Bariatric Obstetrics is the new term some doctors have invented for practices that specialize in seeing fat women during pregnancy and birth. The New York Times just did a big article on this, called "Too Fat and Pregnant." (Pbbbttthhhh to the editor who came up with that title.)
But is "Bariatric Obstetrics" a good idea? Doesn't it just "ghettoize" fat women? It punishes them for being fat by limiting their weight gain (or even telling them to lose weight while pregnant), and targets them for extensive interventions all through pregnancy because they're assumed to be "so high-risk." It makes a cesarean and/or complicated delivery practically a self-fulfilling prophecy. And most of these women then get pressured for significant weight loss after the pregnancy, using whatever scorched-earth techniques du jour the clinic favors, ignoring the role that yo-yo dieting plays in increasing long-term weight.
And has anyone even studied whether this high-tech, high-intervention approach to birth in fat women actually improves outcome? Or do they just assume it must? The truth is that these interventions go almost unquestioned in obstetrics today, with pressure to do more and more, despite lack of proof that these are free from harm.
Unfortunately, "Bariatric Obstetrics" is a concept that is only going to get more and more wide-spread, until most average doctors will be pressured to refer all their fat patients to these "specialists," and most midwives will be forbidden to attend women of size at all. This is already happening: anecdotally I am hearing of this more and more often now. All without any proof that this approach improves outcome and is not harmful. And all while taking away the possibility of CHOICE for fat women in determining the kind of care they prefer to receive.
I understand the concept behind "Bariatric Obstetrics," and I'm sure most of the doctors involved think they're doing fat women a favor by creating practices just for their needs. Most doctors aren't bad people, just people trained into a mind-set around obesity that is so extreme they can't even begin to question what they are taught. Some genuinely want to help, and have been taught that this approach, in all its extremity, is the best way to do so. But the road to hell is paved with good intentions, and policies undertaken with the best of intentions often still lead to poor outcomes and discriminatory treatment in the end.
Most of the doctors in these clinics cloak their practices under of false banner of fat-friendliness by promising equipment that fits larger people, bigger chairs in the waiting room, understanding nurses, etc. They probably go out of their way (like weight-loss surgeons and diet companies) to do the fat-support double-talk, where they SEEM like they are fat-friendly and only doing this in YOUR best interests, REALLY. They only want to HELP you have a healthy baby, TRULY. And they might even mean it.
But the reality is that, whatever their intentions, they are perpetuating fat bias, discriminatory policies, and scorched-earth interventions. As with fen-phen and orlistat and weight loss surgery, in the end, fat people often end up worse off than they started. Only now they're doing it to fat people's babies too.
The premise of these practices are based SO much on fat-phobia and mistaken beliefs about obesity (fat people all eat too much and the wrong foods, they never exercise, they are at extreme high risk for problems, they are a danger to their poor babies, they have to be taught different habits for the sake of the children, etc.) that it is doubtful they can provide objective and respectful care for these women. And the fact that more and more fat women will be railroaded into this type of care, restricted from access to any kind of "alternatives," is especially frustrating.
Although they are not publishing them, I'd bet the cesarean rates and induction rates at these bariatric clinics are practically off the charts. However, then they'll just blame those high rates on the effects of obesity ("See how high-risk they are?"), rather than actually looking to see whether their policies had anything to do with that or not. Convenient, no? All while getting to charge insurance companies more and more money for such specialized care, and all while racking up more and more billable interventions for their clinic/hospital. "Bariatric Obstetrics" is going to be a profitable sub-specialty indeed.
The best way to fight against this mentality is to opt out of the medical model altogether. Your best bet for size-friendly care in pregnancy, frankly, is a midwife instead of a doctor. Although there are good and bad in every profession (not every midwife is size-friendly, and some doctors really can be size-friendly), midwives in general are much more size-friendly than doctors, especially in this current climate of extreme intervention around obesity. And your chances for induction, cesarean, episiotomy, and many other interventions are also much lower in general with a midwife.
If you are pregnant and looking for a care provider, don't let them bully you into this model of extreme intervention and fat-phobic care. Just because you are fat does NOT mean you "need" to see a high-risk specialist. Just because you are fat does NOT mean you need every prenatal test in the universe, or to be induced early for a "smaller baby," or to have an automatic early epidural or internal monitor placed, or to be pressured into a c-section "just in case." Just because you are fat does NOT mean you have to go to a "Bariatric Obstetrics" clinic.
In fact, unless there is some special complication that necessitates closer care, your best bet is usually midwifery. Anecdotally, many fat women have found that they have had much better births (with much better outcomes) when they saw midwives instead of OBs for their care. I certainly found this to be true, as have many other fat women I know.
Too Fat and Pregnant? Bariatric Obstetrics? Just say NO.