Please Document Your Stories of Mistreatment

For years, I've made it a practice to document stories of fat-phobic treatment and weight bias in fertility, pregnancy, birth, and parenting. 

I do this for several reasons.

First, I find that many health practitioners simply aren't aware of (or don't believe) the extent of discrimination that exists out there towards women of size. Documenting actual stories helps them gain a better understanding of what some women of size have been through and why many are hesitant or negative about seeing a care provider. It also helps hold up a mirror (to medical professionals in general and to maternity providers in particular) to their own attitudes and practices, and helps them understand how bias -- even unconscious bias -- can slip through and how it impacts women.

Second, I think it's important that these experiences be documented simply because all stories of discrimination and bias deserve to be acknowledged.  Fat women should not have to endure egregious treatment like this, and our experiences of discrimination and bias should be heard and honored.  For too long, we've been told that such treatment is our own damn fault, that we're "too sensitive" about these things, or that we shouldn't be questioning it --- it's for our own good because we're so incredibly high-risk.  Documenting these stories makes connections with the discrimination suffered by other groups, shows that discriminatory practices have patterns, and that weight bias is a real form of stigmatization and discrimination.

Finally, I think it's especially important to document stories like this so that the fat-acceptance movement and the birth world start to understand and grapple better with the problem of fat-phobic treatment and discrimination during pregnancy and birth, an issue they tend to ignore.  Surprisingly, over the years I've found more respect and attention to the issue of size discrimination in the birth world than I have in the fat-acceptance world, which I always find puzzling and frustrating. Much of the birth world has a long ways to go, but some segments of the fat-acceptance world (those who don't want/have children, or are young enough that it's not on their radar) have an even longer way to go.  Documenting how egregious the treatment can be in pregnancy and birth is important because it helps establish that there really is a problem here that deserves attention, regardless of whether size discrimination affects you personally and regardless of whether you have (or plan to have) children or not.

More Stories of Mistreatment

A few weeks ago, I re-posted an entry from My OB Said WHAT?!! about a fat woman being told that if she got pregnant, she'd get gestational diabetes, high blood pressure, and would probably "die anyway."  This is just one of several "gems" I've found like that on that site.

I was surprised to get a high number of comments from my readers relating similar discriminatory stories, stories I'd not heard before and didn't have documented. 

While I'm disappointed that these things are still happening in obstetrics and midwifery care even today, I'm glad to be able to document some more of these stories.

But I want readers to go further.  If you have a story like this, I want you to document it thoroughly, in multiple places. 

We must have a record of things like this happening if we ever want to see things change.

How and Where To Document Your Story

So how do you go about documenting your stories? 

First of all, you can always send them to me, at kmom AT plus-size-pregnancy DOT  org.  I like to keep a record of such stories; when sending your story, please give me your permission to use them as needed (i.e. on my blog, on my website, in presentations I make, etc.).  You don't have to use your own name; you can choose to be as anonymous as you wish.  Just remember to give explicit permission to use it.  [If you posted your story in a public forum like my comments section, I consider that explicit permission...you've already made it public.  But I still like to have formal permissions.]

Second, don't forget the blogs at:

• First Do No Harm, http://fathealth.wordpress.com/
• My OB Said What?!?, http://myobsaidwhat.com/

The First Do No Harm site documents stories of discrimination against fat people in the healthcare world, but sadly, they have very few entries under pregnancy, reflecting the lack of crossover between the birth world and the fat-acceptance world, I think. The stories here on my blog need to get repeated there. 

The My OB Said What?!? site documents stories of outrageous treatment in the birth world; it's not just limited to fat folk, of course, but it's important that the birth world hear of size discrimination and weight bias and how prevalent it is.  And it's important that they hear about these stories from someone other than just me as well.  I am one of the very few voices out there talking about this; it would be great to have other voices corroborating the stories of weight bias and discrimination out there.

So if you have a story of bias or mistreatment, I urge you to submit your story and document it in multiple places.  There really is a lack of understanding and acknowledgement in both the birth and fat-acceptance worlds that such discrimination really exists and is so common, so be sure to document it in multiple places. 

Documenting our stories is one way to start raising awareness about this problem and start confronting and challenging such treatment.  We don't have to suffer in silence anymore, and by speaking up, we can start changing the status quo.

Here are just a few of the stories from the comments section of my last post, edited for length.  I thank these women for sharing, and highlight a few of their stories here because not everyone reads the comments and might have missed some of these.  [A few have beeen edited or broken into more than one story for the sake of readability.]

• My last OB told me that I needed to lose 50 lbs during my pregnancy or else she was sure I'd need a c section and then a hysterectomy. I gained 4 lbs total, and my baby was 8lbs 6 oz. I will never see that doctor again. I refused to go to my 6 week check up because of some of the nonsense that went on during my labor/delivery.

• I was told during my second pregnancy (I was about 6 weeks in) that I would have to have a c-section because I am fat. No ifs or buts, I simply would have to. I ended up having a straightforward natural (2 hour) labour and delivery and without any mention of a c-section.

• I was told at the beginning of my pregnancy not to gain any weight AT ALL. And in fact to lose weight. When I asked why, he told me because otherwise, I was being selfish and putting my baby at risk. Thing is, I was stuck with him because I had no insurance at the time and the delivery (emergency c-section that I HAD to have) still gives me nightmares.

• That I must have so much fat inside my vagina that I would not be able to give birth without forceps or more drastic interventions....That my blood pressure would shoot up in the midst of labor (despite having been perfectly normal all through my pregnancy) and I would die without IV drugs. Now, with my kids around me and the bed they were born in just a few steps away, I can laugh about it. Then, not so much.

• My MIDWIFE told me that she couldn't feel my baby through all of my fat. Which is funny, because she would barely touch me. Her doppler couldn't find the heart rate because I was too fat too. Once she dropped me from her care, I interviewed several other midwives, all of which could feel the baby AND find the heartbeat.

• I was mostly able to avoid the scare tactics, thankfully, but during my cesarean, after my husband left with the baby, someone said "We should just do some liposuction while we're in here."

• In my first pregnancy, at 11 wks I started spotting heavily, and my GP sent me for an u/s to see what was happening. I ended up in the imaging department at our local hospital with a sonographer who was visibly put out with having to take care of me. At one point she told me to 'hold all that fat out of the way' so she could do her job, and how she wasn't sure she would be able to 'see anything through all the fat'. Not only was I beyond stressed over the possibilitiy of losing that pregnancy (which I did, sadly), but that 'professional' made me feel awful.

• I was a virgin at my second gynecological exam requesting birth control for the first time and the doctor told me I needed to lose weight if I ever wanted to get pregnant. She said she would not "let me" get pregnant at my weight and that it would be too difficult for me to carry a child at my weight. I changed doctors when I found out I was pregnant a year later while on the Progestin-only birth control pill she prescribed me (I did research and that pill has a way lower rate of working on bigger women... - she never mentioned that). I was actually in fear that she would suggest an abortion or something drastic because she was so adamant that I not get pregnant at my weight. I think she thought I wasn't going to be having sex anyway at my weight or something like that. I weighed about 290. I am now 38 weeks pregnant at 305 pounds and the baby and I are doing great. No GD, no high blood pressure. We've been fine. Looking forward to a healthy baby later this month.

• I've got a ton of horror stories. I moved to the SF Bay Area from Seattle when I was 28 weeks pregnant and spent hours on the phone looking for a doctor that wouldn't counsel immediate termination ("You or the baby will die, you are just too fat to carry to term."), "necessary" c-section ("Women of your size never have a natural labor. You will have to have a c-section.") or were anti-VBAC ...("Women with your BMI can't VBAC in our hospital. You won't find a better hospital in the area."). I wound up with a doctor that said she was comfortable VBACing who decided at 38 weeks that I needed an "emergency" c-section and called me in the middle of my grocery shopping about me "dying before the weekend was out" and generally pressured me into yet another c-section. Now I'm being told (by any doctor I can find) that a VBA2C is "impossible" at my size/BMI or at all.

• I was told by my OB at the first office visit (8 weeks) that I needed to lose 15-20 lbs. When I asked if this would be harmful to the baby, I was told that I could safely LOSE weight during pregnancy and it would have no effect on my baby because I had so much "reserves" the baby could survive from that. Luckily I knew that was BS and ate normally to sustain my energy, stamina, and that of my baby. When he balked about my weight at every subsequent visit, I flat out told him that I KNOW how unstable I feel during dieting, and there's nothing he could say to convince me that would be healthy for my baby, he shut up.
  

• On the day of induced delivery, my doctor (who had been cautioning me that I would "most likely" need a C-section because of my size) was afraid to break my water as I neared full dilation and effacement and called in the OB specialist again to perform the procedure. My doctor actually left the room during this procedure to scrub in and ensure there was an operating room available to do an emergency C-section. When the specialist was finished and labor progressed normally, my doctor was shocked. Within three hours, my 9lbs 1oz baby girl was born and proceeded to pee all over the doctor. Instant Karma.....gotta love it.

• I am pregnant with identical twin girls. I went to the perinatologist and he lectured me for 20 minutes. Telling me I was going to have GD and high blood pressure, and that I needed to lose 20 pounds during this pregnancy.

• I had an OB tell me (over the phone) that I wasn't "really" pregnant, since my BMI was too high for me to actually be pregnant. Her office then told me that they'd be happy to schedule me for a biopsy to determine what kind of tumor I had. I replied "The kind with two arms, two legs and a head." and hung up. (I was 28-ish weeks pregnant and had a number of ultrasounds under my belt.)

You can read more stories of size discrimination I've documented over the years here.  There are stories of fat women being pressured to abort --- simply because of their size.  There are stories of women being told that they will die if they dare to be pregnant at their size.  There are stories of women pushed to have cesareans they don't need (or intervened right into cesareans). There are stories of draconian diets and mega-interventions and abusive treatment, simply because of weight. 

Of course, not every woman of size encounters such egregious treatment.  Oftentimes the bias is more subtle than that, and sometimes arrives with completely good intentions from the provider....but it's still bias.  I encourage you to share those stories too. 

It's also important to note that some fat women DO receive truly size-friendly treatment during their pregnancies and births; if you are a woman of size already pregnant or just considering pregnancy, please don't despair.  It IS possible to get decent treatment, and of course not all OBs or midwives are horrible people or size bigots.

But size discrimination does occur and I believe it's becoming more and more common as the rhetoric in the "War on Obesity" heats up. So it's important to keep documenting and challenging these incidents, both subtle and overt, as often as possible.

Please, folks, take time to document your stories, in as many places as possible.

Health care professionals and the general public need to become more aware of the scope of the problem of size discrimination.  It's the first step towards change.