Obesity And Pregnancy: Time To Change The Conversation
On Sunday, the New York Times published Claire Putnamโs article Pregnant, Obese … and in Danger.
Like most articles about obesity and pregnancy, it focuses on the increased risks and calls for care providers to have frank conversations with their patients about their weight.
The reality of โhealthโ and how plus size women are best supported, however, is much more nuanced. These conversations may very well have the opposite of the intended effect.
The framework of such conversations must be one of compassion and support, rather than fear and shame.ย
Studies have proven that when people of size are shamed by their care provider, they are less likely to receive routine medical care and more likely to gain weight.
I hear from plus size women nearly every day who have been told by care providers that their โvagina is too fatโ to birth their baby or they need to have a c-section based only upon their BMI. Obese women do face increased risks in pregnancy and birth. They need to be informed of those risks in a straightforward manner, rather than being scared by exaggerated possibilities or subjected to additional risky medical interventions only because of their weight.
Related: 4 Things No One Tells You About Being Plus Size and Pregnant
Articles like Putnamโs tend to be fear based and donโt share uplifting stories or positive research. For example, there was a study by Oxford University that found otherwise healthy women, did not have as increased risks associated with obesity as have been previously reported. โThe chances of first-time mums of normal weight having medical interventions or complications during childbirth are greater than for ‘very obese' but otherwise healthy women having a second or subsequent child.โ
All pregnant women, regardless of size, can reduce their risks by being proactive with their nutrition, remaining physically active, managing stress and by paying attention to weight.ย โHealthโ cannot be reduced down to a BMI. Many plus size women are perfectly capable of healthy pregnancies, but you wouldnโt know that from what you see in the media or often hear in a typical prenatal consult. Focusing narrowly on a number on the scale misses the bigger picture of โhealthโ and can sabotage the efforts of women at a time in their lives when they are more motivated than ever to make positive lifestyle changes to benefit their precious babies.
Itโs time to change the conversation about obesity and pregnancy. Rather than only focusing on the risks and making people feel ashamed about their bodies, itโs time to start promoting positive information and resources to empower women to make healthy decisions. This includes not classifying women as high risk based only upon their BMI and thus limiting their options during childbirth.
We need to stop placing the blame for poor outcomes solely on obese women and start looking at the entire maternity care system. When healthcare providers are size friendly and practice evidence-based, compassionate care, patients are more likely to follow their advice. That can make all the difference.
- Plus Size Pregnancy Confessions: We Listen and We Don't Judge - December 15, 2024
- Plus Size Pregnancy Bumps: From D to B-Bellies, Love Your Shape - August 18, 2024
- 17 Plus Size Pregnancy Myths and Facts That Might Surprise You - June 11, 2024
Being a plus size momma myself it really breaks my heart seeing articles like Miss. Putnam’s!! My pregnancy was perfect.. No morning sickness, gestational diabetes, deficiencies, HBP, or any other “normal,” or serious pregnancy issues. My daughter came 5 weeks early weighing 5lbs 7oz and was in perfect health… Suffering from Hoshimotos disease I have gained so much weight from my norm. Society doesn’t define me! They can think what they’d like, because I’ve had a better pregnancy than my “skinny” friends!
Thank you for sharing your story Katlyn and I love what you said about how society doesn’t define you.
I hate the fact that articles like that are being published. It seem so much more like fear-inducing propaganda than actual fact. It totally perpetuates ignorance and hate.
I am a “morbidly obese” mother of 2, had no issues getting pregnant, no health issues during the pregnancy and no issues during labor and my munchkins came out perfectly healthy (7-1 and 6-10). My OB for my second was horrible to me at the end. She didn’t mention anything about my weight til I was 8 months pregnant and when she did, she said “You are way too overweight. You need to lose weight or you’re gonna die.” First of all, who says that to a woman who is 8 months pregnant?! And second of all, with no previous mention of weight and no health issues to speak of, where the hell did that come from? I was even more livid when reviewing my medical records for the pregnancy and I saw that she had noted “Maternal Obesity negatively affected pregnancy” although in the same note she put “pregnancy and labor were complication free.” The fact that doctors treat patients this way and allow their personal prejudice to influence care is atrocious!
Luckily, I was able to find a Primary Care Doctor who has been amazing! Her words: “Yeah, you’re big, but you’re healthy, so who cares?” I have been going to her for a year and a half and I hope I NEVER have to change doctors! Now, I am embarking on my new journey of being a surrogate. Sadly, plus size surrogates are constantly berated and attacked by our thinner peers. I have had other surrogates say “REs are lowering their standards, seems they’ll accept anyone” and “I don’t care what you say, once you reach a certain BMI, I can’t believe it’s possible to be healthy.” The RE, Agency and IPs all think I’m an excellent candidate due to my previous pregnancies and labors as well as my health history. I passed my medical screening with flying colors and despite the hate thrown at me by other surros, I am determined and optimistic. I can’t wait to prove them all wrong!
Rachel I’m always in shock when I hear stories like yours, regardless of how many times I hear them. I’m so incredibly sorry your care provider said that to you. I’m glad you connected with a size friendly health care provider now and are on a surrogacy journey. I hope you won’t listen to those people who don’t have anything kind to say. I don’t understand how people get off saying such hurtful things. I wish you all the best and anytime you’d like to share more about your journey for my blog, I’d be delighted!
I just saw your reply to my comment! A little late. LoL But I would love to share my story with you and let you know how everything goes. So many families are looking for a wonderful surrogate to help them grow their family and now that more doctors are understanding higher weight doesn’t always mean unhealthy or more complications, more women who were not accepted as a surrogate before will be able to help families fulfill their dreams! ๐
I think articles like this are ignorant, I know thin people who are not as healthy as I am and could never walk 5ks and 10ks like I do to keep active! I am 6 1/2 months pregnant and apart from a bit of heartburn have had no issues whatsoever. I lost 5 stones before I got pregnant for myself but am still big and as soon as my bmi was measured that was it I needed to be monitored more. They have never found any issues I have only put on 17lbs through my whole pregnancy so far and im signed up to walk a 10k at 32 weeks pregnant and I am looking forward to it. I know many people who are slim but could never manage it. Bmi should not be used in this way you can have a bigger bmi and be perfectly healthy, apart from getting my gallbladder removed last year I have never been seriously I’ll in my 34 years so why would I suddenly be I’ll when im pregnant a perfectly natural state for a woman. Keep your heads up ladies we are bigger, beautiful and very capable!!!! I love this blog ๐
Emma thank you for sharing your story. Women of all sizes can have healthy outcomes! That’s so awesome that you’re doing a 10K at 32 weeks pregnant. Go you! I was obsessed with water aerobics during my pregnancy ๐
I am obese, and my husband and I have been trying to get pregnant for over two years.
Every doctor, or person I ever told we were trying to conceive assumed it was because my weight that we were not pregnant yet. Ever since I was a teenager (and wasn’t even trying to conceive, or even having sex!), and even two weeks ago, doctors have told me I was either going to kill my (unborn) baby during pregnancy or delivery, die myself during pregnancy/delivery, or, that in the very least, my baby will be fat, and therefore unhealthy and unhappy..
After many tests, it turns out I am in perfect health and that there is nothing “wrong” with me, other than my BMI that is (according to doctors).
The one test they did on my husband however, showed that his semen count and mobility is incredibly low and that we, most likely, will never be able to get pregnant without the aid of IVF.
However, they will not perform the IVF because of my BMI..
So on our last doctors visit our doctor told me I should lose 36 kilo’s, preferably in 3 months time (because in three months I will be 37 years old, apparently an other “risk” factor..).
When I asked her how I could possibly lose 36 kilo’s in 3 months, she only replied: ‘I don’t know, that’s not my field of expertise. Try surgery’.
(I am NOT getting surgery.)
She even told us, that studies showed, women who lose weight will become pregnant more often!
(All I could think was: ‘Yes, of course that is true, because you will not perform the IVF otherwise, duh!’)
I am in the Netherlands and rules/regulations are different here and I can’t just “get” an other doctor.
Sorry for the rant, but these last few weeks have been incredibly frustrating and sad…
I just don’t understand your care provider’s logic. Rapid weight loss can be dangerous! That’s over 70 lbs in 3 months. Even if you did surgery, you can’t attempt to get pregnant for 1 year after surgery. So what was this care provider trying to do?? I’m always baffled by this. I’m so terribly sorry Sarah!
Hi Sarah,
Can your care provider not refer you to someone who can help you with weight loss? They are putting a lot of pressure on you to loose a big amount of weight.
If you do want to go for it and look at loosing weight i can give some advice because i lost 5 stones in 2 years before getting pregnant.
The first thing i did was get hypnotised and they did virtual gastric band work, so the benefits of the surgery without the actual surgery and i lost 2 stones with that. Then i needed more help i.e. What to eat and quantities and i went to a weight loss support class called Scottish slimmers and i have lost 3 stones with them! They suggest loosing 1-2 lbs a week to be healthy.
I hope that this helps you in some way and i wish you happiness whatever happens.
Emma
I was told by a nurse at my doctors to loose weight or my risk of miscarriage would be higher…after trying for over a year I fell pregnant and had an ectopic…so now blaming myself!
I’m incredibly sorry for your loss Carrie.
Hi Carrie,
I am so sorry for your loss!
I am also sorry about the way you have been treated as miscarriages happen for many different reasons. Also ectopic pregnancies as far as I am aware are not linked to weight.
Please don’t blame yourself babies either come into this world as babies or angels, you had an angel. This does not mean you will not be able to have a healthy baby in the future.
Please get some support and someone to talk to because this isn’t your fault.
Take care
Emma
I’m actually kind of pissed that their comment section is closed on that article. I’d love to thank the author for being part of the problem that could have cost me my life. I was around 256 when I because pregnant and around 295 when I gave birth. Half way through my pregnancy I ‘failed’ my gestational diabetes test due to a pre-existing insulin resistance issue (dating blood sugar has been 105 since my early 20s, no after food issues at all) that was well documented on my medical history and no amount of perfect A1C numbers would let them see anything different. So I was transferred to a high risk OB that was a giant asshole and began our first appointment with ‘I’m enducing you at 37 weeks because your baby is going to be huge’ NO tests or measurements at the time to even verify that, just that’s how it will be. Fast forward a few months, I start having blood pressure issues, they start all the testing for pre-eclampsia because all fat girls have pre-eclampsia. Everything comes up negative except my very high blood pressure with is usually exceptionally low. This continues with multiple 24 hour urine collections, me complaining of being extremely tired abd it all being brushed off as ‘you’re obese and pregnant’ I was induced at 37.5 weeks through the prompting of another doctor in his office after the nurse took my blood pressure with the small cuff and announced my BP was 200/100 (it was not…I’d just come from an NST it was 185/90 still high but not how are you alive type high), I was so tired and sick of arguing I agreed to the induced. I managed a vaginal birth to a HUGE 6lb 2oz baby through pure stubbornness dispute a nurse telling me that I’d be the afternoon c-section… And three weeks after my beautiful son was born the real reason for my insane fatigue, lack of end of pregnancy weight gain and high blood pressure was discovered. Hodgkins lymphoma, stage 2b. Thanks for being assholes about my weight and continuing to focus on that as the root of all my problems instead of actually figuring out with the issue was, had anyone run a simple blood panel, I would have known nearly 3 months earlier and been able to avoid some of the treatments that may have robbed me of the ability to have any more children.
Wow Callie! What an intense story. Thank you for sharing because your story is one of many and people don’t realize that until they actually hear these heartbreaking stories. I hope you’re doing okay now.
I’ve been in remission since April and finished treatment last September. I would hesitate to say I’m fine, but I survived cancer and each day gets better.
I’m glad that each day things keep getting better!
I’m a plus size mom, i gained 80lbs the last trimester of my son due to my job. i birthed a healthy 9.4lbs baby boy who came at 42wks by csection last May. now I’m currently 5mos pg with a lil girl who’s due in Sept and she popped out right away and getting bigger faster than my son.
Thanks for sharing your story!
I was 250 pounds when I became pregnant with my now 5 year old. My doctor said he would not treat my pregnancy as high risk just on my weight alone unless I developed complications. He was honest about the possibility of complications but did not automatically treat me as high risk just due to my weight. I only gained 15 pounds during my pregnancy. I did develop preeclampsia at 34 weeks and was induced at 36 weeks. My doctor had the goal of it being a vaginal birth but after 24 hours with no progression it was an emergency c-section. My son was 5 lbs 2 oz. I did deal with secondary infertility as I suffer with depression and PCOS and gained up to 300 pounds after his birth. Thanks to PCOS I do not ovulate at that weight. I have lost back down to 250 and am now ovulating and having fairly normal cycles again. We are trying for number 2 now. I am still trying to lose weight but have been stalled for a long time. I am worried about preeclampsia again as I do know it is a risk but I’ll be 35 this year and can’t wait forever. I am a lot healthier and happier at this weight than at my heaviest. It is not perfect but I am healthy other than my BMI and PCOS but then I had PCOS as a teenager at 160 pounds so it’s not going away any time soon. I don’t have diabetes or high blood pressure. All my blood work was normal. I lost weight to help my menstrual cycles regulate which they did but don’t feel I need to be thin to have that second baby.
Thanks for sharing your journey with us and I’m sending ***baby dust*** your way!
I am 5 months pregnant and was 275 when we conceived. We weren’t really trying to concieve but we weren’t really trying not to either. I don’t have any health issues or conditions other than obesity. So far, no weight gain. All tests given have produced normal levels… I received a bill in the mail from the doctor’s office and thought it to be in error. When I called, I was told that I had been designated as high risk from my doctor which then meant that my appointments were “specialty” with an added cost. I emailed my doctor asking if there was a reason other than my weight as the cause for her designating me as high risk. Her response was no and that she had gone over the elevated risk of gestational diabetes and preeclampsia with me due to my weight. I was taken aback and in shock that although the tests all came back as normal, she still had me as high risk because of my BMI…. and didn’t tell me. I think that if she had taken the time to speak to me as an educated, aware person I may have understood her reasoning a bit better. Although my blood pressure has been normal, I recently received an email from her suggesting that I take low dose/baby aspirin daily as it has been linked to lowering rates of preeclampsia. I don’t know if in her experience all overweight women that she has treated have developed preeclampsia but it bothers me… after discussing with my husband, we decided to not challenge her reasoning further because if it means I get more treatment then we are fine with that! We’ve also discussed with her our goal of a vaginal birth and she seemed on-board. I’m not sure what to think as I haven’t felt shamed exactly but more or less questioned on whether or not I am able to have a healthy pregnancy. And it seems to boil down to my weight.
Thank you for this article , I am really glad I found it through Pinterest . I am 7 weeks pregnant currently and I was really scared what will happen , will my doctors treat me correctly , will I be able to give normal delivery coz I weigh 220lbs on my conception , I feel really motivated by hearing so many success stories. I am less scared now Thanks
I am considered obese. I’m 5’7 and was just over 200 when I got pregnant. I have had regular mensural cycles and it took my husband and I only 3 months of trying to get pregnant after his vasectomy reversal. I’m currently very early (9 weeks) but my ultrasound turned up a healthy heartbeat of 167 bpm. “Everything looks terrific!” and “I would have to get a doctor if there was something wrong.” my radiographer said to us. I have always been an athlete and I am very strong (stronger than my husband :-D). So I do not feel that a BMI chart defines me, but it also doesn’t represent those of us that are more muscular than our thinner counterparts. I don’t have high blood pressure and I eat relatively well most of the time (darn those cravings!). Articles like that, really anger me. They don’t know me, my story, or my background. Shame on them!
I am very happy for anyone who has had a healthy pregnancy without complications, despite their pre-pregnancy BMI, and I do find it disturbing that some people tend to communicate scientific information in degrading and shameful ways! But, as a scientist who works on the effects of maternal obesity, I think it is important for women to understand the effects their body can have on their child’s development. It’s great if you managed to avoid the immediate pregnancy complications for you and your child, but a lot of new research is finding there are likely effects on the child’s cognitive and behavioural development as well. There is fairly strong evidence that maternal obesity is linked to cognitive deficits, reduced academic performance and behavioural problems. This is besides the increased risk for the child to become obese in their lifetime, have hypertension and increased inflammatory markers. We need to work on communicating scientific information in a factual way, without shame, because this information is very important to disseminate. We should love our bodies, but we also need to stress the importance of a healthy living, for us and our future generations.
I’m interested in learning more, as from what I’ve read, the increased risks are present but small when we look at the actual risk and not the relative risk. Talking about increased risks is important because it empowers people to be proactive with their health throughout preconception, pregnancy, and postpartum. With that said, so often, the information is presented misleadingly. Thanks!