Pregnancy and a HAES Crisis of Confidence

Many fat-accepting women face a crisis of faith in their own self-acceptance and in HAES (Health At Every Size) when they become pregnant or consider becoming pregnant.

It's something that many of them don't want to admit out loud, especially in fat-acceptance circles, but I have observed it often in others over the years. I know it was certainly true in my own case.

Even though we still fully believe in fat acceptance and HAES, many of us guiltily go through a stage anyway where we start secretly obsessing over the possible complications of "obesity" in pregnancy, whether we could possibly have a safe pregnancy and birth at our weight, whether our babies could possibly end up healthy, etc.

It's a natural reaction to all the years of propaganda we have heard about how unhealthy being fat is, about how dangerous all that weight is, yadda yadda. Then you add in the natural insecurities that go along with being pregnant for the first time, the media onslaught of negative stories about being fat and pregnant.....and it's a potent recipe for doubts and worries, even in the most self-accepting, empowered woman.

We may or may not admit our fears to those around us, but I think many of us do experience them. But unlike other women of size, we may not feel "safe" to admit to those fears out loud for fear of what others in the HAES community may think. Or we may not even admit them to our partners, lest that cast doubt in their minds about us being pregnant and fat. So that can leave us incredibly alone, stewing in our own fears and letting them ferment.

We may not talk about it much out loud....but I'm convinced that many of us who have been pregnant (or considered pregnancy, or even just had a pregnancy scare) experience this fat-acceptance crisis of faith. I know I did, and I'm willing to take the chance to speak out about it in this forum in hopes that it helps others understand that this is a natural phase that many of us go through....BUT that it doesn't have to be a place where we stay emotionally, and that we don't have to let these fears impact our birthing choices.

If you didn't experience these fears, more power to you. I applaud your empoweredness, and I think it's important we hear from you too. But many others of us have felt these doubts, yet may feel a bit muzzled about talking about it because then it looks like we don't really believe what we've been saying all along.

I think it helps to discuss these fears openly, and to see them as a very normal part of plus-sized pregnancy in this fat-hating society.

I also think it's important to understand how these fears can sometimes influence our birth experiences and our decision-making in pregnancy, and to know that we have other choices besides the high-tech, high-intervention, high-fear model that most fat women experience.

Finally, I think it's vital that we acknowledge these fears and then find a way to move past them, so that it doesn't overshadow our entire experience of pregnancy and birth. We deserve to have happy, joyful pregnancies just like anyone else, and it's within our power to have that, regardless of size. Acknowledging the fears and talking about them is the first step to moving past them.

My Experience

When I was first pregnant, I experienced a huge uptick in fear levels about my size, despite having been part of the fat-acceptance movement for many years. Partly this was because it was an unplanned pregnancy and I hadn't sufficiently girded myself for all the worries of pregnancy, and partly it was because there was no information available then about being pregnant and fat.

What little information about it I could find in mainstream books had all kinds of scare tactics--and that was just for those who were a little bit "overweight." I was significantly "morbidly obese"----if things were that bad for overweight women, how bad would they be for me as a morbidly obese person? Gah!

So yeah, there was some panic on my part when I learned I was pregnant. I indulged that for a little while, then I took a bunch of deep breaths and tried to figure out what I could do to address my concerns and see what did and did not have merit.

I had been a member of NAAFA (National Association to Advance Fat Acceptance, http://www.naafa.org/) off and on for years before I became pregnant. So the first thing I did once I calmed down was to call NAAFA to see what kind of sensible size-friendly info I could get there. I hoped that they could provide an antidote to the fear I was experiencing.

Sadly, I got no help. They had no information about pregnancy at larger sizes. I said, "Surely someone in NAAFA has been pregnant in all these years it's been around?" The person I spoke to said probably, but she couldn't point me to anyone at that point. And she really didn't seem very concerned at all about finding me some reassurance or help either. So NAAFA, my best bet, was no help at all. That wasn't very reassuring, and I felt very alone.

So I thought, Well, I'll just have to find someone in real life who has done this. I went to some of the other fat women at my workplace who had kids and asked them what to expect. Alas, none of them had any help for me either; they said they really hadn't been fat when they had their kids and had only gained weight after having children. So I couldn't even find anyone in real life for inspiration.

My family was not supportive; my mother-in-law had already told me she didn't think I should get pregnant at my weight, that basically I should lose weight and "get healthy" first. My own mother (a thin woman) was very worried for me, and told me that my cousin the nurse said I should be seeing a "high-risk" OB, not just any old OB....because of my size.

On top of that, I couldn't find ANY maternity clothes above a size 16/18 in my area (a major metropolitan area in a large state). None, zero, zilch, nada. So I went through my entire pregnancy----still working until the last month, mind you----without any maternity clothes at all. That also just reinforced my perception that apparently, fat women just didn't get pregnant, and I must simply be an anomaly, a science experiment gone wrong.

The internet was around back then but hadn't really taken off yet. I was online more than most people at that time, but even the fat-acceptance bulletin boards back then had little to offer me in the way of reassurance. I thought, Surely some fat woman SOMEWHERE had been pregnant before---but you would never have known it. So basically, I was on my own, in seemingly uncharted territory.

I had no substantive information on being pregnant and fat...certainly no information that while there were risks to consider, outcomes could also be just fine in women of size. All the booga-booga scare tactics in the books made me terrified about what might happen, and the fact that I started bleeding and cramping in the first trimester only seemed to reinforce the thought that my body was broken, that somehow being fat made my pregnancy so incredibly high-risk that I'd be lucky to get out of this with a baby at all.

My OB and midwife tried to reassure me that other fat women had been pregnant before and that they'd get me through this, but while they meant well, they also filled our appointments with plenty of fear-inducing information and pressure for extra tests and monitoring.

They told me I had about a 50/50 chance to miscarry, that I might well have a baby with birth defects, that I had a very high chance of having problems with my blood sugar or my blood pressure, that it was good I wasn't gaining much weight and not to worry about eating if I felt nauseous, that we wouldn't want the baby to get "too big" so it was okay not to eat much. They tried to reassure me that even though I had all these risks, they'd take "good care" of me by ordering all kinds of extra tests to carefully watch over the baby and me.

That was supposed to reassure me, but all it did was make me feel like ticking time-bomb. Still, I was grateful they weren't yelling at me for my weight, so I sucked it up and never questioned what they were saying.

All of a sudden I went from being a take-no-prisoners fat-acceptance advocate and empowered health care consumer to being a meek little sheeple who didn't question anything her OB said. "Whatever you say, doctor; you must know best," became my mantra. I now know all those tests ended up actually causing more harm than good, but then I dared not question anything; I was just intent on getting through my pregnancy and having a live baby.

The truth is that I was paralyzed with fear that somehow my fatness was going to end up hurting my baby, and so I checked my brain at the OB clinic door. That directly led to many of the very negative experiences of that pregnancy and birth, and sadly, most of them were avoidable.

The Crime of Being Pregnant While Obese

It's one thing to be accepting of your size and body when the only person that might be harmed is you; it's a lot different to be so confident when a little baby is involved and when what you are, the very core of you, might be harming the baby.

It's very hard to stay body-accepting when everything and everyone around you is telling you that you are going to have problems because of your size, that you might actually kill your baby because of your size.

That is SUCH a powerful, guilt-inducing thought, and it makes many women of size become unquestioning sheeple in a quest to avoid any such scenario. I know it helped make me a sheeple.

Unfortunately, this situation often becomes a self-fulfilling prophecy, simply because you and your doctor expect problems to happen and therefore go looking for them. The more your doctors perceive you to be "high-risk," the more likely they are to submit you to multiple tests where a false-positive result is a real possibility, or to interventions (like early induction of labor) where the risk of harm is significant. The mere expectation of problems often results in those problems.

But when you are living in a state of fear that your body might harm your baby, you just assume that these tests and interventions are necessary to get you and your baby through pregnancy alive and well. And because you are fat, you may not question whether they might be causing more harm than good, whether the risks outweigh the benefits.

And in that rare situation when you do start to question your doctor about these things, out comes the "obesity ooogabooga" fear tactics and the "dead baby" trump card, which shuts down those kinds of inconvenient questions really fast.

On the one hand, we can't ignore that pregnancy at larger sizes does carry some risks. It's not wrong for us to be informed of these potential risks, or to be proactive about trying to minimize them. (More on that in the future.)

On the other hand, exaggerating these risks and using extreme interventions to manage even the slightest possibility of these risks has not been shown to improve outcome. In fact, no one has actually really studied whether the high-tech, high-intervention management of "obese" women improves outcome. They just assume it does.

Anecdotally, it does not seem to; it actually seems to worsen it. Certainly the cesarean rate has gone up drastically in "obese" women since the high-intervention management style has come into use with this group. But does that improve outcome? Where is the real, qualitative research on best practice care for "obese" women? It is stunningly absent, with doctors just going on the assumption of what's best.

The blame and the fear around being fat and pregnant is so intense that it's hard to avoid this high-tech, high-intervention model of care, and even empowered fat women often feel powerless in trying to avoid it, despite the alternatives available (the midwifery model of care).

And it's all motivated by our inner guilt, our secret inner fear, that our fat might hurt our baby.

Then and Now

Women of size having their babies now are lucky in some ways; at least today there is some information available about pregnancy at larger sizes, there are maternity clothes more widely available in plus sizes, and women of size can bond together in online communities regarding our experiences around pregnancy, birth, and parenting.

However, on the flip side, fat women having their babies today are bombarded with even more negative information and scare tactics than I was when I was first pregnant 15 years ago. Take the scare tactics I was told and multiply that by ten now; not only do you hear the negativity from your "scare provider" but also now constantly from the media. Furthermore, the sheer amplitude of the shaming and scaring has increased greatly too.

That's some pretty powerful stuff to try and counteract mentally, especially while in the emotionally vulnerable state of pregnancy.

Google "obesity and pregnancy" and you'll find a whole bunch o' scary stuff before you ever find this blog or my main website, http://www.plus-size-pregnancy.org/, which focuses on realistic information, reassurance, and proactive behavior instead of scare tactics. Most people won't continue searching long enough to find my websites; they'll only end up seeing the ooga-booga scare tactics. And that kind of negativity can't help but impact women who read it.

Honestly, I think it's those exaggerated fears of complications that leads so many fat women down the path into highly-interventive births and surgical outcomes. There are other causes too, of course, but I truly think that the exaggerated sense of fear---in ourselves, in our families, and especially in our caretakers---has the most to do with it.

But I also want to note that acknowledging these fears, then being proactive about dealing with them, becoming aware of how they can influence choices negatively and positively, can go a long way towards recapturing the joy we deserve to feel in pregnancy, towards making plus-sized pregnancy the positive and joyful experience it really should be.

It's normal and okay to have those fears.....but you don't have to let them paralyze you, and you don't have to let them dictate your pregnancy and birth experiences. You CAN have a beautiful and joyous pregnancy too.

What Were Your Experiences?

If you have had children, did you experience a crisis of faith in HAES principles? Did you feel suddenly less empowered as a health-care consumer? Do you feel the negativity and scare tactics helped convince you into interventions you might not otherwise have been so quick to accept? What kind of fears about pregnancy and birth did you experience related to your size?

Or were you already in such a secure place in your fat-acceptance journey that pregnancy didn't rattle you, not even a little bit? Am I the only one that had this giant crisis of faith?

Let's talk.