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.
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.