Plus Size Stigma within the Medical Community
Plus size pregnant women were the topic of multiple news articles last week. Including OB-GYNs in Florida refusing to work with larger women, and plus size women having more โnecessaryโ interventions during birth.
Up until this post, my blog has consisted of me sharing my story in hopes of inspiring other plus size women to have healthy and empowered pregnancies.
Today, however, I shall climb upon my soapbox. Iโm standing strong for plus size womenโs bodies and our ability to birth healthy babies vaginally!
Today Iโm speaking out about the plus size stigma within the medical community.
Plus Size Stigma
There is a stigma associated with being plus size, and frankly, a lot of individuals who just donโt want to be associated with larger people. Unfortunately, this is also true within the medical community where there is a clear plus size stigma.
I believe women should not be automatically classified as โhigh riskโ due to their weight. Not all OB-GYNโs agree and this was evident in Sun Sentinelโs articleย about OB-GYNs in South Florida turning away overweight women.
โSolomon and Otero donโt want to begin seeing heavy women and then have to send them to specialists if they later develop problems, said their office manager, who asked not to be named.โย ย This woman went on to say,ย โThis is not a high-risk practiceโย andย โThey are not experts in obesity.โย
Related: Feet In The Grass: When Birth Trauma Is Triggered
Plus size women are going to get pregnant no matter how many narrow-minded OB-GYNs close their doors to them. Women of all sizes need to find supportive medical providers who will honor their wishes.
There was another article last week from theย Montreal Gazetteย about the propensity for plus size moms to birth via c-sections.
Overall this article frustrated me but there was a voice of reason:ย โAbenhaim and his co-author, Dr. Alice Benjamin of the Royal Victoria Hospital, are challenging doctors to change the way they manage labor in obese women โto allow equal opportunity for a vaginal birth for all.โโย ย Rather than degrading women by refusing to provide medical care, letโs empower them to have healthy pregnancies!
Medical providers should talk with a plus size woman about her ability to give birth vaginally without pushing interventions upon her.ย ย In turn, Iโd like to think women will embrace their bodiesย and continue to lead healthier lifestyles after giving birth.
My midwife sure empowered me!
Other than my weight Iโve always been a healthy woman. When I became pregnant I knew it wasnโt ideal because of my size and I became aware of risks to my baby and me. I immediately made a commitment to do anything possible to remain healthy and active.
According to my BMI, I was categorized as โmorbidly obeseโ but according to my midwife I wasnโt โhigh risk.โย ย At the beginning of my pregnancy, I was working with an OB-GYN and was given the standard โdonโt gain more than 15-20 poundsโ speech. I didnโt find this very helpful. When I started working within the midwifery model of care I felt fully supported.
Related: From PCOS to Motherhood: Meganโs Storyย
My midwife and I had long talks about the healthy choices I was making and that I had the ability to birth a large baby. She never once made me feel like I was going to have a c-section.
I realize there are compassionate OB-GYNs who provide this level of care and not all midwives are as wonderful as mine.ย ย That is why itโs critical to ask a lot of questions when selecting a medical provider.
As a plus size woman, I knew without a doubt that I would have a difficult recovery and higher odds for infections if I birthed via c-section.
The Montreal Gazetteโs article stated,ย โA study of nearly 12,000 women who delivered over a 10-year-period at Montrealโs Royal Victoria Hospital found that doctors are far quicker to call for a C-section on women with higher body mass index, or BMI.โ
I want to make it clear I believe c-sections and other medical interventions are at times very necessary and save lives. With that said, Iโve spoken to plus size women who feel robbed of their birth experience by being made to feel like interventions were their only choice.
Along with the comments about c-sections, I was discouraged by this quote: โTheyโreย (OBG-GYNs)ย also more hesitant to use forceps on an obese mother to pull the baby out.โ
What about not forcing a woman to deliver on her back to accommodate the OB-GYN? How about moving her onto her knees, allowing gravity to help the baby move down? I donโt say this as someone with a medical background. I say this as a โmorbidly obeseโ woman who pushed for only thirty minutes and delivered my son on my knees!
What can plus size women do to reverse this rise in interventions, c-sections, and doctors refusing to work with larger women? What can we do to reduce this plus size stigma?ย
Work with a supportive healthcare provider!
If an OB-GYN isnโt โsize friendlyโ then a plus size woman probably wonโt have a dignified birthing experience. By being empowered with a supportive healthcare provider, women will receive more guidance around eating healthy and being active throughout their pregnancy. Itโs important to know firing a current provider is an option if they arenโt meeting the needs of the woman or pushing an induction or c-section.
Hire a doula!
I really encourage all pregnant women, especially women who are planning a hospital birth, to hire a doula.ย ย
Doulas decrease the odds of medical interventions and working with a doula has been proven to shorten the length of labor. As a plus size woman, I had some anxiety around inviting strangers into my birth circle. Iโm so glad I overcame my fears and worked with an incredible doula who advocated for me throughout my natural hospital birth.
Related:ย Do I Need A Doula?
ย
Write a birth plan!
Make sure wishes are clearly stated by writing a birth plan and reviewing it with the chosen medical provider. Of course, a lot can happen during birth that cannot be controlled or planned for in advance, which is why my birth plan began with this simple statement: โWe are completely aware that everything may not go according to our plan but hope youโll support our desire to have as close to a natural birth as possible.โ
I also wrote a birth plan for a c-section. I firmly believe medical providers who arenโt amenable to birth plans wonโt be as likely to respect a womanโs desires during birth.
Related:ย Best Laid Plans: Creating a Birth Plan
ย
Speak up!
When articles are written with such negativity around plus size bodies, write a letter to the editor. I wrote one responding to OB-GYNs turning women away and it took me fifteen minutes. Advocate for plus size pregnant women by sharing positive articles and informative websites. Womenโs voices are valuable and should be heard.
I canโt change the way people view plus size pregnant women or rework the BMI chart to be more realistic. What I can do is use my voice and help others to find theirs!ย ย
Plus size women have normal healthy pregnancies and natural deliveries all the time. I should know because Iโm one of them!ย ย
Below is a poll from Plus Mommy Facebook pageย showing the majority of the 242ย women surveyed had vaginal deliveries.
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- Plus Size Pregnancy Confessions: We Listen and We Donโt 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
Brilliantly stated! And please, feel free to stand up on that soap box more often!
I found this blog a few days ago and it was honestly a God send. I am plus size and ttc. My OBGYN slapped the to fat to push (as I call it) stigma on me. On our first meeting she told me I had to loose close to 100lbs before I could have a "normal" and "healthy" pregnancy. She also said that if I were to get pregnant I would be high risk, because I WOULD have hypertension and I WOULD have gestational diabetes. Then she started talking about how I was probably infertile due to my size anyway. It really was a scaring experience and made me feel like a failure as a woman. So thank you for your blog, it has given me hope that even though I am plus sized that some day soon I will get my 2 pink lines!
Both pregnancies I started out at 299. With my older daughter, my OB was actually very wonderful. She mentioned that if I wanted to, I could see the dietician. She told me I would probably lose some weight since that's been what she has seen. When I gained weight in the end, she wasn't concerned. GD test was at the recommended time and I passed. No high blood pressure. Baby ended up being born by cesarean NOT due to my weight but due to non-reassuring fetal tones. That was late 2005.
Fast-forward almost 4 years later. I'm in South Korea. I return to the US on vacation when I find out I'm pregnant. I'm 299 lbs. I return to South Korea and start looking for an OB. Korea's obesity rate is 3%. First OB was VERY concerned, especially since my daughter weighed 9 lbs, 7 oz at birth. Started hemming and hawing over needing to check the size by ultrasound before the due date. Learned a few things about OB practices over there including that there isn't always the option of getting a spinal block if a cesarean is needed which meant going under. The thought of being this man's first obese patient on the operating table did not reassure me. By the time I was 15 weeks, my husband and I decided I would return home. At 30 weeks, I made the over 6000 mile journey home without my older daughter. First OB I met there told me she would have to schedule me for a cesarean because the hospital doesn't allow TOL for women over a certain BMI. I canceled the rest of my appointments with her. I started seeing and talking to a midwife but we were having some trouble getting the details down on the birth. I saw another OB who wasn't really for the TOL but wasn't going to say no to it either because 1. it was my choice and 2. he didn't want me leaving and going to a midwife and having a homebirth. Midwife and I agreed to hire her on as a monatrice. I had a friend as a doula and I didn't go in until I was quite far along (quite a bit father along than I was with my older daughter). I was in the hospital just over two hours when I squatted down next to the bed and hit ten cm. I would have delivered the baby in this position too but the nurses started freaking out and every one started running in. I tried to get into the bed (mind you, the baby is ready to come NOW) into a kneeling position. No can do says the OB and makes me get OFF the bed, walk to the side of the bed, get back on the bed, and scoot down so he can catch the baby. It took longer to get into position than it took to push her out! She came out in less than two pushes (backed off a little when I felt the stinging but then forged ahead). To think I would have lost the chance to give birth to my baby vaginally still makes me angry at this stupid nitwit of an OB who was going to stand there and tell me I had a 60% chance of FAILING because some stupid study said so. Yeah well, I DIDN'T!
Oh, forgot to mention, I gained no weight during the second pregnancy and my baby was 8 lbs.
Sadly, stupid OB at my six week post partum check tells me that I really need to work on losing weight and if I can't do it with diet and exercise, then I should look into bariatric surgery. This after he told me I should consider breast reduction surgery WHILE he was doing my breast exam.
I've had three babies, fell pregnant at 250ish, 274 and 272 lbs respectively. All three were unmedicated, vaginal births. Babies were health and weighed in at 8#6, 8#11.5, and 8#7. I did not have GD, HPB, pre-E, etc. I went past my EDD with all three. My first 2 were with OBs, the third was with a HB CPM. I gained only 12 lbs with my 1st, and lost 12 lbs and 25 lbs with 2 and 3. I ate much better with 2 and 3. Of the three care providers, my midwife was the BEST. She took time with me and addressed me as a whole person, not a gravid uterus encased in fat. Thank you for this post. I firmly maintain that the higher C/S rate in obese women is due to provider bias and standard of care, not primarily to do with any dysfunction of obese women's bodies.
I plan on getting pregnant soon. I do not want to be weighed and lectured during the pregnancy. Do any of you ladies know of ob/gyn in the Chicagoland area who will not force you to be weighed? My current doctor does not force be to be weighed nor does she lecture me;however, I don’t know if she will continue this practice once I am preg. I appreciate any help.
I’m going to post your question above on Plus Mommy Facebook page.
Thank you plus size birth. I don’t have a facebook account. I am kind of behind the times. I will set up one so I can correspond with these ladies. Again thanks.
You got some feedback on the FB page. Are you able to view it? ๐
This is my question. Yes, I finally have access. However, I can’t find my original question on your facebook page. Can you please post it again. As I am still looking for a plus size friendly doctor in the Chicagoland area. Much thanks.
I’ve had six babies, all overweight at conception and delivery. In order, I weighed 230, 240, 240, 250, 240, 260 at the deliveries. I gained 75 pounds with the first, but the others I gained around 30 pounds each. All were vaginal births. But the 4th and 5th, the doctor on call when I first arrived at the hospitals (mind you they both knew nothing of my medical record or previous pregnancies) told me to gear up for a c-sect. because of my weight I would be getting one eventually. Ugh. Little did they know that my births are extremely fast. My longest was 6 hours. I had my last baby at home in the birthing pool. I had always wanted a homebirth, but because I had moved to, ahem, south Florida, no doctor would take me on. My previous births were at the naval hospital so they ‘had’ to take me, I guess. Lol anyhow, I wouldn’t say I was forced into a homebirth because I really wanted to do it anyway, but if I hadn’t wanted one, I would have been forced… Make sense?
I was supposed to have my first at a birth center (I am 5’6”, started off at 210 and gained 40), and had a terrible experience ending up in an unnecessary c-section at the hospital. I am pretty convinced it’s because the terrible midwife I had has some fat bias, or I was making too much noise, or something. Anyway, it sucked. Am now 19 weeks with #2 and have a wonderful home birth midwife who I love. She does not weigh at all, she has a scale in her office but said to me on the first visit, “we don’t want you weighing yourself every visit, it’s just there if you are curious”. It’s so refreshing.
So, plus size woman, if you are open to a home birth, I would recommend finding a midwife you like, go to her for your well-woman visits and get to know her. In my experience, people in the medical professions have bias so ingrained into their education and minds they are unable to see a large person as healthy, even when they are. It’s shameful but true. Good luck.
Thanks for your blog post. This is really reassuring. I’m 26 and I’ve been a bigger build my whole life and my husband and I have been holding off on getting pregnant for one, because I’m in school full time and work full time and because he works out at sea at the moment. He’s finally coming home to work on land and we both really want to start trying. The last time I was at the Dr. she said that ideal plus size birth weight was 200lbs. Well, I’m at 300 now after having lost 50 lbs since February. I’ve created a much healthier lifestyle by eating healthier and exercising several days a week. My mom has instilled a lot of fear in me based on online studies about all the complications of plus sized pregnancies. While I am still in the process of getting healthier and losing more weight, this provides hope for someone like me.
Thanks for sharing Jessica. I wonder where your doctor got it in her head that 200 lbs is the ideal plus size pregnancy weight. In all of my research I’ve never read that. You’re doing all of the right things to prepare your body for pregnancy! TTC can take awhile so don’t get discouraged if you don’t get pregnant right away. Just keep doing what you’re doing and enjoy your TTC journey. Best wishes!!!
I have been plus size most of my life. I had my first babe by emergency cs b/c of failed induction (unnecesarean), second I was scared uneducated and influenced and had another cs. Third weighing the most I have ever weighed, had a vaginal birth after 2 cs. Babe was 10lbs, 2oz. Not because I was overweight but because he stayed in a little longer to develop fully (42wks 2 days). My cs were because I was uneducated not because I was overweight. If your health care provider does not have faith in you, then you should not have faith in them!
Reading some of these comments has really made me feel a lot better.
I went to my ob/gyn & told her my husband & I are ttc. She told me I really needed to loose weight first & she didn’t want me to even try for another 6 months. She told me the reason was because it is harder to hear on the fetal monitor & it is more difficult to do a c-section. She is super nice, but her even mentioning c-section concerns me.
Also, I was worried about my thyroid. My TSH was over 4 & she said it needed to be under 2 to ovulate properly so she retested me. The office called & said my TSH was normal when I asked for my results, they told me it was 3.8. I was/am really upset now. I feel like since she doesn’t want me to get pregnant until I loose weight, she isn’t going to address my thyroid. So, I found a doctor who will treat me for hypothyroidism.
At this point I don’t know what to do. We are still ttc but I really want a doc/midwife who I feel like I can trust & be supported from. I don’t want to have to worry about disappointing her though the whole process. I have met with a midwife who I think will fit that bill but she doesn’t do well-woman exams yet so I guess I’m stuck with my chick until I get pregnant.