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Sunday
Nov222009

Birthing Fat: Background

This series of three articles/posts, combined, examine the issues surrounding obesity and pregnancy. As more and more women find themselves fitting into this designation, it begs to be discussed. This is not a scholarly series, yet does quote and refer to many studies and professional experiences. There is not a bibliography, but feel free to click the many links sprinkled within the pieces. Interspersed throughout, my experiences as well as other mothers I have spoken and worked with, flesh out a technical piece. While anecdotal stories do not tell the whole story, to many of us, neither do the studies. Therefore, I have chosen to make the series more accessible and enjoyable. I welcome comments and even advice. 

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Part I: Under the Armor   

Fat folks, in general, struggle through life with their ample asses. However, I am finding it less and less of an issue as time goes on because our society is getting so used to seeing fat people of all ages. 

We could sit and talk about all the reasons why people are fat(ter), but for goodness sake, that is yacked about over and over with doctors, reporters and across picket fences. Pretty much, if you eat more calories than you expend, you get fat(ter). Eventually, you become overweight, then obese, then morbidly obese and then super-sized. That is, of course, if the increase in calories and lessening of moving/exercise continues on its inverse course for many years. 

Dieting is a multi-billion dollar a year business. Having a gastric bypass is no longer taboo. Plastic surgery to “repair” sagging skin or to suck out fat cells is pretty darned common, too. Entire television shows are dedicated to extreme weight loss. Yet, using myself as a gauge, being made fun of as a fat woman hasn’t happened in years. Even in my bathing suit at the Y, a place I used to be regularly moo’d at, no one makes a passing glance at the copious amounts of flesh, fat and cellulite that oozes out of my suit. In fact, I am hardly the ooziest person there! I look around and am really quite stunned by how many fat people there are out swimming nowadays. I used to be the only one who braved a bathing suit while the heavier folks sat in clothes on the side of the pool watching their kids.

 I’ve sat on city benches and let my eyes feast on the plethora of humans walking down the street and am really just baffled by how many fat people there are. It seems no matter how fat anyone is, wearing low-riding pants, letting the belly roll lop over the edge of the jeans, is the norm. I feel old-fashioned when I think everyone should tuck the gut in. Teenage boys should pull their pants up and fat people shouldn’t be able to tuck a pencil under their fat – when they are IN their clothes. (Don’t I sound almost 50?) 

What about women having babies? News comes out every few months roaring the information that fat women have more and more complications, that they require cesareans more often, that they are at risk of giving their babies birth defects – it’s just not good news at all. It can be a total drag to be a fat pregnant woman today. The fatter the woman, the more prejudice she will find with care providers, strangers and even family and friends. “What? You’re PREGNANT!?”  It’s cruel and stupid to be seen as a pariah, but worse to feel like one. 

A lovely story, “A Curvy Gal’s Fight for a Natural Childbirth,” made the rounds via MyBestBirth.com. Jenne speaks about the prejudice she faced by a midwife with fat phobia, a woman who believed women “with BMIs higher than 26 tend to have cervixes (sic) that won’t dilate without chemical induction.” Well, besides the BMI scale being woefully inaccurate, making such a blanket statement that someone with a (relatively low) BMI of 26 would (always) need a chemical induction is all but ludicrous.  

However, we cannot ignore the growing amount of information that bespeaks of the dangers of obesity and pregnancy as well as the postpartum issues for both mother and baby. 

Obesity and Pregnancy: complications and cost, an article from 2000, illustrates many of the difficult issues women of size and their babies might struggle with. Sadly, the number of obese, morbidly obese and severely morbidly obese women has skyrocketed since the article was written. We could read identical words throughout the literature of today: “Compared with normal weight, maternal overweight is related to a higher risk of cesarean deliveries and a higher incidence of anesthetic and postoperative complications in these deliveries. Low Apgar scores, macrosomia, and neural tube defects are more frequent in infants of obese mothers than in infants of normal-weight mothers. The regional distribution of fat modulates the effects of weight on carbohydrate tolerance, hemodynamic adaptation, and fetal size. Maternal obesity increases perinatal mortality.” 

A policy in Great Britain allows midwives and doctors the permission to refuse to care for fat women at their smaller hospitals. They state they don’t have the facilities to attend to more complicated pregnancies and all high risk women have to go to larger and better-equipped hospitals. 

Talking about fat women is like walking in a minefield. I like to believe that since I am fat myself, I am able to use the term “fat” with love and respect. I have great self-esteem, but know I am not as healthy as I want/need to be. As a healthcare provider, being fat takes on some unique problems. Sitting with a woman and counseling her on food choices rings hollow; how can I give advice when I don’t live that life myself? This is one of the major reasons I want to lose weight; I know I am losing midwifery clients because of my size. 

I had gastric bypass in 2001 and lost 190 pounds, but, for a variety of reasons including severe illness, I regained all but about 60 pounds. I, once again, made the rounds of diet and medication, but, of course, nothing has helped me get to a healthier weight. I am eager to have a revision of my Roux-en-Y gastric bypass because, as a compulsive overeater, I need to have surgical portion control to help me live the life I desire, a life without diabetes, high triglycerides and unhealthy cholesterol… a life where I don’t break my feet just taking the dog out for a walk (which has happened twice). 

Here, there is NO judgment regarding anyone else’s choice to either lose weight, get healthier or to stay fat; I do believe some of it is a choice and other parts are biochemical, heredity and/or hormonal. Again, we could re-hash all the theories about why we are getting fatter, but let’s leave that to the nightly news and scientists in the lab. 

Just my writing this might have others calling me size-ist, that some of the most prejudiced are those that are themselves. Calling names doesn’t change the facts, however, and I feel that until we are able to accept the information that our ever-growing bodies are putting a strain not only on the woman’s pregnancy, but also on our medical system as a whole, we’re merely spinning our wheels, throwing dirt onto each other. 

But there needs to be a place where we can talk about fat and pregnancy. There must be the allowance for this discussion because obesity is a risk for pregnancy and the postpartum period. Tip-toeing lightly through the topic hasn’t gotten us very far. In fact, women who might need the information most are not hearing the message because of political correctness. 

A 2005 article from WebMD says, “… health care providers must make sure that their patients know about the risks. The point is not to bash obese women and make them feel bad… it is to make health care providers aware of this, because they are in a position to make a difference. A past president of ACOG says, “ob-gyns have an obligation to discuss the dangers of obesity with their patients. ‘While the topic may make us uncomfortable, in that we feel we may offend our patients, we should take a more direct approach in helping to identify their health risks," she says.’”

So, how does a healthcare provider –OB or midwife- talk about the risks of obesity without being told we are prejudiced against fat people? How does a fat woman confront a care provider when she senses fat prejudice? I’d like to see a truce between the fat community and the medical community, each stating their “case” while listening to each other. Talking about pregnancy and obesity should be no different than discussing taking what supplements to take and when a woman might need an ultrasound. If we can remove the intense emotion, we might be able to address the medical aspects so fat women can have healthier and safer pregnancies. Believe me, I know the ultra-sensitivity of being fat and ridiculed, but now we need to set that aside and look at the realities.

They might just save our lives and/or that of our babies.

References (10)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    - Navelgazing Midwife Blog - Birthing Fat: Background
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    Response: kapsels lang haar
    - Navelgazing Midwife Blog - Birthing Fat: Background
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    Response: korte kapsels
    - Navelgazing Midwife Blog - Birthing Fat: Background

Reader Comments (25)

I understand that medical professionals feel the need to "inform" their patients about the risks of being fat, but I always wonder "what makes them think I don't KNOW I'm fat?" NGM, you apparently are very aware of your own body size and its limits. You seem to know what your size is doing to you. What I don't understand is why medical professionals, especially those that are of size, assume their patients are uninformed and stupid. I've never met a large person who didn't know that being larger has risks, and most of what those risks are.

I'm a few pounds overweight, I admit. I have a BMI of 27 at my 2 week postpartum weight. I know full well that I have additional risks. I'm not eating donuts every meal, in fact I keep my calorie count to 1800-2000 while breastfeeding, and I had a calorie limit per day of 1800 during my pregnancy. I keep close track of my intake, and eat a balanced diet. I gained 22 pounds, and still had/HAVE to excuse my weight and justify my eating and exercise level EVERY APPOINTMENT. Being told I'm a fattie at risk of X, Y, and Z every month, then every 2 weeks, then every week got very old. What am I supposed to do? Lose weight while pregnant? Completely change my activity level and risk serious injury?

Losing weight while pregnant is not safe. Drastically increasing my exercise is not safe. So what does criticizing me, "informing" me of my risks, and me not being able to change them do for anyone? Does it make the professional feel better to harass a woman about things she can't change and making her terrified that she's committed some heinous horrible act that has damaged her child? I heard over and over how I should *never* have gotten pregnant at my weight, and I can just imagine how those who are obese or supersized must feel when they repeatedly get the "you're a lying stupid fattie" talk, because OF COURSE they're lying about their intake, lying about exercise, or just too dumb to understand that they're fat and fat is dangerous/bad? No person who has access to TV or the internet today has any doubt that being fat is bad for your health.

You may be a different sort of provider, I suppose, but please, one lecture is enough. We know. Most of us, like you, have dieted and done other things to try to get our weight down. We're trying, and we're not stupid. Please believe us when we tell you how much we eat, and how much we exercise. We're not all liars, and having a medical professional treat us like lying, ignorant toddlers repeatedly just makes us want to go without medical care at all, which would be much worse for our babies than just being fat.

November 22, 2009 | Unregistered CommenterStaudtcj

This is actually something that worries me greatly. My husband and I will be trying to conceive early next year and I have already researched birthing centers. Will my center of choice/midwife accept me even though I have a BMI of 32? I don't feel obese but I guess I am on paper. It is on my mind daily. Will they see a woman who desperately wants to do the right thing for her family or a woman with the words "FAT LIABILITY" on her forehead.

November 22, 2009 | Unregistered CommenterAmyB

The discussion continued for awhile on the post Fighting Fat Bias and Fear of Faulty Cervixes.

The BMI scale is a joke.

November 22, 2009 | Unregistered CommenterJill--Unnecesarean

Staudtcj: Part of why I am writing this is there is information that *isn't* well-known and that is what I want to share. I do not want to bash anyone or treat someone like they are stupid or don't know they are fat and have some risks. But, I am writing because I believe I can offer a different voice to the discussion - or else, why write at all? I continue work on the next installment (it's almost completed) and look forward to your thoughts about it and the third one. Please do let me know if it sounded as if I was preaching, to the choir or otherwise. I can feel where my intention is and it comes from being a fat provider who looks at things a little differently and thinks others might be interested in reading what I have to say.

I hope that is true.

The BMI scale is extremely inaccurate, but plenty of providers still use it and I could see a birth center risking out a woman because of her BMI. (In England, it is a woman over 27.) Until another measuring stick comes along that is more accurate, I'm afraid we are stuck with this one... as much as we wish otherwise.

Part of why I am writing, too, is so women who *are* at risk can DO something before getting pregnant. It would be stupid of me to just say, "lose weight" without offering options that include medications and surgery. It is when I am told, "Can't you just leave us alone without sounding like the rest of society that tells us to lose weight everywhere we turn?" that I am wanting to work through with women. I believe many women brush off the risks of getting pregnant very fat, reading about fat women having babies all over the Net; what's the big deal? It is similar to the UC movement, being applauded and encouraged online, but can take on a sobering image when explored on a less superficial manner.

Again, not harping. Illuminating.

November 22, 2009 | Registered CommenterNavelgazing Midwife

I'm curious about the first commenter saying that it is unsafe to lose weight while pregnant. I have heard this over and over again, but if the risks of being fat are so high, then what exactly are the risks of losing weight while pregnant and how do the risks compare?

I'm also curious about Jill's comment about the BMI being a joke. I am also "obese" according to my BMI, and I admit I'm fat, but I don't feel I'm "obese".

Also, I admit that I put on weight over the years by eating too much and not moving enough. However, now I move more and eat less and eat healthier food. I have to try extremely hard to lose weight and it barely seems possible, but I do feel I am overall healthier now than a few years ago even though I am the same weight. If someone like me were to get pregnant, would a current healthier lifestyle mitigate the effects of the higher BMI? So I guess I'm asking is it the lifestyle that is unhealthy or the weight itself, and how do those balance out?

November 22, 2009 | Unregistered CommenterJennifer Z.

I haven't gotten into the issue of losing weight while pregnant because I think that would be something a woman and her provider would need to talk about. I'll see if the muse takes me in that direction, but so far, it has not.

I believe lab work is a MUCH better gauge of a woman's health than the scale. Before I was diagnosed with diabetes, my labs were wonderful... then, suddenly, they sucked. By the time I had the gastric bypass in 2001, I was one lab-sick puppy. Within 3 months of the surgery, my labs were 100% normal and I was OFF all medications. Today, they are climbing negatively again. It sucks. But, I have long believed labs are a more truthful gauge of a person's overall health or not.

I will be addressing the issue of it being very hard to lose weight.

November 22, 2009 | Registered CommenterNavelgazing Midwife

I wasn't intending to bash you, NGM. My main point was that one "lecture" is plenty. I'll listen to one lecture from any given professional. They may have information I don't. But please, just one. Give the spiel the first appointment, not every appointment. You're right that there are women out there that don't know, and one informative talk can help. More than that and it really starts to hurt, not inform. Saying it over and over infantilizes the woman, and can make her feel stupid and dehumanized.

JenniferZ: The reason that it's considered unsafe to lose weight during pregnancy is that many toxins are stored in your fat cells. Doing things that release the contents of those cells can cause those toxins to be released into the mother's bloodstream, and from there transfer to the baby's bloodstream.

I just gave birth with a wonderful midwife (aside from this issue, actually. She really hammered the weight thing.) who explained it to me over and over and over and over... Every appointment. "You're fat, and that's bad, but DON'T lose your fat or you could kill your baby..."

I was told that organochlorines, including DDT, PCB’s and Dioxins; mercury and other heavy metals; other pesticides and herbicides; and various environmental pollutants, like smog ingredients, can be found in fat cells, and released when the cell is emptied (fat loss). Also, something called "ketones", which is some chemical that's made when your body burns fat, can be harmful to the developing fetus.

November 23, 2009 | Unregistered CommenterStaudtCJ

I don't like the new hip/waist ratio measurements. Not at all.

November 23, 2009 | Unregistered CommenterVeronica

Why not?

November 23, 2009 | Registered CommenterNavelgazing Midwife

Actually, I wish my midwife had made a bigger deal about my weight while pregnant. With a BMI of over 30 when I got pregnant, and then adding 45 pounds to that, it was definitely an issue.

But there was no mention of changing my eating or exercise habits or any of the risks of being overweight, one of which I realized too late is macrosomia, therefore increasing the risk of shoulder dystocia.

At 39+ weeks, my midwife informed me that she was concerned with how high my fundal measurements were, and she was no longer comfortable with the home birth we were planning, and wanted us to move to the hospital when the time came, just in case shoulder dystocia did become a problem.

Looking back, I realize that I should have taken more initiative about my weight. I could justify it by saying that it was an emotionally stressful pregnancy (and I am definitely an emotional eater) but my inactivity and excessive eating were completely my own choices.

I guess I had erroneously assumed that since the midwives were aware of my weight gain, they would have said something sooner if it was important enough. But they didn't, and in the end it cost me the home birth we had been hoping for.

Born one day before his due date, my son was only 8 lb, 7 oz, but 22 inches long, so it seems that his length was affecting my fundal height more than his weight and there was no shoulder dystocia or any other complications.

But I can't help but feel that if my midwife had said something to me earlier in the pregnancy, I might have had the incentive to watch myself more closely, and prevent the last minute panic.

November 23, 2009 | Unregistered CommenterKristyn

That's hard, losing your homebirth... especially after learning the birth weight of the baby. (Not picking, but...) Did they send you for an ultrasound? I realize they can be terribly inaccurate, but maybe it could have helped? +/- 2 lbs would make him look like he was 10 lbs... and that isn't gigantic. Was your midwife your midwife in the hospital? If not, I am shocked a doctor didn't do a cesarean based on her transferring you. When you changed care, did that provider also think you had a macrosomic baby?

You see, while I don't have an inordinate amount of fat women in my care, the ones I have had were not happy with my discussing their eating habits. Even women who are not fat can have crappy food choices and I try to address *everyone*. However, in my experience (including my own), many women lie about their food choices and amount they eat. Quite simply, you don't get fat, and especially super fat, from eating quality foods in the proper quantities, even with minimal movement (exercise) activities. When a woman sits in front of me, looking me right in the eye and says, "But I just don't eat that much!" or I look at a "perfect" diet sheet, I understand I am sitting in front of a woman who believes what she says. Because of my own eating issues and being pretty open about them, I am able to say, "Let's look at this again," and dig a little to find the culprit/s of extreme weight gain, before, during and after pregnancy.

It is correct that women should not lose weight during the pregnancy because of releasing toxins, However, maintaining the original weight or even losing because of healthier eating and increased exercise (not becoming a stellar athlete, but increasing movement choices even a little compared to pre-pregnancy) is not a problem. DIETING *is* a problem, but making positive food and exercise changes is not.

November 23, 2009 | Registered CommenterNavelgazing Midwife

Yes, my midwife did offer an ultrasound. I declined becaue I know they are notoriously inaccurate, and didn't want *that* to be the reason for my decision. Of course, hindsight is 20/20 and had I gone ahead with an ultrasound, it may have shown his average weight, and I could have gone ahead with the home birth.

And I'm in Ontario, so my midwife remained my primary care giver even in the hospital - it didn't require a transfer of care, thankfully.

November 23, 2009 | Unregistered CommenterKristyn

I'm kind of surprised to hear talk of birth centers ruling out women with BMIs of 26 or 27. I thought you weren't obese until 29 or 30.

I'm also a little surprised to hear you sound so confident that you know how women eat by their weight gain. My friend's midwife (who actually was mine, too) was on her a lot about her weight gain (50 pounds over the course of the pregnancy). I know my friend well and know what's in her kitchen and how she eats. We eat together often. She eats really well. Better than me, who only gained 30 pounds during my pregnancy, in some regards. She also had a much more straight forward, less complicated, birth than I did. As far as I could tell, that was just the way her metabolism responded to being pregnant.

(My friend and I are in agreement that this midwife, who my friend is using again for her second pregnancy, is awesome at birth but a little bit of a worry-wart during pre-natal. She was always on me to eat more protein because she thought I wasn't gaining enough weight.)

November 23, 2009 | Unregistered Commenterchingona

You said: "Quite simply, you don't get fat, and especially super fat, from eating quality foods in the proper quantities, even with minimal movement (exercise) activities." In the proper quantity is key here--my food report sheet looks pretty darn good and I've had doctors argue with me that I must be a closet eater--very few processed foods, tons of vegetables, lean meats, and fruits, no refined sugars, and quality carbohydrates--brown rice, sweet potatoes, brown rice pasta, stone ground cornmeal. However, I KNOW exactly why am I fat--I eat way too much in terms of portions, especially at dinner. Also, I have PCOS/insulin resistance so the only way that I can lose weight is by eating a very low carbohydrate diet. However, I have found this unsustainable long term--I get really hungry and moody. Traditional diets like weight watchers just don't work for me. Seven years ago I lost 100 pounds. It depresses me to no end that I am back within 40 pounds of my high weight. But, not in the "oh woe is me" sort of way---I think that I, like most fluffy women, know exactly why I am large and exactly what I would need to do to change that. I will never be within my ideal BMI--at the 100 pounds lost mark I was still higher than the BMI chart would like, and I looked gaunt and unhealthy. When I was pregnant with DD, I limited my weight gain to 25 pounds (I started 10-15 pounds lighter than I currently am) by eating like I currently do, just watching my carbs a little closer, essentially eating a GD diet although I never developed it. I also think that there is a HUGE difference between fat and active--eating essentially healthy foods and maintaining some sort of activity level and fat that comes from eating unhealthy foods and no activity. I had hoped to lose a lot more weight before having another baby, but it doesn't look like that is going to happen, so I will just keep eating healthy, trying to watch my portions a little closer, watching my labs closely--I checked blood pressure and blood sugar daily when pregnant with DD (I never developed problems with either, and I think it was in part due to the monitoring--if I saw a slightly higher number, I made immediate changes for the next day), trying to get some exercise each day, and keeping limber.

November 23, 2009 | Unregistered Commenterwb

Did you read At Your Cervix's post about pregnancy pre vs. post gastric bypass? She had some good points about nutritional needs and malnutrition due to the bypass that to her would argue against gastric bypass before pregnancy.

Sigh, I am morbidly obese, I have been for a long time, I am also very physically active and delivered two babies so far and pregnant a 5th time presently. My labs are perfect, I do have mild hypertension (it's being treated), seemingly from the last miscarriage and stress in the last two years. I don't have diabetes, I have never had gestational diabetes and I bet I will never have it.

But I do know that there are still risks with being as big as I am. I know that it causes concern for those who care for me, and I don't want to die, I don't want a still birth, I don't want to be disabled so I don't kid myself about the messages about obesity being a scolding (BTW, I'd love to have a BMI of 27!), I know what they really are - my caregivers fears based on past experiences and statistics. As a patient I make a point that I am balancing my risks with my desires, I aim for the best good for me and my family, my only compromise is my weight since it's overwhelming to try to get where I want to go right now. Someday, when I am done procreating, my plan is to have a Lapband placed (because of my present malabsorption issues with celiac disease gastric bypass is a bad idea for me), my goal is to loose about 100lbs, I wouldn't have a BMI of 27 but I'd be in 'my' ideal weight of about 220lbs.

I think we obese women need to be more honest with ourselves about the real risks we face, I don't think if you're just fat (overweight) there are real risks as we know that with being overweight comes lower morbidity, being the "right" weight, thin, or obese is fraught with issues for long term health that really can not be ignored.

November 23, 2009 | Unregistered CommenterEthel

(In England, it is a woman over 27)

++++++++++++

I'm not sure where you're getting that from. The actual BMI at which birth in an obstetric-led unit is recommended is BMI 35+ at booking. That's quite a significant difference.

I also don't think you should rely on the Daily Mail as an accurate source (also known as the "Daily Fail" and widely ridiculed for the sensationalist inaccuracy of their reporting).

On the inclusion/exclusion criteria for use of the Ashcombe Maternity Unit at Weston, it is important to understand that this is a really small midwifery-led unit (640 births in 2008) that does not have the facility to perform caesarean section or instrumental delivery. They provide care for women who are low-risk at the onset of labour, and "risk out" women on all sorts of grounds, not just high BMI.

Finally, any woman in the UK has the right to decline hospital admission and midwives have a duty of care towards her so she will receive care at home in the event that she declines hospital care. But admission to a low risk unit is a different issue, because it is not simply declining a service (hospitalisation) but demanding one (to give birth on an MLU). That is not equitable to women who *are* low risk and have excessive staff resources diverted from appropriate care for them in order to provide inappropriate care for someone who is outside the unit criteria. Not to mention the impact on the safety record of the unit of accepting women outside their low risk criteria, which jeopardises the reputation of the unit and its staff.

November 23, 2009 | Unregistered CommenterYehudit

Chingona: I understand and acknowledge weight gain differences, but I find that women who gain a lot... over 40 pounds or so... are eating *something* that is causing the weight gain. In my experience, it is usually dairy. When women who previously gained a lot of weight (and even others who simply had macrosomic babies without gaining >40) eliminated dairy from their diet, their subsequent babies were smaller and their weight gain more in-line with the 25-35 pounds.

(Of course, 40 pounds on a 5'2" woman is very different than 40+ pounds on a woman who's 5'9", so this discussion is subjective by its nature.)

I also see women who are gaining quickly, when they begin or increase *some* sort of movement/exercise, even if it's walking (in fact, I *love* walking for pregnant mamas... great sun, great meeting others, great for other kids or partners to join in), will slow down their rapid increases.

I feel I am a pretty good judge of whether a woman is lying or not. I also now do all their visits at home, so see their refrigerators, their lunches and dinners and often go out to eat with them; that information helps, too. I do not "harp" on women. I talk to them with respect and love, especially with understanding IF there are food issues, which many, many women have and share with me.

I hope this helps clarify.

November 23, 2009 | Registered CommenterNavelgazing Midwife

WavyBrains: I totally understand the carb thing. I know... KNOW... I am a carb addict. I've never been able to eat low/good carb... South Beach? Ha! I'm sure it's obvious I have done a zillion and a half diets. With most, I couldn't sustain it for more than a few days.

At the moment, I am 4 weeks into an epiphany experience for me. It was like I woke up one day and said, "Here I am!" I am not preaching or advising at all and I absolutely believe there are biochemical aspects at play, but for some reason, it has been easy not eating added fat, no fried foods, no white foods, no sugar. No DAIRY except a splash of milk in my oatmeal and coffee (I am a serious cheese-a-holic). I am down 13 pounds in 4 weeks.

I think I know what may have happened. I have been taking 8000 IU of Vitamin D a day for several months now. I was very deficient in D and took it upon myself to treat the deficiency with a more accessible level and I REALLY think the D levels are finally normal. D affects so many aspects of our lives and fat people are much more depleted in D than normal-weighted folks anyway... I don't know, but it is my theory.

All that to say I understand, which is why I know I need surgical portion control. Even now, I eat more at a time than I should/need to. And that is even WITH a gastric bypass already! erg.

November 23, 2009 | Registered CommenterNavelgazing Midwife

Yehudit: Thank you for clarifying! I appreciate that a lot and will fix it in the piece asap.

November 23, 2009 | Registered CommenterNavelgazing Midwife

I don't have diabetes, I have never had gestational diabetes and I bet I will never have it.

When I went to have my initial lab work done with my first pregnancy, I sat next to a woman who gave me my first real taste of how obese women get treated by the medical system.

She was a very large woman. I'm not sure I would have realized she was pregnant if we hadn't struck up a conversation. Anyway, she was there for her FIFTH glucose tolerance test. She kept passing them with flying colors, and her doctor just couldn't believe that she didn't have GD because of her size.

November 23, 2009 | Unregistered Commenterchingona

I was moved by this post, as well as the comments. There are so many complex threads in your discussions here. Essentially, what it all comes down to is the immense suffering we experience as a result of our relationships with food. Please consider visiting checking out Overeaters Anonymous at www.oa.org.

Overeaters Anonymous offers a program of recovery from compulsive eating using the Twelve Steps and Twelve Traditions of OA. Worldwide meetings and other tools provide a fellowship of experience, strength and hope where members respect one another’s anonymity. OA charges no dues or fees; it is self-supporting through member contributions.

OA is not just about weight loss, gain or maintenance; or obesity or diets. It addresses physical, emotional and spiritual well-being. It is not a religious organization and does not promote any particular diet. If you want to stop compulsive overeating--or other compulsive food behaviours, try Overeaters Anonymous.

OA has given me freedom from my food worries and given me a life I never imagined.

November 24, 2009 | Unregistered CommenterIsabel

ACOG makes me laugh in this case because in my experience, they don't even begin to talk about nutrition with patients. None of the clients I've worked with have been asked to write up a food diary and I was not asked to do this by the OB I had for four years and two pregnancies. The midwives do. As a CBD and doula, I do. And the issue with obesity isn't the obesity itself, its the habits and diet choices that the mother is making that causes most of the problem.

IMO, ACOG getting involved in this is just going to make it worse for "fat" women. Because they'll "complain" in the form of studies and opinion articles about how tough "fat" pregnant women have it and not address the real issue of prevention and diet counseling.

November 27, 2009 | Unregistered CommenterVanessa

Vanessa, FABULOUS commentary on ACOG and fat women. Really, really astute. Thank you for sharing that. You are absolutely right about the Diet Sheets and the concern OBs have versus Midwives. Thinking, OBs preach about the dangers while hardly offering any solutions, whereas midwives talk about issues and DO offer solutions. Your writing just this small comment will inject a delightful part of my next post I was struggling with. THANK YOU!

November 27, 2009 | Registered CommenterNavelgazing Midwife

Yes I've read many of your posts. Often your writing goes above my head even though I feel like I have a pretty good knowledge of birth and babies, but you really make me reach. I feel like you often touch on issues surrounding my body and birth. But nobody (midwives anyway) talk about this. And as you know it's hard to trust any allopathic doctors or midwifes. So I've always felt like there was no one who is holistic enough to even converse with about this subject.

I've felt like weight could have been an issue in my first birth, but my second midwife didn't really think so. In fact, I'm not even sure she believed I really really went past 42 weeks with my first baby . Although she tried to hide that, I seen a remarkably huge difference in her attitude when I brought her a copy of my first early ultrasound (8 week) of my first baby, confirming my dates and putting me past 43 weeks when my son was finally born.

I feel like my issues are complicated, yet simple. Does that make sense? I mean there is no tangible reason that I have failed to produce a baby two times, but I have. Both times that cervix wouldn't budge. I don't care what the tests say, I know I did so many things right, and yet had the same outcome. My body did not cooperate.

If your familiar with ICAN you might have seen the video of a VBA4C. The woman lost a ton of weight before the fifth and successful birth. She got really fit, and guess what, did nothing else different...... ahhhhh ha baby born! Boy was I nervous watching this video being fat and gestating my second baby. It was too late to change anything at that point.

Looking forward to part two!

November 27, 2009 | Unregistered CommenterSavannah

I'm so glad to see you taking on the fat issue. And I completely agree with the previous poster about ACOG. I'm 5'9" and was 195 pre-pregnancy (28.8 BMI, for whatever that's worth). By the time I went into labor I was 240. I saw an OB practice for the first 28 weeks. Though I always got the impression I was like a ticking time bomb to them, the closest they ever came to saying anything about my weight or diet was when I had swelling in my feet at 24 weeks. I cut out eating prepackaged lunches and soups and the swelling disappeared. I switched to midwife care at 30 weeks, which was the first time anybody actually did any dietary counseling.

Looking back, I know I was eating a lot of things I shouldn't have been. Even with their dietary counseling, I don't think I really understood the kind of stress sugars and simple carbs can put on a fetus. Long story marginally shorter, my son was born at home weighing 7 lbs 13 oz after about 24 hrs of labor.

About 6 months ago I reached the point physically and emotionally where I was ready to do something about my weight and I joined Weight Watchers. I understand how it doesn't work for everyone, but that type of system works really well for me -- compulsive record keeping? Bring it on!! Now I'm 3 lbs over a "normal" BMI and trying to talk DH into starting our second child. This next time around I hope and plan to eat a much cleaner diet to better nourish my baby.

December 4, 2009 | Unregistered CommenterKimberly

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