not healthy for the baby.
bloomingpsycho
/ October 16, 2009It is ridiculous to tell a person not to gain weight during pregnancy. These doctors need to be smacked upside the head.
WellRoundedMama
/ October 16, 2009Of COURSE you can have a healthy pregnancy and birth as a fat woman….DUH. But you can bet a dime to a dollar you won’t if you continue to have this doctor attend you, because he won’t ever see you as anything but unhealthy and will manage you accordingly. It has a good chance of becoming a self-fulfilling prophecy because of the interventions and extra tests he will think he “needs” to order because of your size.
Try a midwife. Generally speaking, they are more size-friendly than OBs and are more proactive and birth-friendly. Of course, midwives can have fat bias too, just like any medical professional, so you still have to screen them as well….but they are LESS likely to have the over-the-top attitudes (like OMG, you can’t gain any weight!) than docs.
And there are many types of midwives, from hospital midwives to birth center midwives to home-birth midwives. You don’t have to commit to an all-natural birth to have a midwife…but you are more likely to feel able to have one with a midwife if you want one. In fact, research shows BETTER outcomes with midwives than with doctors.
There are lots of positive stories about pregnancy and birth in women of size on my website, http://www.plus-size-pregnancy.org, and on my blog, http://www.wellroundedmama.blogspot.com. I invite you to come and dig around on them a little, maybe even share your own stories there.
Zobo
/ October 17, 2009I have been using both your blog and website to provide my midwifes with research and case studies to help over come their fat bias. I am committed to an all-natural birth but it’s an uphill battle at the moment! I can’t just go to someone else as the UK health system doesn’t work like that, however they have to respect my choices so long as I am fully informed about the “risks.” Your site and blog have been really invaluable in helping me trust myself and my body and to know what to say to proffessionals who are just being ignorant. Thank you!
MargB
/ November 30, 2009UPDATE:
I’m now 29 weeks pregnant and despite all the dire predictions am still healthy and all the signs are very positive. Blood pressure still a boring 120/80, I have been tested for gestational diabetes and do not have it and BEST OF ALL I have a new doctor who is treating me like a human being. The other irony is that without trying at all, without dieting or beating myself up for the occasional ice-cream, I somehow lost 2kg between my 16 and 28 week appointments. I don’t know how this is possible as all I seem to be doing at the moment (like most healthy pregnant women at this stage) is sleeping and eating.
The ultimate irony of all, however, is that because of my weight I am still classified as high risk (even though every test has come back as ‘within the normal/healthy/expected range’)- and hence will be getting two more growth scans of the bub at no out-of-pocket expense. Even though there is no indication the bub is growing too quickly or slowly. All my other pregnant friends are jealous as they have to pay $200 for any extra scan at this stage.
Kez
/ August 23, 2010I also was overweight for my first child, I was told by my anaethesist that i may need a higher dose of the epidural because I was so large. I was so upset by his comment, and it has stayed in my mind ever since, who gives people the right just to say what they think it is so cruel. Anyway I had a beautiful 7 pound baby boy and I weighed 128kilos at my heaviest. My advice is just to stay positive and healthy and enjoy the precious moment being pregnant brings.