At the age of 30, my size-friendly midwife Eliza Burelle was the first care provider to ever touch my body with compassion. With this simple act, she not only put my fears at ease but also helped to instill a belief in my body I had never experienced before.
Eliza taught me that I deserve to be treated with dignity and respect by care providers. For her, this was standard of care. For me, weighing nearly 300 lbs., this was a new experience.
Receiving care from a size-friendly midwife (or as some people prefer to say – fat-friendly midwife) changed my life forever. Since that time, seven years ago, I’ve supported thousands of plus size pregnant people as a certified childbirth educator and consumer advocate.
A few years ago I gave a presentation at a midwifery conference on supporting plus size birth. In the middle of my talk, a midwife interrupted me and said I was just preaching to the choir.
What that midwife still doesn’t know is that a midwifery student, sitting in the back of the room, came up to me after my presentation. With tears in her eyes, she shared her story of being fat-shamed by a midwife. She said what I already knew, that not all midwives are size friendly.
I’ve heard far more heartbreaking stories than uplifting ones of what it’s like to receive maternity care as a person of size. We live in a society where it’s still socially acceptable to shame people because of their size and midwives aren’t immune to this societal norm. There are studies that indicate a clear weight bias in the medical community, a community to which midwives belong. While I truly believe care providers don’t intentionally want to harm people, harm is occurring.
It’s critically important people of size connect with a care provider who practices evidence-based compassionate care – a size inclusive care provider! It is my belief that midwives enter into this field with every intention of helping and healing people, regardless of their size. To support that, here are five steps midwives can take to be size-friendly.
5 Steps To Becoming A Size Inclusive Midwife
1. Address Your Personal Bias
When you see a person of size, do you make assumptions about their lifestyle? Stop and really think about your answer.
The only thing you can tell by looking at someone of size is that they exist in a larger body. When assumptions are made about a person’s food intake, activity level, or personal habits, the trust a patient has in their care provider can be broken.
Challenge yourself to not just assume you’re already a fat friendly midwife and listen to the experiences of people of size. Notice where a bias exists in you and challenge it. There are online courses you can take to address your personal biases as well.
Doing the hard work of changing our personal biases isn’t easy, but it’s necessary!
2. Assess Your Environment & Equipment
Imagine being a pregnant woman of size, walking into a care provider’s office, and not having anywhere to sit comfortably. Before you even receive care, you get the message loud and clear that your body is not welcome. As a provider, this probably isn’t the impression you want to give to current and future patients, but not recognizing a need for chairs without arms is problematic.
If you work in a clinic or have an office space, be mindful of the seating options you provide, not just in the waiting area but in the exam room as well. When people undress, make sure to provide paper sheets that will adequately cover your patients or stock large enough gowns to do so. People of size often have their dignity stripped away by having to settle for being over-exposed during exams.
As you care for people of size, in an office or at their home, you’ll want to make sure the scale maxes out at a high enough weight for the patients you serve (this one goes to 550 lbs). Further, while all bodies are unique, a larger speculum is good to have on hand. A urine catch basin can help a person provide a urine sample with ease regardless of their size. If you provide a birth ball, make sure you know the weight limit. Amazon offers options for exercise balls with weight limits that exceed 2,000 lbs. (yes, you read that correctly!). Lastly, a large-sized blood pressure cuff, most often sold as an adult thigh cuff, is imperative to use on larger pregnant people for an accurate reading.
I surveyed 100 pregnant women and the phrase most of them prefer is plus size. With that said, listen to the language people use when they talk about their body and ask what language they’d like you to use.
Supporting people of size physically and emotionally can be changeling. That’s why talking to people in a compassionate manner about their bodies, while doing what is necessary to provide excellent care, is so important.
4. Provide Positive, Evidence-Based Information
There are increased risks when having a plus size pregnancy and it is your obligation to establish an open and honest dialogue with your patients about these risks. How these conversations take place, from the language used to how the information comes across, is what matters.
For example, when we talk about gestational diabetes, we know that people of size face about a 10% – 15% increased risk. We can flip the script, while still providing the same information! You can tell your patient they have an 85% – 90% chance of not developing gestational diabetes.
From there, go onto have a conversation about nutrition and how someone can help to reduce their risk even further. By sharing positive, evidence-based information in a compassionate manner, we empower people to take charge of their healthcare which we know leads to better outcomes for everyone.
5. Speak Up!
I will continue to raise my voice, even if I’m often preaching to the choir. Join me by speaking up when you hear colleagues say disparaging things about people of size. By continuing to have these conversations, we help to reduce the misinformation and stigma that surrounds plus size pregnancy.
People of all sizes deserve to be treated with dignity and your work is so important in this world. Thank you for investing in yourself and the people you serve by striving to be the most compassionate, evidence-based, size-friendly midwife you can be!
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