Their cutoff for "too" fat? 200 lbs., a ridiculously low cutoff. There is no way the risks of complications at that size justify denying these women care across the board, and there is no way that they should be denying care to an entire group of women based on complications some individuals might develop.
Other people have covered the story just fine so I don't feel the need for extensive comments, but I do like the coverage from The Unnecesarean. One commenter ("Mel") there, had a good summary:
I think the point of it all, the reason this is such an ugly decision, is that this group of doctors (and many others) have isolated the risks of obesity as THE ONLY risk, right off the bat, that makes people "too risky" to serve. What can account for this?
...These are OBs, who by nature of their training, are best equipped to help people with any remotely moderate to high level of risk, right up to the sorts of very high risks that are better attended to by MFM [maternal fetal medicine] specialists. I don't see them passing on caring for multiple pregnancies, or a woman who will need a 5th c-section for instance.
Why single out obesity as a risk factor? The only plausible answer, given the scope of their practice, is bias. Prejudice. It's an excuse so they don't have to treat people they don't like and of whom they disapprove.The Florida doctors use the excuse that it's more difficult to get a good quality image during an ultrasound of an obese woman, and their office machines can't handle that.
...I don't buy for a moment that these doctors won't treat overweight patients because it's SO risky! I could understand a person by person decision for women with really high risks that included being very obese. But that's not what they're doing here.
The answer to that? Train your docs and techs in techniques that improve the image for women of size, delay the scan by a few weeks, and if that isn't enough, send the woman to a specialty center with more advanced equipment....for the ULTRASOUND. No need to transfer all of her care to a high-risk maternal fetal medicine specialist just for ultrasounds!
The doctors also complain about their potential for being sued. Now, I generally have great sympathy for doctors who are sued unjustly (as does happen sometimes in obstetrics), and I do think many docs are between a rock and a hard place in terms of malpractice insurance.
But I'm sorry, many doctors face high malpractice rates and don't deny care to fat women. Other docs (and midwives) somehow manage to care for a variety of women, not all of whom are super low-risk.
Categorically denying care to "obese" women, regardless of actual complications, is the result of an inflated perception of risks around this group and sheer outright weight bias.
Another wrinkle to this story is that not only won't they see fat pregnant women, they won't see fat non-pregnant women either now. That's new...but it's a trend that started with obesity and pregnancy and is now extending to non-pregnant fat folk as well. So all of you in the fatosphere who read my posts about weight bias from OBs and think it doesn't apply to you because you don't plan to have children......au contraire. Now it's spread to GYN care. Apparently pregnancy weight bias is just the canary in the mine, warning of further dangers to come regarding equal access to care for all fat people.
Some in the birth world have commented cynically that the one bright spot in this story is that at least fat women in Florida know the worst fat-bigoted practices up front and will be able to avoid them. Too many doctors smile and nod and pretend to be size-friendly, then turn on the mom at term and tell her she "needs" a cesarean or an induction or whatever because of her size.
So, yeah, I suppose that's the one good side to all this. But I'm sorry, I just can't celebrate that.
This is just a further step along an ominous trend to segregate people of size into the care of ultra-high-risk docs, based on their size alone, regardless of whether or not they actually have poor health or develop complications, and regardless of whether such high-intervention care actually improves outcomes.
It's another step along the path of denying people of size health care choices and life choices, "for their own good," and I find that extremely ominous.
We've discussed before in "Ghettoizing Fat Women" that there is an increasing trend to shunt all women of size, regardless of actual complications, into specialized "bariatric obstetrics" practices and regional high-risk hospitals, and denying them access to midwives and a low-intervention model of care. Sadly, I only see that practice increasing. I've heard from women of size who have been denied care from homebirth midwives (despite prior births with them with good outcomes), from birth centers, from regular OBs, and even from some hospitals.....simply because of their size.
No, these are not "super obese" women; these are often "mid-sized" fat women. The idea now is that ALL "obese" women, pregnant or not (and regardless of actual health status and health habits), are being considered far too high risk for any care but the most centralized, most interventionist, most high-risk practices and centers─without actually proving that this sort of care improves outcomes.
And it's a very frightening step down the road of taking birth and healthcare choices away from a substantial group of women. Where is the respect for patient autonomy? For people having the right to choose the kind of care they prefer? For people having a say in their own care? For people being able to say no a style of care they don't want?
Each person needs to have their care individualized, based on their health status, their healthcare preferences, and their needs. We should not have our healthcare choices taken from us, simply because we are fat. And this latest story is just another step along the path of denying patient autonomy to people of size.
An ominous canary in the mine indeed.