{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.

A Correction! (and My Experience with Prenatal Classes)

First Off, I missed some important classes offered in Ottawa in my last post and also wanted to make a correction - Mothercraft offers a fee-based class tailored to all expectant couples in Ottawa. According to Mothercraft staff, their content is similar to that which is offered through the Ottawa Childbirth Education Association. My apologies for confusing this with their Birth and Parent Companion Program, which is designed for families with little or no support. I blame my pregnancy brain for this mistake :)

And thanks to all my readers for pointing out other great classes in the city - how lucky we are to have so many choices!

Birth to Breastfeeding
Healthy Beginnings (the Bradley method)
Journey Into Life (Hypnobirthing)
Mother Nurture Childbirth Services (Ottawa Valley)
Ottawa Prenatal Services (Riverside South)

The Ottawa Hospital Cancels Prenatal Classes

So as you may have already heard from Facebook and other social media, The Ottawa Hospital (TOH) has announced plans to cancel their entire prenatal education program:

The Ottawa Citizen
CTV
CBC Ottawa


For months, rumours have been circulating throughout the community that the classes would be cancelled by September 2012. A group of community organizations with a keen interest in childbirth education got together, with the intent to draft a letter of inquiry to TOH.

Before we could send our letter, prenatal instructors at TOH received a curt letter from hospital staff, informing them that classes were indeed to be cancelled, and that their services were no longer required. Our group quickly realized we needed to do something other than just a letter, and we sent out a press release first thing Monday morning. Which resulted in my phone ringing off the hook for about 5 hours.

But this was good! We now had people's attention, and would hopefully get an official response out of TOH.

Despite the helpfulness of the media, there are still a number of issues that need to be addressed and things that the community needs to understand. Please keep in mind, any opinions I give here are my own. I'm not writing this on behalf of any community partners. So don't blame them if I say something stupid.


1) Get Your Stats Right: several of our (extremely smart, talented) doulas/educators have pointed out that TOH's stats are flawed (or rather, they have been reported in a way to sway the public to see their side of the argument). They claim that about 10% of couples - 600 or so - take prenatal classes. However, they didn't point out that over 40% of birthing women at the hospital are first-time mothers, and that the classes are geared to these women - about 2560 or so. Therefore, 600/2560 is actually 23% - this is close to the Ontario average of 28% of couples who partake in prenatal classes.

2) Duplication: Ann Mitchell claims they are cancelling classes because they "did not want to duplicate a service that was already being provided in the community." How, exactly, are our classes a duplication? We offer education from a wide variety of perspectives. Yes, some of our classes are very similar in content to those at TOH, but not all. And many women want to take classes at the hospital - where they will be giving birth, and where they feel safest. 


3) Books and YouTube are acceptable forms of education: um, NO!! If you think reading some books and watching a few videos on youtube will prepare you for birth, you are in a sad state. I would love to be the fly on the wall at the hospital when you show up at triage - chances are, you will be sent home multiple times (because you don't recognize the signs of active labour), you will receive more interventions (because you don't know about the alternatives or the risks/benefits of these procedures), you will have trouble breastfeeding (because, ya know, apparently this just comes naturally to us), and you may have a higher risk of postpartum depression (because your expectations of parenthood are being shaped by popular movies and television)

4) The City of Ottawa provides great classes (ahem): I almost choked on my coffee this morning when I saw a comment from someone describing these classes as "great." First of all, the City classes are run by Ottawa Public Health. Their primary goal is to spout all the health and safety information they live and breathe by - don't smoke, don't drink, don't do drugs, don't sleep with multiple partners during pregnancy (what???), and don't, UNDER ANY CIRCUMSTANCES, sleep in the same bed with your baby. You might as well just throw your bundle of joy out the window if you plan to do that!! [My apologies to Public Health Nurses - you truly did help me out by doing home visits after I had my daughter. But in terms of preparing couples for labour and birth? I think they'd be best to stick to public health issues].

5) People are losing their jobs: In the Ottawa Citizen article, Mitchell claimed that "the program...[is] taught by nurses and social workers outside of their regular hospital duties. For that reason, no staff would lose their jobs once the program ended..." This is false information. Most of the prenatal educators at TOH are private instructors, and WILL be losing their jobs. The coordinator of the program, who has been there for 20 years, is also losing her job.

I'm sure there were other claims made that require clarification, but these are the few that have been brought to my attention.

My wish is for ALL expectant parents in the Ottawa area to have access to classes they want and need. The City of Ottawa classes may be beneficial to you if you are looking for more of a "prenatal health" program.

For couples hoping to get a comprehensive class that encourages women/partners to learn about all the options and make informed choices, check out the Ottawa Childbirth Education Association or Mothercraft Ottawa. Strapped for time? No worries, Birthcare offers a 1-day condensed course! Need all the help you can get because you're hoping for a natural or home birth? Try some of the alternatives, such as Birthing from Within, Nesting in Ottawa or Lamaze.


Have I missed any? Who did you take your classes with, and what was your experience?

Top 10 Innovative Ways to Stay Cool During Pregnancy

10) Eat lots of ice cream and/or popsicles. Even if you gain 50lbs during pregnancy, it's OK.

9) Have a cold shower, and then run naked to your bed. Let evaporation do its job.

8) Run through the splash pad with your toddler (bonus points if you try to splash the other parents)

7) Put your head under the water sprays in the produce aisle of the grocery store (bonus points if you then toss your wet hair in a very sexy way, attracting the eyes of the produce boys)

6) Buy a Japanese Ice Bra!

5) Drink hot tea (the British in India swore by this)

4) Bathe your feet in ice water (bonus points if you do this at the office)

3) Crunch loudly on ice cubes (again, the cubicle is a great place for this - especially to annoy your insufferable cube-mate)

2) Always expose your stretch-marked belly at the beach by wearing a bikini (bonus points if your bum is eating your bikini bottom)

1) Go skinny dipping (bonus points if you do this in a public pool)

32

I've borrowed the idea for this post from my friend Sara over at My Points of View

Today, I am 32 years old. Is it cliche to say that I still feel like I'm 22? That I'll probably always feel 22, even when I'm hobbling around with a cane and wearing Depends?

I started writing a big sentimental post about birthdays and ageing, but then I realized I'm only being sentimental because I'm pregnant. Much better to be practical.

So for a fun post, I decided to share 32 things about me....

1. I once wrote and recorded my own CD

2. I busked on the streets of Huntsville, ON, a la Hawksley Workman

3. I worked one summer at Billie Bear Resort in Northern Ontario

4. I convinced a group of students I was travelling with to go skinny dipping in Thailand

5. I have eaten bugs (some type of fried worm, to be exact)

6. I've visited England, Ireland, France, Germany, Switzerland, Spain, Thailand, Japan and many parts of North America

7. If given the time, I can read a novel in a matter of hours

8. I'm a crappy housekeeper

9. I like big ideas, but struggle with the small details

10. I  have attended 3 universities, and completed 7 years of post secondary education

11. One day, I hope to do 4 more years of graduate school, and get my PhD

12. When I was little I wanted to be a musician in a "pit band" for broadway musicals

13. We had our wedding reception in a 100-year old barn

14. At that same reception, I may have been the first woman to pee in a port-o-potty in my wedding dress

15. I once caught a baby in a car

16. I've birthed at home, and plan to do it again for my second

17. I once got a job bottling mosquitos for testing in Northern Ontario...I later chickened out

18. I'm scared of bugs, but I don't mind snakes or rodents

19. I can't sew, knit or craft

20. But I can make a mean sweet potato pie

21. In 2008 I ran my first (and last) half marathon

22. I hate my smile, because I think my teeth stick out

23. I like my curly hair

24. I don't own a scale, and rarely weigh myself

25. The first CD I ever owned was "Five Days in July" by Blue Rodeo

26. The first concert I ever went to see (unless you count Sharon, Lois and Braham when I was 5) was U2 in Toronto. It was during their "Pop" tour

27. I was a cheerleader in high school

28. I hate shopping, I hate shoes and I hate clothes

29. I do like purses and bags

30. Our 10-yr plan is to own a small piece of land, build a strawbale home, and raise Nubian goats and chickens (ok, my husband doesn't know about the goats yet...shhhh, don't tell him!)

31. My "when I'm grown up" dreams used to be that I would own a Pug and an old Mini Cooper S. I have the pug, but no mini yet.

32. This morning at 1am, I welcomed a beautiful baby girl into the world (someone else's, not my own!) Clearly, she was born on the coolest day of the year

Spring Fling

Is anyone else finding this spring excessively hot? These high 20/low 30 days are getting to this pregnant gal, and I feel a little slow. I'm scared to see what July brings!

The warm weather hasn't stopped Daddy and A. They've been out biking...

And picking the radishes from the garden...

Our peas seem to have been eaten by the rabbits, but the tomatoes, peppers, squash and carrots are growing well.

I heard awful news yesterday that we may have lost up to 90% of our tender fruit in Ontario, due to the late spring frost. No local apples this year?? Sob!

What's growing well in your garden this spring?

Why The Office is Bad for Pregnancy

Image Source

Everyone  knows that our sedentary lifestyle is slowly killing us. When we work 8-9 hours a day sitting at a desk, come home, and plop ourselves down in front of the TV, we know we're doing our body a disservice. But what choice do we have? Money needs to be made, and our jobs are sometimes stressful (hence why we zone out in front of the TV every night).

But all the risks associated with our choices seem so far off in the distance. It's hard to take cardiovascular disease seriously when there's a "chance" that we'll develop problems. The payoffs we get now (money, power, job satisfaction) outweigh the negative impacts we may experience years down the road. That's why it's so hard to change - getting more exercise, eating better, and lowering stress have long-term benefits. Our brains are hard-wired to want what we want RIGHT NOW.

However, pregnancy is a short time in our lives. Long enough that we can appreciate what our bodies are putting us through, but short enough that we can see the outcome. And office life can have some detrimental effects on pregnancy and birth. But the good news is that short-term positive changes can be made to facilitate a healthier and less stressful pregnancy. And when we can see the benefits (i.e. a healthier mommy and a healthier baby), then we're much more motivated to make changes.

I've worked in an office for many years, and have never had an issue with sitting for long periods of time, typing all day long, and working under fluorescent lighting. Never, that is, until I got pregnant. Pregnancy changed my body, and made it hard to handle the demands of office life.

So here are some tips/tricks I have learned along the way, in both my first pregnancy and this pregnancy:

1) If possible, try to work from home or negotiate "flex hours" with your manager. Even 2-3 days a week at home can give you a much needed break from the fake lighting and lack of fresh air. Plus, you'll save time on your commute, which will give you the opportunity to get a bit of housework done or go for a walk.

2) Drink lots and lots of water. Office buildings have recirculated air, which can make them stuffy and dry. Keeping yourself well hydrated is a must.

3) Get up frequently - every 10 minutes. Go to the bathroom (not hard when your bladder is getting squished); take a quick trip to the water cooler; go for a walk around the building; or just do some stretching by your chair.

4) Sitting - we have an epidemic of malpositioned babies here in Ottawa. Some suspect it's because most of us are government/office workers, and we spent a lot of time reclined back in our chairs. This encourages our babies to take the "sunny side up" position, which can make labour and birth long and difficult (usually resulting in more interventions). One way to fix this is to buy an exercise ball to sit on instead of your office chair. This encourages you to arch your back, open your legs up wide and strengthens your core muscles.

5) Activate your commute. I park my car a 15 minute walk from work, which forces me to get 30 minutes of physical activity each day (I try to do a power walk). On the days I take the bus, I get off at a stop further away from the office, which again helps me to get short bursts of activity.

6) TV at night is still OK - just remember what I said above about posture and positioning. If you're watching TV at night with your hubby, bust out your yoga mat, and do some stretches. Or sit on your exercise ball instead of the couch. Even better? Turn off the TV and sign up for a yoga class!


Have you learned any special tricks/tips for being pregnant in the office?