Wednesday, May 13, 2009

Care Providers vs. "Scare" Providers

Far too many doctors and other healthcare professionals have decided to become "Scare Providers" instead of "Care Providers." This seems to be particularly true for fat women in the realm of pregnancy and childbirth.

I am hearing more and more stories lately about doctors telling fat women that they will never have a healthy pregnancy, that if they dare to become pregnant at their size they will probably die, that their baby will die, or that they will never have a healthy baby.

This kind of bullying is not the experience of all fat women, mind, but I am hearing this kind of story much more often than I used to. The risks around pregnancy in women of size has become SO hyped now that some doctors are totally distorting the actual risks way out of proportion, trying to scare fat women away from having babies at all.

The Newest Story for the "Scare Providers Hall of Shame"

A mother from a support group for women of size recently wrote about her experience going to a Reproductive Endocrinologist (RE). She gave me permission to share it here.

She is 29 years old, "overweight," and has been trying to get pregnant for 2 years without success. She saw an OB, who determined that she has a blocked tube and doesn't ovulate regularly. They did lab work and counseling to discuss her risk factors and to work out a healthy, sane proactive plan for having a healthy pregnancy. Then her OB sent her to her local RE for help in getting pregnant.

The RE took one look at her size and started interrogating her. In the end, he refused to help her, telling her it would be "unethical" to assist them with pregnancy because of her size.

He also told them that if they were to get pregnant somehow, "The baby would only have a 5% chance of survival." FIVE PERCENT.

Then he told them that he would be writing a letter to her doctors so they would quit wasting his time with cases such as hers anymore.

Now, I have no idea where that doctor got that "5% chance of survival" bullshit. I've read a LOT of medical studies on "obesity" and pregnancy, and I have NEVER seen any number like that in ANY study.

It was purely and totally a scare tactic number, pulled out of his behind and not based on any real research. Bottom line, it was designed to bully and frighten this woman out of having a baby.

Fortunately, she didn't buy into this bullshit at all, but how many fat women have been told crap like this (or read scary online "information" articles and media releases) and are intimidated out of having children?

Other Stories in the Hall of Shame

This is just the latest story of fat bias mistreatment. You'd think I'd get used to reading these by now, but my blood starts boiling every time I read these things.

I've documented other stories like this on my blog before, but it was early in the history of the blog and few people had found me then, so pardon me for a little repetition. Let me hit some of the "highlights" for you.

First, there's the story of the woman who emailed me last year about "Suicide By Pregnancy." An OB at a prestigious university medical school told her that if she chose to continue her pregnancy, she would almost surely die. Here's a quote:
He told me that I wasn't going to make it alive through my pregnancy and that they would "have to take drastic measures to try save me before they would even attempt to save my baby" etc.

He kept saying I shouldn't have gotten pregnant, that I had in a sense, committed suicide! He told me that my heart was going to give out, or that I was going to stroke out while attempting to push my LARGE baby out, therefore I was going to have a c-section. He told me that I was going to have massive blood clots in my legs and severe pre-eclampsia.

I left his office completely panicked and in tears. I was shaking so bad I could hardly walk and all he did was look at me and said in a cold voice with no emotion at all, "It's really scary, isn't it."
Or there's Gina Marie's story, where she was induced early because of a suspected big baby, which resulted in a cesarean, as inducing early for a big baby often does. (Of course, they blamed the c-section on her obesity instead of on inducing for macrosomia, naturally.)

Just before the cesarean, the OB pressured her to agree to tie her tubes so she wouldn't have any more pregnancies. When she would not agree, they implied she would not survive the surgery, asked if she was an organ donor, and wanted to know what funeral home to use.

Then they used a classical incision in the cesarean (a huge up-down incision, which is usually used only when a baby needs to come out as FAST as possible, which was not true here), and told her that if she dared have another pregnancy, her uterus would "explode."

In other words, they found a way to punish her and scare her out of another pregnancy, despite her not agreeing to let them tie her tubes.

After the surgery, they took turns coming into her room and yelling at her about losing weight:
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.
Then of course, there are the fat women who are pressured to terminate their pregnancies, simply because they are fat. The implication is that the baby of a fat woman could never be healthy, that pregnancy at larger sizes is so dangerous that the pregnancy must be aborted in order for the woman to survive, or that the baby would die in a fat pregnancy anyhow so you might as well abort sooner than later.

As one woman recounted:
I also was told I could not have kids. Then when I got pregnant I was told by various doctors for various reasons that I should abort.
This is the latest tactic in the obesity hysteridemic------extreme medical bullying.

A New Form of Medical Bullying

Medical bullying has been around for "obese" people for a long, long time, but it only seems to be getting worse now with all the hype about obesity.

Fat women have been having babies for years too, but the risks of obesity and pregnancy are so hyped nowadays in the media and the medical literature that doctors have a hugely exaggerated sense of risk with it.

Because of this, they feel justified in a nearly 50% cesarean rate for "morbidly obese" women (or more; that study was only on first-time mothers); in preventing fat women from having access to reproductive technology (as is happening in the UK); in pressuring women of size to not get pregnant unless they get to a "normal" BMI first (which, given the long-term failure rate of dieting, basically means that very few will ever have babies); or in scaring fat women out of trying to conceive at all or into terminating their pregnancies.

Basically, they are trying to emotionally manipulate fat women out of pregnancy (or further pregnancies) by any means they can.

I've said it before but it bears repeating.....this kind of over-the-top BULLYING is a total exaggeration of the risks, and basically amounts to trying to scare women of size out of having babies rather than giving them reasonable counseling about possible risks and ways to mitigate those risks.

It is a unique and insidious form of eugenics and IT MUST STOP.

*If you have a story of fat-biased treatment that you encountered during pregnancy or birth, please feel free to email it to me at kmom at plus-size-pregnancy dot org. It's very important that we document these kinds of incidents.


spacedcowgirl said...

These stories are absolutely disgusting, and I agree 100% that such providers are just trying to keep fat women from reproducing. Seriously--5% survival rate?! Shouldn't someone lose his license for misleading a patient like that in an attempt to strongarm her into NOT EVER HAVING A CHILD? It makes me want to throw up.

SuSuseriffic said...

Uggg! you are so right! My docotors office (not pregnancy realted luckily) stopped bothering me about my weight when I seemed to not be gaining anymore. I mean they actually said it outloud! "well your weight seemed to plateu so we woudn't talk about that today"

Tanz said...

I had to respond to this, to give some hope to women who have heard and believed the lies being told them about the dangers of an obese pregnancy.

I was 28 years old and approximately 300 pounds when I fell pregnant (naturally) with twins after 3 months of no birth control.

I expected to be given a hard time by the medical profession (I live in New Zealand, and they're fairly fat hating over here) but I was pleasantly surprised. I was told by my GP (in response to a question I asked about risk) that as I had no pre-existing health problems I had pretty much the same risk as anyone else for pre-eclampsia, etc.

The only time was weight was mentioned was by the anethatist (sp?) at the hospital, when he was encouraging me to have an epidural. His argument was that if I needed an emergency c-section (which can happen with twins) it would be better for me to have had an epidural rather than be put under a general - due to my size. However, he was matter-of-fact about it and not shaming at all, and the decision was left to me to make.

In the end although it did come close to a c-section (due to issues I won't go into, but they're not weight related) my OB tried his hardest (at my request) to avoid it - and I ended up giving birth to both twins vaginally.

My point is - if you are being pressured - please remember that women like you and me get pregnant and give birth safely all the time.

Your Doctor may be well educated, but he can still be an ass.

Jill Arnold said...

It is absolutely negative eugenics based on the attitude that a "fat" life is not worth living. The practice of obstetrics and medicine in general tends to be extremely ahistoric, so it sadly does not surprise me that this kind of abuse would go unchecked.

Lady said...

You are my hero.

I am absolutely ASTOUNDED by the pure, unmitigated EVIL being spouted by these docs. "First, do no harm" my FAT ASS.
Wow. Just... wow.

The worst that ever happened to me was being told that I should lose weight before trying to conceive. And I was only 190 lbs at the time!!! (I'm 5'9" - that put me in a size 14, kids. SO NOT FAT.) But I've also had docs blame my weight for things like sore throats (true story), so I never give any heed to those docs and ditch 'em as soon as I get the chance.

Anonymous said...

I'm so saddened and surprised by this story. I am six and a half months pregnant with my first child, and weighed about 230 before I got pregnant. AT NO TIME has my weight been an issue. (Well, there was that time I gained 8 pounds between visits, having complained at the last visit that I wasn't gaining any weight. They gave me some gentle ribbing over that - "We told you you'd gain eventually!"). Because I have an underlying health condition, I was sent to a perinatal specialist who also said NOTHING about my weight. There has been NO mention of a c-section except in case of an emergency, and when I asked the doc if she could tie my tubes at the same time if I did end up having a c-section, she REFUSED. She said that she hates doing them under those circumstances because women tend to regret them later. If I still wanted to go with it in six months, she'd be fine with doing it.

I know that I'm extraordinarily lucky to have found these doctors, and just don't see why all of them can't be the same way. They've been nothing but supportive and wanting to do everything to make sure that I and the little one come out of this safe and healthy. That's the way it should be!

Meowser said...

Wow. That is some outrageous shit you're reporting there. I'm with SCG, the "doctor" who gave the "5% survival rate" figure is guilty of malpractice. With crap like that going on, fat women might as well make like Cass Elliot and drop acid and shoot up heroin while they're pregnant, since they're going to get treated like they're doing stuff like that anyway. (snerk)

Tiana said...

The more of these stories I hear, the more I wonder if doctors haven't long since realised that weight is genetic and all of this is just part of a huge conspiracy to keep the fat genes from being spread.

Evenspor said...

This is really, really sad. I haven't ever had a problem like this with OB related things, but I have had some trouble from regular doctors at our clinic when I've gone in to try and solve real health problems. "It's because you're overweight. Diet and excersize, and it will all be solved." One doctor refused to even listen to my symptoms unless I had excersized for a month first.

Anonymous said...

A short time ago I terminated an unplanned pregnancy. This was not an easy choice for me, it was something I struggled with. When I finally rang a clinic to schedule an appointment for a termination, I was given a date and time and then asked a myriad of other questions. When I was asked my weight, I answered honestly. I was then told my BMI was too high for me to have the procedure carried out. I am 250lb and my BMI is 42. I have also had other surgery several times in the last few years (when I weighed more than I do now) and my weight wasn't bought up as an issue. I was devastated that I might have to continue with this unplanned pregnancy simply because I couldn't get a termination because I was considered too fat. Thankfully I found another clinic who was happy to do the procedure, although one anaethetist there also refused to administer the anaesthetic to anyone with a BMI over 40. The anaethetist I ended up with had his cut off line at a BMI of 43. Surely there are women fatter than me who have had need for a termination? What do they do? I was devastated by the extra stress at an already stressful time and disgusted by the apparent disregard for my feelings. Now I am angry. Really angry.

Kketcher said...

So sad. I am so lucky to have the OB that I have! My primary care physician recommended my OB stating that she went to him and he was aweseome, and she was ABSOLUTELY correct. I'm having a great experience thanks to Dr. Williams. He has not once said anything about my weight, in fact, he is always encouraging, today telling me that the weight I've gained is fine as long as I'm eating healthy and taking my prenatal vitamins. I wish my experience with him so far for all overweight mommies to be.

Ecologista said...

I'm not a very large woman, being at ~165. But I do know that even very small women have a lot of risks, because sometimes they are too small. There are risks for every woman... but I switched to a cnm for now, I may switch again because they don't really communicate with me... I switched because the ob I was with said that women are inferior! Not a good thing to tell a heavily postpartum depressed woman following her 3rd miscarriage in 1.5 years!

I think it's disgusting all the crap that goes on. Really, women all over the world and throughout the ages have given birth with or without assistance.

I have a cousin that is really tall and really really skinny - really I like I'm two of her! I know she's been told she may never be able to have kids cause of how tiny she is and she has gyn issues as it is... but her sister who is my size that has gone thru endometriosis, years of ovarian cysts and uteran fibroid tumors - along with miscarriage and chem pregnancies is expecting a later this summer.

So, really, larger women don't just get a lot of the crap. Overall, we women have to deal with crap in all aspects of our lives.

That's my two cents.

Jen said...

I am an obese woman and mother of one healthy boy, I am also 5 months pregnant with my second. I just want to put out there that it is our right to shop around for care providers who do care. I went to one who told me my baby would be born ill, I asked him for information to back up what he was saying, of course he could not provide any. I told him I would report him for unethical treatment of a patient and discrimination, he shut up real quick.
I then found an OB (female) who did not give a shit about my weight. During the whole pregnancy not once was I weighed, she only told me to eat well and exercise, the same advice she gave all her patients. She told be while the might be some higher risks involved these sorts of things are watched for and if no indication of a problem was noted, no worries.
I had a 20 hour labour with my son that ended in C section when my blood pressure got very high and my sons heart rate slowed right down.
I am with the same OB again who is very support of my desire to VBAC and see's no reason why I can't have this baby the normal way.
Shop around till you get what you want and report anyone who discriminates based on size. We are people too!

Merrie said...

I was planning a home birth and went into hospital to have a scan because my baby was almost 3 weeks overdue. They sent the head Dr in to do my scan who promptly told me that if I wasn't induced that day my baby had a 1 in 6 chance of being stillborn because I was so obese. He must have said the words "dead baby"about 15 times in the space of 15 minutes. I was scared into an unnecessary and traumatic induction and didn't get the blissfull homebirth I wanted. I wish I had never gone into the hospital in the first place. I have had 2 pregnancies as a fat woman and both have resulted in beautiful healthy normal sized babies.

Tina said...

I'm 22 and my doctor has been no hope for me at ALL!!! Basically I went to the doctor because after being off Birth control for 5 months and still no period (only spotting) I asked her to help me because I was not becoming pregnant(negative preg tests).
Well my mean and thoughtless OBGYN told me that it was impossible for her to help me get pregnant until I lose 100lbs!!! Yeah 100lbs!!!Obviously she never had to deal with being overweight so she doesn't know how it is. I can't believe she said that. Being overweight my whole life 100lbs sounds so ridiculous! She suggested that I do the Lap Banding procedure to lose the weight and then she would help me. Other than being overweight I'm healthy, No high blood pressure, no cholesterol, no diabetes. I eat right 95% of the time, and exercise, I would understand if I had other medical issues for her to not want to help me but I don't. Why are doctors so cruel to over weight women trying to conceive? I'm at my wits end now and I'm thinking to making the appt to see the Lap Banding surgeon in a couple of months, thats the only way she will help me find out why I'm not conceiveing :(

Ecologista said...

Tina, don't do it! Find someone else who is more open. There are a few good docs out there. I pray God will guide you and help you find a good doc. Ask around. Do "meet and greets" for free to find one. If you are healthy that's what really matters! Give it time - sometimes it takes awhile before you re-balance.

Drink herbal raspberry leaf tea - only rasberry leaf.

It has helped me so much in my gyn issues and a girl friend that had pre-uterine cancer drank it and it worked better than her pain pills! And she is free of that particular issue.

I wish you the best.

tina said...

Thanks for your advise Ecologista,
I will try to look for a new GYN but with the insurance I have I don't have many options. I am a military wife and I have Tricare prime so I have to go to the doctor they appoint me or get referred out to another doctor. I'm actually thinking about filing an complaint that way it will be easier to get an referral to another doctor.
I'm not going to lie but I do have an appt to go see an lapband surgeon (they had no problem giving me the referral to the lapbannding surgeon) on the 14th of July. Not just because of what my GYN said but because I have struggled with weight all my life and I tired of always being the one that stands out. I know I shouldn't take what my GYN said to heart but I've been treated like that all my life and I just want to be like everyone else. All those mothers getting pregnant with no problems because the doctors don't look at their weight before they will look at the person trying to get pregnant.
Sorry for the rant but I'm in a very depressed state right now. Thanks for all your support and I'm so happy for the ones who could find a doctor that could help them achieve pregnancy without looking at weight. I'm hoping for the best! :)

Anonymous said...

I was 330 when i concieved my first daughter, with little to no trying... I did gain about 40 pounds while pregnant (she was also 9lbs 13 oz) but my husband who was born to a normal sized mother weighed 10lbs 6oz, so whatever! LOL I had a perfect pregnancy with no diabetes or high blood pressure all which i was told i would have! I went in for a normal birth and after dialating to 5 and not progressing any further after 12 hours of being induced on my due date after an amniotic fluid leak they opted for c-section (the only other option was trying to proceed, which the doctor told me could result in breaking her collarbone, NO THANKS) Soooo.. This was all after They could not get an epidural on me after and hour of poking and me screaming and bruising, (gee wonder what stalled my labor, hmmm) I was told it wasn't working because I was fat (come to find out later its because my spine is curved at the bottom) so they told me with a c-section that a spinal may not work either which would then result in me being knocked out and then since i was fat i would suffocate or choke on my own vomit and die... ahhh yeah that was so reassuring for a first time mother who had never had surgery before... the spinal went fine, the surgery went fine, i had a healthy as can be baby... despite being scared to absolute death... I was then told I should lose 100 pounds before even thinking about having a second child.. LOL like i'd be fat if it was that easy... *eye roll*... i went immediately back to my pre pregnancy weight within a few months... I have a beautiful 2 year old and I am 29 weeks pregnant with number 2! Also a happy and healthy pregnancy with no complications thus far... In retrospect I assume they are required to warn people of risks associated with any and all surgery but they could at least be sensitive and tactful... No woman should be treated as though she made the biggest mistake of her life for wanting to procreate with a high BMI... Also, if you look back in history at the average size of a woman in paintings or random tribal statues of fertility goddesses.. FYI they weren't skinny ;)

Summer Kinard said...

The doctors I had with my first pregnancy seemed to be under the impression that fat women live on a diet of cookies and ice cream and potato chips. I hardly gained weight for the first 5 months, and when I gained in the last trimester (duh! like everyone else) they tried to put me on a diet. I was thinking, "I probably eat healthier than you thin people; I'm just fat." They really couldn't stop themselves from telling me to lay off the junk food, though, even without asking what I ate. I'm not going back to that practice for the next pregnancy.

But it's mind-boggling what was said to the women in your post!

majnoona said...

Any Ottawa mamas out there who can share their plus size friendly obstetricians?

Anonymous said...

I've wanted to have a baby my entire adult life but never wanted to do it alone, and being a fat chick has meant being alone much of the time. So, I have waited and waited... I'm 40 and don't want to wait any more. I'm 5'4", ~230 lbs. and getting fertility testing to see my anatomy all is in order (which it seems to be, so far). I'm so grateful to have found this blog, because I've been looking around, wondering if my size could mean I'd never manage a pregnancy. Your stories give me tremendous hope.

Anonymous said...

In lots of other cultures a fat mama is a thing to be proud of and they succeed in birthing lots of babies naturally. This kind of prejudice is just another example of the medicalization of birth and the lack of respect towards women's bodies (of any size) to do the work they were intended to do. disempowerment makes me so angry.