Although this is one of the more egregious stories of fat bias in pregnancy I have read over the years, size bias in pregnancy and birth is distressingly common, and many fat women hold deep emotional wounds from the treatment they endured during what should be a most blessed time in a woman's life.
"Gina Marie" sent me her birth story in order to help other fat women, stating:
I didn't have a good, normal birth story. In fact, my son's birth was absolutely horrible. However, there are some important things that I learned afterwards that I think large women need to know and need to be on the lookout for.It is in this spirit that we reprint excerpts. You can read the full story on my website.
Gina Marie hired midwives because they seemed the most size-accepting. Even so, they induced her at 37 weeks because her baby looked "big" and because she was developing symptoms of pre-eclampsia (BP issues with complications). Her baby was not yet in an optimal position for birth so labor did not progress. With her IVs, she developed severe swelling, and eventually a decision was made to do a cesarean.
The back-up OB then came in and proceeded to pressure her into having her tubes tied so she would not have any more children. [This is unethical; sterilization decisions should not be made in the middle of labor and certainly not as the result of pressure from a health-care provider.]
When Gina Marie would not agree to having her tubes tied, the OB was furious:
When she came in to discuss my surgery, the OB sat down and asked me if I wanted my tubes tied while she was in there. I was shocked and told her no, that this was my first child, and I didn't want to make decisions like that at the moment. And she countered with a speech that boiled down to 'You are too fat to have any more children, you shouldn't even be having this one, and if I had anything to do with it, you wouldn't be.'
Then she discussed general anesthesia, and the dangers. Granted, fat people do sometimes have problems with general anesthesia. However, it was a little heavy-handed for her to instruct me to discuss funeral arrangements with my husband before I went into surgery. She asked me if I was an organ donor, and then said it didn't really matter. (I don't know what the hell this was supposed to mean. I guess she was implying that my organs were probably not acceptable or something.)
During the surgery, the OB used a "classical" incision, a huge disfiguring up-and-down incision, instead of the customary side-to-side incision done just above the pubic bone. [Many doctors have been taught that a vertical incision is better in obese women---less chance of wound infection and complications if the incision is not under the belly. However, recent research has shown that a vertical incision is actually TWELVE times more likely to have wound complications.] Afterwards, the OB informed her that this classical incision meant that she should not have any more children.
The hateful OB informed me that the kind of incision that they made in my uterus will make it incredibly dangerous for me to attempt another pregnancy...a subsequent pregnancy could cause the uterus to rupture and I would die horribly from a hemorrhage.The OB found another way to prevent further children, even without a tubal ligation.
During the surgery, Gina Marie had significant blood loss. This caused severe anemia, which no one thought to test for until days later. She didn't see her son at all for 24 hours, and not often even after that. Breastfeeding failed because of supply issues due to the anemia, undiagnosed thyroid problems, and lack of breastfeeding opportunities with her son. Not only did she lose the opportunity for a respectful birth with her son, she also lost the emotional healing that many women with bad birth experiences find in breastfeeding.
Gina Marie continued to struggle with recovery after the cesarean, experiencing infection, severe edema, seromas, and eventually an abscess. The harassment and hate talk about her size continued while she was trying to recover in peace. She writes:
While I was in the hospital...every doctor in the whole evil practice came by my room to bitch at me for being fat and to talk about diets. Some were less aggressive and insulting about it than others, but they all felt it was completely important to tell me that I am too fat. "Have you ever considered dieting?" was how they all started out. Like any fat person in America could possibly get to be 30 years old without dieting at some point. Like I haven't been informed by family, friends, strangers, and doctors that I am fat fat fat fat fat and I need to diet for my entire life. As is this was a completely new discovery.
I felt particularly betrayed when the lead midwife came in and gave me the speech. When I first became pregnant, I told her that I was worried about my eating habits and I wanted to take care of myself and give my baby good nutrition. I kept a food diary for two weeks and showed it to her on my next visit. It was a faithful diary. She praised me for the variety and content, told me that I was doing a good job of eating healthy low-fat foods. She suggested that I eat more protein, but otherwise did not criticize my eating habits. So it was a shock and a betrayal when she came in and told me that the best plan for my life was a really strict diet.
The bitchy cruel OB got in on the act, which is hardly a surprise, and laid it on with a trowel. Not only did I need to diet, but if I did not do so, I would be dead before ten years, because women my size don't live past 40. My child would never love me because he would be so ashamed to have a fat mama. Fat women are bad mothers who can't keep up with their children, and their children suffer for it. By obstinately continuing to be fat, I would show myself to be an unfit mother.
Gina Marie was greatly traumatized by her whole experience. She concluded her story with a few final words of warning to women of size:
- If you use a midwife because she is size-accepting, check out the back-up OBs as well, so you won't get a nasty surprise like I did
- Ask about the [c-section] procedures, even if you plan on a natural birth. I found out later that doctors can and do perform "bikini cut" incisions on women with belly aprons
- Thyroid disease is commonly underdiagnosed in women, and it can interfere with breastmilk production. It can also interfere with fertility, cause miscarriages and some birth defects (thank God this didn't happen to me)
- An easy pregnancy can lull you into a false sense of security, and leave you unprepared for a bad birth
I would add a last proviso about the importance of finding TRULY size-friendly care. Just because a care provider seems size-friendly on the surface doesn't mean they actually are. Many have protocols (well-intentioned or not) that result in poorer outcomes in women of size.
Women of size must take time to really educate themselves about pregnancy and childbirth issues and ask lots of questions of their providers. Many are lulled into that false sense of security during pregnancy that Gina Marie mentions, only to be shell-shocked when their providers change their tune at the end of pregnancy and pressure fat women into intervention after intervention. Fat women CAN birth vaginally and gently, but in this climate, they have to be well-educated about birth and fierce advocates for themselves and their babies first.