Big Baby, Healthy Body

My theme this week on my Twitter account (@chickadeedoula) is Big Babies. I find this topic relevant to discuss, as the incidence of macrosomic babies (macrosomia is arbitrarily defined as babies weighing more than 8lbs, 13 ounces) is on the rise.

You might be wondering why this is a problem. We hear about a lot of babies being born bigger than 8lbs, 13 oz., and they seem to be fine!

With a big baby, there's a greater chance for labour complications. Moms of big babies can have significant perineal tearing, blood loss and potential damage to their tailbone. Big babies can also get stuck on the way out (called Shoulder Dystocia), which can result in severe injury or death. I have attended a birth such as this, but luckily everything turned out fine in the end. However, you can imagine the distress parents must feel when going through such an experience.

Research shows that bigger babies are on the rise - not surprising, given that our society as a whole is getting bigger. There are certainly risk factors - a higher prepregnancy weight, excessive weight gain during pregnancy and gestational diabetes. And keep in mind it can be entirely possible to have a big baby who is healthy and the "perfect" weight  in relation to you and your partner's genetics.

Instead of focusing on the medical side of macrosomia I'd like to discuss what this mean for the pregnant woman in relation to body image.
As always, I try to see this from the woman's point of view, and understand how her personality, genetics, and socio-economic status might have an impact on her pregnancy experience. We all know from our current struggle with overweight/obesity that sitting a patient down and telling her to lose weight doesn't work, and often increases an individual's anxiety about their weight and body image.

However, a pregnant woman is different, in that she may not be obese - weight gain during pregnancy is variable, and depends on many different factors. Women who experience a lot of morning sickness tend to eat a lot during the day, as an empty stomach can lead to nausea and vomiting. Other women seem to have increased cravings for sugar or fatty foods. Some women who begin pregnancy at a completely normal weight will be surprised at their weight gain, despite all their efforts to exercise and eat well.

Perhaps we need to start at the beginning in our approach to prenatal education. I don't think weight gain "limits" are helpful at all, as we don't want pregnant women worrying about that number on the scale. However, the widespread belief that we are "eating for two" is also not helpful. Pregnant women actually don't need many extra calories, and a better approach to take is to eat when you're hungry and stop when you're full. And as well all know, avoiding excessive sugar and fat intake is something we should do regularly, even when we're not pregnant! (and just so you don't think that I'm a saint here, I once went to a midwifery appointment with a large Slushie in hand - I was duly scolded by my midwife for eating empty calories. Sometimes though, you just need that special something to settle an upset tummy!!)

Many women find that they are much more accepting of their bodies during pregnancy, as there is no societal pressure for pregnant women to be thin. For once in our lives, we are not judged by our body shape (in fact, everyone celebrates the beauty of a pregnant body!) Suddenly we find ourselves "letting loose" and eating things we never dared to eat prepregnancy, as we feel we deserve a break.

So instead of focusing so much on the food, perhaps we need to focus on healing our relationship to our bodies. The hormones that are flowing during pregnancy make us especially receptive to new ideas - here's a chance for us as women to work towards a better body image. Things such as yoga, meditation or other healing practices can go a long way in building self confidence that may spill over into the postpartum period. In fact, women with serious eating disorders who become pregnant tend to have 9 months of "recovery" - symptoms will return after they give birth, but suddenly they have a base from which to move forward.

If we enter pregnancy with a healthy relationship to our bodies, we will be much more likely to treat ourselves well, and feed ourselves and our babies with nourishing, wholesome food. But women who begin pregnancy with a distorted body image will only struggle with weight gain, either restricting too much or going overboard. It's time for health care providers to approach weight from a different perspective - one that takes into account women's ongoing struggles with body shape and food.

Any thoughts on this topic? Leave a comment here, or tweet me @chickadeedoula