Fighting Fat Bias and and the Fear of Faulty Cervixes
Tuesday, October 27, 2009 at 6:49PM A birth story titled “A Curvy Gal’s fight for a Natural Childbirth” was posted on My Best Birth by a woman named Jenne who had something of a conflict with her midwife after refusing an unnecessary induction.
Jenne was curious about her midwife’s recommendation that she get a “Miso” induction.
I was scheduled to get induced initially two days before my due date, but thankfully, I rescheduled. I made this induction appointment after a midwife (one of many at my OB practice) told me that going beyond my due date might put my baby at higher risk of stillbirth. The literature does point to pregnancies that go beyond the 42 week mark as being at higher risk, but I wasn’t even at 41 weeks yet. Of course if a medical professional says, “if you don’t do what I am saying, you may hurt your baby”, you listen. She explained my options: I could have a mechanically induced labor to ripen the cervix (“but who wants to have a catheter inside them?” she added) or I could have a “Miso” induction—which she presented as if it were as harmless as having a cup of Miso soup — “you come into the hospital, we give you a small dose of medicine to ripen the cervix overnight, and you’ll probably sleep through it and go into labor the next morning”.
The midwife was talking about Misoprostol, or Cytotec. Jenne researched the risks of the drug and had questions for her midwife.
So how could she justify scheduling me for an induction that posed so many risks for myself and my baby? This midwife clearly did not believe in my body’s ability to birth. She probably assumed I would have a failed induction and need a cesarean. After some research, I called my midwife to say that I did not want a Miso induction, and that I wanted to wait and go into labor spontaneously.
Her midwife responded with some that sounds like it belongs on My OB Said What?!?
“Well, in my experience, women with BMIs higher that 26 tend to have cervixes that won’t dilate without chemical induction.”
Jenne was concerned. Not only is the Body Mass Index badly flawed, in part because no distinction is made between body weight from muscle and body weight from fat which labels a broad segment of the athletic and similar healthy populations as overweight and obese, but because the idea that a hypothetical 5’ 7” woman weighing 168 pounds (a BMI of 26) would be hopeless in labor without chemical induction is ludicrous. View the BMI Project for a reality check.
Okay—first I was being pressured into induction because of the increased risks of a long gestation to my baby and NOW she’s saying that because I am a curvier gal, my body is somehow clueless about giving birth (by the way, I had NO other risk factors in this pregnancy—no gestational diabetes, no elevated blood pressure, etc) I have since searched high and low for ANY medical study that supports her belief and have come up with nothing. I argued with her that I’d like to give my body the chance to go into labor on its own—at least through the weekend (agreeing to the postponed induction with the foley catheter instead). She was condescending and doubtful, but ultimately said it was up to me.
Jenne noted in the comments that it also “seemed like [the midwife] had a personal prejudice against larger women. I later heard that she referred to patients who had gained too much weight during pregnancy as her “walking wounded”.
In order to gather as much information as she could about actual risks and benefits of induction, Jenne contacted Henci Goer, who hosts the Ask Henci forum on the Lamaze International web site.
I wrote an email to Henci Goer, author of wonderful book The Thinking Woman’s Guide to a Better Birth in hopes for some insight. Henci was so encouraging about my body knowing exactly how to birth. She also sent me links to research about induction—particularly the dangers of Cytotec. Luckily, I also had the support of my wonderful doula, Rachel, who encouraged me to wait it out—reminding me that most first time moms average a gestation of 41 weeks and a day. The day I went into labor naturally marked that average—I was pregnant 41 weeks and a day when I had my baby!
Jenne went into labor spontaneously, labored at home for as long as possible and had a wonderful hospital birth experience.
I went to the hospital at 2:00 pm and my 7lb 9oz son, Nathaniel Hayden Lima, was placed in my arms just two and a half hours later. This birth was the most incredible experience of my life so far. I was truly blessed with a beautiful and merciful birth.
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Reader Comments (34)
Thank you so much for posting this. As a fat woman, my body is seen as broken and wrong already, and this absolutely translates into birth. I purposely searched for providers who were fat positive, and found some, but heard some pretty obnoixous stuff along the way. My first birth was vaginal but with interventions, and one of the midwives who checked on me afterwards told me that I would have to lose weight or have a smaller baby (first was 8lb7oz) if I ever wanted an uncomplicated birth. Well, I guess I showed her, my second baby was a totally natural home birth of a 9lb5ozer! Fat women get told they are not good enough for pretty much anything, it's nice to hear that acknowledged.
BMI is a complete crock, so I haven't checked it in years. Until thought it would be amusing to for this comment. Apparently, I should be dead or something, instead of the reasonably healthy mother of an 8 year old, 4 year old & 7 month old. The last 2 who came in completely spontaneous, vaginal births at about 37 weeks & at 40w5d. Active labour for the baby was about 4 1/2 hours. The fatphobia, blaming & *lies* about the dangers of being fat need to end!
Well-rounded mama has a great blog about birth & about obesity bias.
(the BMI was 44.1, btw, that medwife would've freaked)
I've been thinking a lot about this sort of thing lately and I'm really glad you posted this. It's hard enough to find an unbiased, fat-friendly, knowledgeable health care provide, let alone trying to accomplish that while pregnant.
Her example is funny, since I *am* 5'7" and average between 165 & 170lb. All my babies were born naturally at home - first labor was 5 hours, second was 4 hours, third was around 2-1/2 hours. I guess no one told my cervix that it was incapable of dilating without mechanical assistance!!
Oh, and I have to agree about the silliness of BMI. I started running before my third pregnancy. Although I dropped a good amount of fat - my body hardened significantly and I went down 2 pants sizes - my weight, and thus my BMI, stayed the same. What I had done was drop a significant amount of fat and replaced it with heavier, stronger, denser muscle tissue.
Welllll, from a super-sized midwife who had 3 kids as a super-sized woman, I am here to speak on behalf of the fat women who *do* need help to birth their children. Women who have PCOS not only have a hard time getting pregnant, they often have a hard time getting *un*pregnant. There is a very real biochemical misfire that affects the hormones surrounding birth. The main "fertility" medication is Glucophage/Metformin... the medication used for PCOS/Insulin Resistance.
BMI is very outdated and, besides, each woman has her own set-point for when issues arise. For me, I stop having periods at 280 pounds, but they aren't regular again until I am about 220. For other women, they ovulate perfectly normally until they weigh 375... and still others stop ovulating about 230. It isn't an exact science, so that nurse was ridiculous in what she was saying - it was pretty obvious her fat phobia.
Please know that fat women CAN have issues, even those that test "negative" for GDM. Women don't get fat by eating 1500 calories a day. It is denial to think otherwise. Fat women walk the line between health and Insulin Resistance/PCOS/GDM and the line blurs the fatter a woman is. Working on the diet isn't a bad thing for fat pregnant women. I think it's easier sometimes for me, a very fat woman, to look another fat woman in the eye and say, "Let's work on this together." It's easier for some women to talk to me about their food choices/issues - and I don't mince words when talking about the whole food thing.
Believing that all fat women are perfectly fine is just as bad as thinking that all women left alone won't need a cesarean; it's unrealistic and untrue.
Let's meet each other where the truth is and then birth can unfold exactly how it should.
NGM - all that may be true, but you're painting a canvas with a makeup brush with that statement. The number of women who will fit that bill AND have those problems you've described is not as common as your note would lead readers to believe. Nor is it exclusive to overweight mothers. Many skinny women suffer with PCOS. While obesity is a symptom, it isn't a requirement. You're far more likely to see a skinny woman with PCOS than a woman who truly *can't* and *never will* go into labour, even at 45 weeks with an otherwise healthy pregnancy.
In these cases you speak of, how long did you "allow" your clients to wait before "agreeing" to an induction or cesarean? Were there any other indications that the pregnancy, or baby, were irregular? Pre-existing endocrine disorders? Thyroid problems? There are so many variables in what you're describing that it would seem impossible to truly blame one cause or another.
The other part that bothers me is the lack of citations. Your note seems largely anecdotal - and tone rather argumentative. Unless there's some research on this topic from women who have gone *significantly overdue without "help"* and they have linked the cause directly to a lack of ability to produce oxytocin, even under stimulation (ie, nipples, sexual activity... even in bursts)... I'm skeptical there are enough cases of this to make it worth mentioning.
For the record, in the worst times of my suffering with PCOS I was never more than a BMI of nineteen. I also have a notable hormone disorder that caused a halt in all my growth and maturation at age eight. I underwent treatment at 14, but growth was irregular and damaged. Hormone problems remained: I never "produced" correctly. Despite a constant slew of fertility and hormone problems (including menopause before my 30's) somehow I went on to have three totally normal pregnancies and births: 40.5 weeks, 34 weeks and 43 weeks.
My labours were 44 hours, 2.5 hours and 3 hours - and all very normal. :)
Of course, this is all anecdotal and not really worth a damn... but it's worth putting out there.
Much like those women who truly cannot breastfeed, even a little (it happens, but it's exceedingly rare!), why should we treat the masses with the extreme caution that really needs to be awarded to a fraction of cases...? To those of which have obvious indications without excessive risk? I'd say someone with a history of diagnosed PCOS reaching 44 weeks without a single release of oxytocin for even a set of braxton hicks contractions is a good candidate for consideration. ;)
...But a fat woman at 42 weeks? We all know better than to paint the 100% with the .00001% brush!
NGM, the fact that you consider 280 to be "supersized" says it all. Fatphobia is often the worst from fat women. Most fat women do not have insulin resistance/PCOS, and I would love for you to find a single source that says otherwise. Please check your internalized hatred before spewing it on the rest of us.
Good for Jenne. Educating yourself and then standing up for yourself is the most important thing a woman can do in giving birth. Basing the liklihood of spontaneous labor on BMI is ridiculous. I don't know what my BMI is, but I'm 5'4" and weigh 240 not pregnant (got up to 263 while pregnant). And even though my baby was not in an optimal position (head centered and pushing on cervix) I still went into labor spontaneously and dialated fully.
Great post, Jill, about an incredibly triumphant birth story.
I also read this story from the BBC yesterday about the U.S. maternal mortality rate being a "scandal" (which it is) - and citing the increased risk among obese women as well as the overuse of cesarean. Regardless of the debate about which women are obese and unhealthy and which are obese (by BMI) and healthy, I think this all underscores the need to be even *more* cautious about our use of interventions and cesarean surgery in high-weight women. If obese women are more at risk for complications of cesarean (including death), we should do everything in our power to safely prevent cesarean. That includes *not* inducing women for bogus reasons, undermining their confidence in their bodies, and using unsafe medications when safer alternatives exist.
At the risk of being yelled at (wow, Kristin, easy there...) I just wanted to note that obesity has been found in numerous studies to be associated with an increased risk of postdates pregnancy (>42weeks). Obesity is an established risk factor for postdates pregnancy. Further caucasian and pacific islander race is also associated with an increased risk of postdates, while asian and black women are less likely to be effected by postdates. At last weeks MANA conference an interesting theory was voiced (as yet unstudied) about obseity and it's relationship with postdates pregnancy; that the extra endogenous estrogen secreted by adipose may interfere with the cascade of hormonal triggers for spontaneous labor.
I agree that the midwife in this story clearly had issues with this woman's size, and also agree that her approach was horrendous. I'm coming down on the side of cytotec/miso induction being much riskier than expectant management of an overweight client. I don't think this represents midwifery care *at all*. I'd point out that at 41 and 1 day when she actually *had her baby* she wasn't postdates... But we can argue about the arbitrary 42 week number till the cows come home...
Morag - that's immediately flawed. Blacks have the highest rate of obesity...
http://www.cdc.gov/obesity/downloads/obesity_trends_2008.pdf
Also, postdates =/= never going into labour, and I don't immediately see the relevance of comparing them. There are so many socioeconomic variables.
Hi Kristin,
I need to ask you to please stay respectful of other commenters. A line like "Please check your internalized hatred before spewing it on the rest of us" is too harsh.
Thank you,
Jill
Navelgazing Midwife said: "Believing that all fat women are perfectly fine is just as bad as thinking that all women left alone won't need a cesarean; it's unrealistic and untrue.
Let's meet each other where the truth is and then birth can unfold exactly how it should."
Did something in this post sound disingenous or dishonest? Could you please point me to whatever it was that sounded like "all fat women are perfectly fine?" Or did the post just spark some thoughts?
You're right. Anecdotal all the way. And talking to docs and midwives over the last 27 years, but if it isn't in the literature, it doesn't exist, right?
I was not trying to be argumentative at all. And that I am fat prejudiced is a hoot. I have long been a fat-friendly healthcare provider, making room in my practice to always accomodate fat women... from chairs without arms to the right sized speculums sometimes needed for pelvic exams. But, defending myself is not terribly important... not as important as living the life I know to be true to ALL women, fat or not.
Fat is a hot-button issue and women, myself included, kick back to defend themselves. For at least 30 years, I said things like, "But, I'm a vegan!" "I come from hearty stock," or "I don't know why I'm so fat." The reality is if we all lived the lives of migrating people, NONE of us would be fat. It is those that sit idle and eat more calories than we burn that get fat.
And being fat can -and does- affect SOME pregnancies... depending on how fat the woman is and how well she treats herself and her pregnancy. To discount that is sticking your head in the sand.
280 *is* super-sized. One a 5' tall woman it is. On a 6' woman, it wouldn't be, but how many of us are 6' tall? super-sized is when you are no longer buying clothes in stores, but are buying them out of catalogues or on-line. I am on the cusp of super-sized again. And I weigh more than 280. (Not bragging; it irks me.)
I would hope that *I* was heard as much as all the rest of you. Not just because I am fat or a midwife, but because I have a valid voice, too.
So many things to comment about on this!
First, thanks for posting her story. The rate of induction of women of size is incredibly high, and while some of it is because of a higher rate of complications like GD or PE, often it's because of suspected macrosomia (which actually increases the risk for CS, on average, rather than lowering the risk) or for postdates (women of size do have a higher rate of postdates pregnancy, but we also have higher rates of longer cycles, which often are NOT adjusted for in due dates) or simply because many care providers do not believe that fat women's bodies work when left alone or that they are strong enough or fit enough to have a healthy pregnancy or birth.
The fact is that many of us DO have healthy pregnancies and births, with or without PCOS. Yes, there are some who don't, and I think the metabolic abnormalities of PCOS have a big role in that, and of course there ARE some fat people who really do have messed-up eating habits and/or eating disorders. "Obesity" is a complex issue, one without simplistic answers and generalizations, which i s one of the messages I always try to get across, but one which so many people resist.
NGM, I honor the work that you have done over the years for many women, including women of size. We have met in person and there are many things I admire about you.
However, we will have to agree to disagree about all fat people having bad eating habits and eating disorders. I thnk your own experiences...and the denial of your own binge eating and issues....have colored your views so that you generalize them to all fat people. We all must be lying about our intakes because you were. (I say that with loving intentions, not critical ones, although you may not hear it that way.) What I hear you saying is that we all must be in denial about our habits and that's why we're really fat.
I say that there ARE certainly some fat folk who are in denial, and some who truly have eating disorders. I also assert that there are plenty who do not. I agree with you that pretending that all fat women have healthy pregnancies and no issues is a disservice....but over-characterizing the risks the way the media does is a tremendous disservice too. I completely agree that proactive behavior....good sensible eating and exercise...can go a long way towards mitigating risk....but it's not all about being proactive either, because PCOS can and does do a number too. Sometimes intervention is needed in the pregnancies of women of size, but often, our pregnancies do perfectly fine with a tincture of patience and belief.
I have to run and get my kids from school and can't take time to reread and vet this, so I hope this makes sense and doesn't come across as rude. I don't mean it that way. I just want to make the point that there is more than one truth out there, and that one person's truth doesn't make it true for everyone else. Also that being an outlier statistically (either in weight or length of pregnancy etc.) doesn't necessarily make it abnormal or pathological or harmful.
There is a wide spectrum of experiences in plus-size-pregnancy, from the unhealthy to the completely healthy to everything in between. Not portraying that spectrum accurately is part of what's wrong with media coverage of obesity and pregnancy these days, IMO.
-kmom
www.plus-size-pregnancy.org
www.wellroundedmama.blogspot.com
I was dx'd with PCOS by an RE before I got pregnant with my daughter - went on Met, got pregnant and stayed on it through the first few weeks (worst m/s I've ever had in all three pregnancies, could barely get out of bed) before going off it (when the m/s completely disappeared). Switched to a midwife, had a very uneventful pregnancy, and went into labor at 40+3 - my very first vaginal birth and my body's very first chance at going into labor since the first was a "primary c/s for suspected fetal macrosomia" because I didn't go into labor on my own by 39 weeks. Very easy labor/birth. Gosh was it ever hard for me to "get un-pregnant"! Oh and I was fat to boot (which is probably the only reason I was sectioned with ds - should have seen the red flags there).
I typically love the kinds of things you post, NG, but am I ever glad my midwife has a different perspective on things. You are right, you do have a right to be heard. Thank you for a good reminder to always interview your care provider carefully. One person's dream provider is a poor fit for another.
WRM had a very good post along these lines this week.
Oh and I should have added that the third pregnancy is progressing the same as the other two - Uneventful. As for the PCOS and difficulties getting pregnant thing...that didn't pan out this time as this one was very much an "oops!"
Context and individuality really do need to be king in this issue - assumptions on either part do more harm than good.
Absolutely on the interview front. The consult goes both ways. One midwife's delightful client is another's nightmare. TRUST is an absolute must in the midwifery/client relationship (and it IS a relationship). It is a great thing to know and admit you would or would not be a good fit. This issue is but one of an endless list of topics that can/should be brought up by both the mother and the midwife. I tell women to pick the midwife they would feel comfortable with in a small room for 20 hours; if she annoys you with her quirks in the consult, she will drive you bonkers in labor. And, fwiw, it is not too late to change providers, even near the end of the pregnancy. Your pregnancy, labor and birth are too important to worry about the midwife's feelings. A mature midwife wants her clients (and consults) to find the exact right midwife for them.
KMom: I think what you and I are saying is pretty similar. Usually in these issues, we are pretty aligned. I don't think this is much different. (And you know how I admire you, I hope.)
I will take a second to say that when you say, "and the denial of your own binge eating and issues" would REALLY piss me off if I wanted to take offense at this. Rather presumptive to diagnose my eating issues, isn't it? This type of statement is extremely inflammatory and I would ask that I not be therapized when having a cogent discussion.
But, fwiw, I absolutely acknowledge my compulsive eating issues (my disorder is not binge eating) and fight with them continually. It saddens me that I have so little control over my own eating that I needed surgical portion control - and STILL managed to eat through that over the last 8 years. If someone wants to ASK what my issue might be, then ask. Please don't diagnose me without living with me, being my therapist or being a part of my life where you have been invited in. I admit my issue, but I am hardly proud.
Sorry, NGM, if my phrasing was off. As I said, I was rushing through my reply.
However, you've been pretty frank about your eating issues on your blogs. Seemed to me like you had said before you were a binge eater but I didn't go back to double-check if that was the phrase you used. if you are drawing a finer distinction between compulsive eating and binge eating, okay. They seem similar to me but not being in the eating disorder community, I may not be aware of the correct definitions.
I wouldn't normally make presumptions about someone else's eating, but as I've said, you've been very upfront about your own challenges on your blog and elsewhere, whatever the correct label is.
I just ask that you don't make presumptions about mine or anyone else's, just because of size. I acknowledge your truth is your truth, but your truth is not universal to all fat folk.
I prefer to keep in mind our commonalities rather than our differences, because in many ways we want similar things. Let's keep concentrating on those.
Thank you for the call to move forward concentrating on commonalities and hopefully staying on topic, which is fat bias in obstetrics (more or less), not Barb's personal history.
It looks like multiple commenters took issue with NGM's statement, "[w]omen who have PCOS not only have a hard time getting pregnant, they often have a hard time getting *un*pregnant" because it sounds very absolute. Perhaps it would have been taken differently had the sentence begun with "Some women" or "Some women I have known."
Thank you,
Jill
A side note (unaddressed in my birth story, which you can read on mybestbirth blogs) is that about 10 years before my birth I was diagnosed with PCOS. I was only put on "the pill" to address the symptoms, which were pretty mild and cleared up somewhat. I had no issues becoming pregnant (happily unplanned), and I would argue that I really had no issue getting un*pregnant either. Perhaps this isn't typical, but it seems that every woman's pregnancy/birth is unique and--whether she be slim or curvy--needs individual assessment and above all encouragement.
My practice never asked me if I had been diagnosed with PCOS, so it wasn't an issue for me or them. I wasn't writing the story in defense or in celebration of my size. I certainly ate (and currently eat) many more than 1500 calories a day, and know that my physical being is one I am responsible for creating and maintaining. I DID write the story in defense AND celebration of my body's ability to birth a child, on my own terms. Even if there is evidence that a woman like me (5'10, 40-50 lbs "overweight") might have some challenges, what good is a practitioner that does not believe in that woman's ability to have a baby with minimal interventions? Yes--practitioners should be mindful that size can be one of many factors that negatively impact a pregnancy and birth. But a high BMI should not be an induction-SENTENCE (as mine seemed to be). It should not be this showstopping factor that dooms a woman to standard interventions. A BMI is a number and it can be challenge. But it certainly isn't the whole story.
There is obviously so much emotional charge to the issue of weight. The midwife I spoke of even told me about her struggles with weight in the past, saying "I was once a fluffy girl like you, and unfortunately I didn't get it under control until I developed diabetes..." I believe she was trying to be helpful, but one can certainly detect a degree of (former)self-loathing, however battered in good intentions.
Fat-phobia and even hatred of obese individuals is so deep seated in our society. I see it getting worse as our media (and sadly, in my opinion, our government) amps up the "war against obesity". Even if this "war" has the best of intentions (I agree the health statistics for kids nowadays are downright scary) it's an avenue for intolerance and discrimination that is bound to have some casualties. And as a former fat kid, i was miserable enough without the billboards and hoopla we see now. But that's really another story.
The story excerpted here is not about what I learned about my weight, but rather what I learned about my strength. I learned to trust my intuition and to trust that my body could give birth, despite what a caregiver thought. I don't think I would have had such a beautiful birth if I wasn't encouraged to believe in myself and my body (thanks to my lovely doula, emails from Henci, and great midwives).
Jill -
Definitely. It would have been far, far more accurate to say, "a very small number of women..." rather than "some" or "[all] women who have PCOS" or even "a bunch of ladies I knew".
I think as mothers fighting against the medical model we have ALL heard these phrases way, way too many times to bully us into believing things we know aren't true. We've all heard the 100% treatment for the .1% of cases, and the fight we get for refusing it, let alone admitting outright to our care providers that what they're saying just isn't true.
To be honest: the phrase seemed utterly ridiculous and a complete non issue. Rare enough (and so incredibly difficult to prove given other factors, and the common lack of "allowing" women to progress far enough into pregnancy to really prove they are physically incapable of producing a steady stream of oxytocin) to not even worth mentioning. It seemed alarmist and unnecessary. Yet another thing for fat pregnant women to worry over... which was ironic on a post about fat bias.
HI Ladies,
Well, I am pleased to see so many women of size speaking up for themselves. I was sort of diagnosed with PCOS. I've struggled for years with problems that all point to PCOS, but my doctor always diagnosed me with "fat and lazy" syndrome. I felt like such a failure. No matter how hard I tried or really dieted and exercised, I was stymied at every turn. I even had a doctor suggest I go see a therapist for my eating problems, which were not problems! I kept a food and exercise olg, which showed I should be losing weight, but he insisted that I was lying in the logs!!!
So, I finally went back to the doctor I had seen for about 8 years and I told her I was not leaving her office until she found out what was wrong. After much discussion, and me mentioning that my thin sister was diagnosed with PCOS, she suggested that I could have the syndrome, but would not diagnose me. Since I did not have a glucose intolerance or apparent cysts, she would only say I had a metabolic syndrome and she put me on Metformin and birth control pills. I was fine with the MET, but I was angry over the bc pills. Firstly, when I was put on the Depo shot by her, my hormonal symptoms went crazy, when I brought this up, she said I would get used to it, and it wasn't the shot, it was undoubtedly my lifestyle! What a joke! Now, Depo has a black warning label on the box. Also, I had said that we wanted to conceive and were trying, which she informed me that it was not a good idea or really even a possibility at my weight or with my hormone imbalance. She was so insensitive and left me with the impression that I would never have children, so just take this medicine and shut up. Then when I did conceive, she refused to prescribe me any more medication, even though my OB and Midwife asked her to. She claimed that she wasn't comfortable prescribing for a patient like me (meaning one of size that was pregnant).
I decided to tough it out with the metformin and I did research about eating and exercising that fit into a PCOS control program. I also learned about herbs and vitamins that supported my fertility and menstruation. I lost 60 pounds in a year and happily conceived almost a year to the day after I was informed that my health would not let me conceive. I am now in my 7th month and carrying a very healthy baby girl. I am working with a midwife and OB who are very supportive and fat friendly. I have gained within the guidelines and I am having a very healthy pregnancy filled with good food, supportive herbs and lots of exercise and yoga. I, and many other large women, are proof that a normal pregnancy really is normal for women of size. My sister, who was well within weight guidelines when she conceived both her children, had pre-toxemia with both. She was thin, but was not healthy when both children were conceived. She smoked, rarely exercised, and lived off of junk food. She now sees the correlation. Not all thin women are healthy and not all fat women are unhealthy!
Thank you to all the brave women who are changing the view of chubby mamas everywhere! We are just as valuable and capable as our skinny minny sisters!!! Bright blessings to all of you!
Hi Everyone,
I am very intrigued by this post and the comments and thought I'd share my story.
I am 26 years old and just had my first child (a boy, 5 months old). I am 5'3' and weighed 172 when I became pregnant. This was a very high weight for me- I am most comfortable at 140 or so, but I had just let my weight get out of hand, not exercising enough and eating the same foods as my ever-skinny-no-matter-what husband. In any case, I don't have PCOS and became pregnant the first cycle I had after stopping the nuvaring. I was initially using an OB/GYN practice for prenatal care and was planning a hospital birth until I realized that the hospital I was planning my delivery had over a 40% cesarean rate. At 29 weeks pregnant, I switched to a homebirth midwife. I took hypnobirthing classes, posted affirmations all over my house and looked forward to welcoming my baby in my own home.
Well, I ended up gaining 74 lbs during my pregnancy and was 246 lbs when I had my cesarean. The last 30 of it happened in the last 8 weeks. I don't think I was eating my way to a 74 lb weight gain. I was actually eating healthier than ever and walking every day (even though my back and pelvis hurt so bad I thought I'd cry). I lost 36 lbs the week after my birth, and I have since lost 58 lbs virtually effortlessly. I had major water retention- terrible pitting edema, and polyhydramnios. My midwife had me drinking 3 cups of dandelion tea daily, taking 10 alfalfa tablets with each meal, drinking carrot cucumber celery and sea kelp juice and eating the white rind of watermelon to induce a diuretic effect. At 40 weeks 4 days she had me get a biophysical profile which suggested a large baby and polyhydramnios. She was very concerned about the size of my baby's head (15.5 inches circumference), the fact that I had a narrow public arch, no dilation and a baby whose head was still ballotable. I also starting spilling protein in my urine and my blood pressure was rising, although it still wasn't considered "high." I did not have GD.
At 40 weeks 6 days she called me and said that she thought a vaginal delivery had the potential to be very dangerous for my baby. She told me that a cesarean delivery was probably our best option, and I cried and cried. We drove to the hospital that day and talked to a very pro-birth OB (who used to run a birth center and whose own children were born at home with midwives). He also agreed that vaginal delivery posed a risk to my son, given his size and the fact that my body wasn't dealing well with pregnancy any longer. I had a terrible recovery. It took my a good 13 hours to stop vomiting and finally open my eyes and see my son, and it was 16 hours before I could attempt breast feeding. Despite all this, my OB sent me home the next day and let my midwife handle all of my follow up care. I was in the hospital only 36 hours.
My midwife said that for the next baby I need to get my weight down before becoming pregnant, and to limit my weight gain (and try earlier to keep the water weight off). For the record, she is a fat friendly practitioner, but believes that my body in particular needs a smaller baby for a vaginal birth. I have started to really wonder what my odds are for an uncomplicated vaginal delivery. Especially because of my family history. My mother actually started labor with me at 43 weeks 5 days with her water releasing, labored for 48 hours and only accomplished 3 cm dilation before having a primary cesarean. I weighed 9lbs 15 ounces. My son was 10 lbs 1 ounce. His head was 15.5 inches around.
I'm planning another homebirth if and when I decide to have another baby. But I have started to feel defective, and I seriously wonder whether my body is capable of birthing babies. Any input/suggestions are welcome.
Thank you for this forum.
I am a big mama. I am 5'8" and currently weigh 303. I have never had PCOS. I have spontaneously gone into labor twice (6 and 7 days early might I add). I do not have eating issues. Unless you count food alergies as issues. I recently gained 17 lbs in 6 weeks bc my food allergies were flairing up again and I could not control them. Complicated by Hypothyroidism. So the next time you see a big mama, dont assume you can put her in the binge eating or PCOS box. Some of us dont fit.
New Mama... I feel so bad neglecting your comment. I need to sit down so I can write more. In a nutshell, congratulations on your little one and becoming a mom, and I'll write more to address your question about what the odds are for an uncomplicated vaginal delivery. Hope you are well. -Jill
New mama,
A number of things struck me in your post but I wanted to mention your significant back and pelvis pain. You may have had SPD, and chiropractic care might be able to help lessen that pain next time. No way to know for sure now, but you might want to consider having your back and pelvis evaluated by a webster-trained chiro. That can sometimes also help maximize the pelvic space available for the baby to get through.
You can read more about SPD on my website, www.plus-size-pregnancy.org, and there's also a FAQ there on how to find a good chiro trained in pregnancy.
Well rounded mama:
I actually went to the chiropractor every other day or so at the end of my pregnancy. She would do webster, have me walk for one hour and then adjust me again. Sadly, it didn't do any good :(
Dang, I'm sorry that it didn't help! However, I wouldn't give up on it yet.
First, did she actually adjust your pubic symphysis itself? They often don't, but that's often one of the root causes of SPD. Whenever I hear about chiro not helping, I always wonder if they have looked at this and often find they didn't. Or that they didn't pay enough attention to the various ligaments and soft tissues around the area.
Second, you may need more in-depth work that you just didn't have enough time for at the end of pregnancy. You are in the perfect spot to do such work right now, between pregnancies, without the interference of relaxin and progesterone, which tend to loosen the ligaments and make it hard to hold an adjustment. You want someone really SKILLED in working both the soft tissues and the pelvis itself.
Chiropractic care is not a cure-all and doesn't solve everything. I can't promise it would help here. But I have a friend who did chiro care in pregnancy, ended up with a hard cesarean with a posterior baby, and shrugged off the whole chiro thing because it didn't help. In her next birth, though, she decided to try it again, only this time she found a more skilled practitioner and had some really in-depth work done by one of the *teachers* of Webster Technique, as well as some supportive massage therapy. There was a lot of work to be done, but I think she feels strongly that it was much more in-depth this time and much more helpful.
She went on to have a VBAC and a much easier birth. Was it the chiro care? Who knows. Probably it wasn't the whole reason....there are always so many factors that go into this. But we both think it was a big part of things, and that the care she received before just hadn't addressed her issues deeply enough. Between pregnancies is the perfect time to do some work on this, if you are still interested.
Best wishes, whatever you decide. And I'm so sorry you had such a hard time recovering after the c/s. Have you been in contact with ICAN? www.ican-online.org