Tuesday, July 3, 2012

{Ottawa Doula} Fat Chance: Being Pregnant and "Overweight"

I wrote this post a long time ago - like, 8 months ago. This was inspired by a client of mine, but I've used no identifying information and have the ultimate respect for confidentiality. This is a rant/story about an issue more of us need to be talking about - and not just for pregnant women, but for all women who dare to surpass the dreaded BMI cutoff point.

I'm angry over a policy (or perhaps a subtle tactic) by which overweight and/or obese women are routinely treated in a disrespectful and unfair way by the birthing community - I say "community" because I don't know how far this form of treatment extends. Suffice it to say, I've only heard bad experiences with OBs. But I'm sure there are nurses, midwives and even doulas out there who have crossed the line of ethical behaviour.

Picture this: you are excited for your 20 week ultrasound appointment, at which point most women will meet their obstetrician for the first time (prior to this, you have been cared for by your family doctor, who may also exhibit similar biases, but with whom you most likely have a good working relationship).

The doc walks in, sits down, and begins rattling off alarming statistics about weight and pregnancy. They advise you not only to "gain 0 pounds," but say it may be beneficial for you to lose weight over the next several months. "Don't worry, they say, "your baby will just eat you." They begin to lecture you on diet and exercise, all the while strapping the blood pressure cuff to your arm. Your blood pressure reads high (no surprise, given Dr. Destructor has just crushed you like you were an annoying bug flying around the room).

At no point in this discussion are you:

a) congratulated on your pregnancy

b) asked how you are feeling

c) probed further for evidence of your lifestyle (do you exercise, eat well, and try to lower stress?)

d) asked about your preferences, knowledge or opinions

Based on your (false) blood pressure reading and BMI, you are automatically referred to a high-risk obstetrician, who treats other women with dangerous medical conditions which can potentially put the lives of their babies and themselves at risk. Your baby, on the other hand, is thriving and by all accounts growing well.

You're out the door in 15 minutes.

The following appointments are all the same - they always begin with, "because your BMI is high, you are at a much greater risk for stillbirth. You will most likely have a c-section. You will need to speak to the anesthesiologist prior to labour so that he can tell you all about the epidural you'll be getting."

This is the part of the post where all the swearing came in, but I've done some rewriting and tried to tone it down. Hubby wants me to keep my positive outlook on life intact. I'm also reiterating here that this is all my opinion, based on anecdotal evidence. Maybe you've had a different experience - I'm happy for you. But at a hospital not-to-be-named here in Ottawa, lots of women with higher BMI's are having a shitty experience. Oops, I swore - sorry.

At NO point in anyone's care should they ever be treated as a patient without a right to respect and evidence-based information. And yes, I realize there is evidence out there that more weight on a woman can complicate a pregnancy. But is this the case for every woman? And should that evidence cloud our vision enough to lose sight of the fact that individuals deserve a shared decision-making model of care? (where a patients' values and preferences are of utmost importance - read more here)

We as a society have some serious work to do in our treatment of the "epidemic" of overweight/obese individuals. Every strategy our government and health care providers have adopted treat weight as some form of disease that needs to be eradicated. In all my work I have done with eating disorders, I know three things to be true: Weight is NOT the problem. Willpower is NOT the problem. Fat people are NOT lazy.

The problem is how we function as a community; how we market food to individuals; how the food industry prepares the crap we can buy anywhere, anytime; how our fast-paced world allows for little or no time to reconnect with our bodies and our minds. I could go on and on (and perhaps I will in another post!) about the TRUE reason for weight issues, and none of the "solutions" we have implemented come even close to dealing with the root cause.

News flash: fat women can be healthy. I will be the first to admit that I'm skinny and slightly unhealthy. I don't exercise enough, I eat a lot of junk (at least lately!), and I fail miserably at coping with stress. And yet I have met women 50 lbs (or more) heavier than me who regularly participate in activites, have ample reserves for coping with day-to-day life, and eat as well as anyone can in an environment where industrial food is available at every corner.

If you are overweight and thinking about getting pregnant, be prepared to get stuck with a care provider who will treat you for your weight, and not for who you are as a whole person. Be prepared to meet with resistance at every corner. Every decision you make will be assessed against your BMI, and you may not be "allowed" to do some of the things you want to do.

Does this mean that you are stuck in your situation? Absolutely not! Despite the fact that we live in a country with universal health care, you still have the right to shop around. You are paying for this out of your taxes, and in no way do you need to settle for prejudiced care. Make sure to find a doctor that seems to be about the "whole package" rather than the number on the scale. The last thing you need during labour and birth is to be at the whim of a doctor who is blinded by your fat. I advocate midwifery care whenever I can, but especially in these cases - you will have a much greater chance of receiving positive direction rather than negative attention. Midwives can do a "shared-care" approach in these cases, where you continue to see your high-risk team at the same time.

Listen Up: This is not just an issue for overweight individuals to deal with on their own. This is an issue we all need to face.

Women are not numbers, and many doctors have a hard time remembering that fact. Our healthcare is suffering in this country because we put all of our faith in the numbers, with little regard for individual's feelings and preferences. Doctors (and other care providers) seem bewildered by any pregnant woman who doesn't heed their unwelcome advice - they label them "problem" patients, and throw up their hands in frustration. If you think practicing obstetrics is about "saving" someone, you need to find yourself another job. Women having babies don't need to be saved - they need to be heard.

As with any prejudice, fat bias hides away in the closet, peeking its nasty head out from time-to-time. Well, it's peaked out one too many times...

Enough is enough! Open your closet doors, air out your dirty laundry and give fat a chance.


  1. Physicians shouldn't advise patients to diet during pregnancy for the goal of weight reduction, and attempting to lose weight can result in depriving your baby of the nutrition and energy it needs to grow and develop properly.
    Maternal weight loss results in excess blood ketone levels. Ketones are toxic to fetuses. I would find a way to report a complaint or at least do some research and send it to the physician. Request another physician/ OBGYN. Next time I would take in a strong patient advocate -- a husband, a friend, etc. and have them ask the staff if they act the same way to all their patients. If you have researched and have your own data use this time to educate. (hard when you are the patient and possible first pregnancy).... sorry your friend had such an awful experience. thanks for sharing this on a blog.

    1. Wonderful idea to surround yourself with positive advocates. If you can do shared-care with a midwife, I think this is great - you're still considered "high risk," but you get the compassionate care you need. And hiring a doula of course! ;)

  2. Another factor is that BMI is entirely based on height and weight. It does not produce a favorable result for athletic women (muscle being denser than fat) or women with large breasts. My first OB was very focussed on my obesity (I was 1 pound over the mark) even though no one looking at me would have guessed I would even qualify as overweight (relatively well toned with large breasts). As with all things, numbers can be easy ways to group people, but people are generally more complex than the numbers representing them. It would have been nice if she had looked at me and acknowledged me as a reality rather than simply looking at her notes and seeing me as a BMI. I eat well, I was fairly active during my pregnancy and even when I was in the best shape of my life (early 20s being hit on regularly by strangers on the street) I have had a BMI that would have led one to believe me to be in rough shape - unless a person actually looked at me and my lifestyle and assessed me on that basis. Fertility clinics are now considering refusing to treat women who are obese based on BMI results. That has the potential to be devestating to a lot of women who, for one reason or another, are unable to conceive without such assistance.


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