Friday, November 12, 2010

Size Bias in British Obstetrics

I received the following email recently, describing the poor treatment one pregnant woman of size received from the British healthcare system.  (I have edited it a bit for clarity.)
I am a 'plus-size' mum...or extra-morbidly obese as my paperwork says. I am British and living in the UK...We have free health care, which I have always been very grateful for and happy with. However, new government policies over the last few years have made being even over-weight and pregnant a problem, let alone as large as I am! (I'm a UK size 22/24.)

For example...anyone who is deemed overweight when they 'present as pregnant to their GP' is now offered a strict diet program overseen by weight watchers or slimmers world, or a termination 'until weight is acceptable'.

Those of us that go against GP advice are ostracised and treated as both unworthy and stupid. My current treatment includes being 'seen' by my GP in a corridor whilst people walk past, rather than in the privacy of an office; and being blatantly lied to about statistics (I was actually told it was physically impossible to give birth vaginally after a c-section, as the baby would 'go the wrong way'!).

My consultant told me I was so fat it made the radiographers sick to have to perform a scan on me...The same consultant insisted I have huge stitches after my C-section, and refused to allow me anything other than normal paracetamol [kmom note: Tylenol] as painkillers after the spinal block wore off to 'teach' me a lesson!

When I refused to have a coil fitted as contraception, I was told 'Well, you probably don't need anything, there can't be many men desperate enough to have sex with someone your size' a room with 3 other mums.

The alternative to that? Well, there isn't really one...I have 'opted out of care'...basically no-one sees me, so there isn't anyone to make the comments! I've had 3 antenatal appointments so far, and am under 'GP care', but as he won't see me in his office and I don't feel comfortable discussing my pregnancy or ailments in a corridor for all to hear, I basically don't see him either.

Now all this would be bad enough with a 'normal' pregnancy, but this is my 7th baby...of my last 3 pregnancies, one was a messy late miscarriage, the other two were c-sections (I'd managed normal births until then).

The first [c-section] was as my son was breech (obese women can't deliver breech babies naturally apparently!), the second c-section gave me one 7 week premature daughter and a still-born not exactly 'perfect' births...then there's my BP (normally high, but I'm currently proud of the level I am managing to keep it at!)....and the added bonus, that if I step into the hospital prior to the baby actually crowning I will have to have another C-section, and likely a hysterectomy, as is hospital policy on third C-sections....

I spoke to an independent midwife over the phone at the beginning of my last pregnancy, and she told me that it was a load of rubbish about the 'too fat for a breech' and 'one c-section means always a c-section'. Without her encouragement I wouldn't have had the guts to stand up to the midwives and doctors as much as I have so far, and she also told me to demand a 30 week scan and to avoid induction as that can increase the chance of a scar rupture.  Unfortunately, I couldn't afford a private midwife and as that pregnancy ended in a late miscarriage, I lost contact with the midwife who I'd spoken to over the phone.

My GP said after 2 C-sections I have a high risk of dying during labour.  [Kmom note: This is totally bogus and not supported by the research at all.]

Aside from worrying about the labour going wrong, I have to admit this is a nice pregnancy---no rushing around for weekly antenatal appointments, no fortnightly blood tests to seen if my organs are failing, no monthly scans and far fewer lectures from 'professionals'!

I just wish people realised that just because I got this big my brain hasn't shrunk. I'm not stupid and I do have feelings.  If belittling me or telling me obvious things like 'you need to lose weight' seriously helped the situation, I'd have been a size 0 years ago!  I know I'm fat, I do have mirrors in my house and have to walk past shop windows during my week!

I have my scan for abnormal placenta (placenta previa and placenta [accreta], I believe) in 6 weeks, and then that's me back on my own until I give birth. We planned this pregnancy and it didn't seem so scary then, but now I have re-occuring nightmares.

Kmom's Follow-up Note: I was able to put this mother in touch with a couple of Independent Midwives in Britain so at least she has some better emotional support and a chance at other care.  Thank you to those who have helped me find other resources for this mother.

As for British policy, I'm sure the attitude varies from consultant to consultant, but I'm hearing more and more stories of egregious size bias in the UK system.  If you are a British woman of size and encounter this kind of treatment, I would remind you of the option of Independent Midwives.  Yes, you'd have to pay out of pocket, but that's better than being subjected to crappy treatment and the risks of a cesarean you don't really need.  And besides, many independent midwives will work with you to find a way to afford their care. 

The same is true in the USA and Canada.  Don't forget the choice of birth center or homebirth midwives.  Yes, there are people who truly cannot afford that and have fewer choices, but too many people write it off as something they cannot possibly afford when there often ARE ways to make it work. Most midwives will find a way to help you afford it via sliding scale fees, payment plans, bartering, etc., and some insurances that say they "do not" cover homebirth actually do (mine did).  Explore the possibilities thoroughly before you decide .

If at all possible, don't let cost keep you from having real childbirth choices and truly supportive care.  It's priceless. 


Kate said...

Sweet jeebus, that has to be one of the most horrific stories I've ever heard about health care. I'm actually wordless.

Thank the mom for sharing her story, and thank you for getting word out.

Generally, I'm a huge fan of universal health care, though I don't really want to get into the pros and cons here, it sickens me to see good care withheld simply based on the inability to be thin. Is that really any different than refusing care for the inability to pay?

I fear for our European, Canadian, and Australian brethren that the threat of the loss of health care will continue to be problem as austerity programs are enacted.

Historically, in other times of economic crisis, at least in the US, some group is always held up as the cause of all the problems, immigrants from various countries and various religions, African-Americans, working women, etc, etc. It's not right, it's not moral, but it happens, and eventually most of it passes.

Heidi said...

Although my case happened before some of the austerity issues in the UK in recent months...I do want to say that, four years ago when I gave birth to my son, the consultants and midwives that took care of me were incredibly caring and positive. There were only three exceptions - the first consultant I saw, who recommended bariatric surgery after I gave birth (!!), a horrible ultrasound tech, and the unfortunate midwife who had to tell me that I could not have a water birth because of my size (I understand this is a problem in the US as well).

The rest of the staff throughout my pregnancy were unfailingly kind and polite. I did have regular blood sugar monitoring because my PCOS put me at a higher risk of GD and they wanted to be sure that it was caught early if it did happen (it did not) but no one ever perpetuated the types of myths that the doctors in the post did. If anything they went above and beyond to make sure that, when my son had decels, they did a fetal scalp blood sample instead of rushing me into a c-section, even after 35+ hours of labor.

He was delivered vaginally, I did not have an epidural (I used gas & air, and a local anaesthetic for stitches in the slight tear I had) and I have no reason to think, when all is said and done, that a thinner woman would have had a better experience, or (for the record) that I would have had better care here, in a privatized system.

But yes. Fatphobia seems to be on the rise in the UK and this is a serious issue. I think it's a matter of, as in the US, finding a doctor who is willing to look past the statistics and treat the person, not the body size.

wriggles said...

I's stunned is this planet earth? I appreciate this lady needs help and assistance and I wish her all the best with having a great birth, but is there any way this can become a matter of public record?

And what is 'extra-morbidly obese'? A size 22/24? At my heaviest I was a size 20/22 and had a BMI of 37.2, I am short too.

This treatment is abusive I do not throw that around lightly.

I don't know what state I'd be in if it was me, but I'd be sorely tempted to ring my local radio station and tell what happened. To shine some kind of light on this, so that fat women are not intimidated into silence.

They must not be allowed to get away with this before they harm someone beyond repair.

A disgraceful abuse of power.

jaed said...

Now this...

anyone who is deemed overweight when they 'present as pregnant to their GP' is now offered [..] a termination 'until weight is acceptable'.

... this just makes my blood run cold. I've heard stories about heartless medical professionals pressuring women to abort because of their weight, but as policy???

And people wonder why women choose such "dangerous" options as unassisted pregnancy and freebirth.

The Singing Doula said...

Could you please contact this mum for me or she is welcome to contact me herself?

I'm a doula in the UK and I'm fat (morbidly obese) myself.

What's happening to this woman is totally unaccpetable and does not have to continue.

There are ways to stop this immediately and organisations to help and support this lady.

AIMS would be the place to start:

Both the GP and the consultant need to have formal complaints made about them for a start.

Please ask her to get in touch. She can contact me through my website:

Many thanks,


Kel said...

I left a comment a while ago about my visit to the local hospital fertility section in the UK. I suffer from polycystic ovaries, and am overweight, was at the time about 25 stone, and a size 30/32. Yes I admit I was very big! I've lost 4 stone since then though over the last 18 weeks, and working on more with specific aim of children.

Anyway, I was told by the specialist that if I did get pregnant that it would be deformed. Those were her words, in front of my already worried husband. Frankly this is rubbish. I am and was a very fit women despite my size. I have no physical problems, and to see me once and tell me this was just a terrible abuse of her power. I can totally understand what this woman has been through as I have spent my life being told I was bad or treated worse because of my size in the eyes of the UK medical profession. My consultant ended our meeting by telling me I should have bariatric surgery.

I'm so glad you shared her story, and I hope to one day have some good news to share with you all too.

Well-Rounded Mama said...

Jaed, I think what that meant in this story was that she would be terminated from receiving regular consultant care unless she agreed to the dieting/nutrition oversight program, not that they were encouraging her to have an abortion.

However, I have indeed documented incidents before where doctors and family members have encouraged women of size to have an abortion, purely because of their weight. Click on the category of horror stories and you can read some of the ones I've documented.

It has happened....just not in this case.

Tanz said...

The sad thing is it's not just Doctors who spout this nonsense... I'm in New Zealand, and we have a midwifery based, state funded maternity system. My midwife for the last pregnancy (my twins are now 5 months old) told me to diet during pregnancy; that I was too large to carry safely and would *definately* develop either pre-eclampsia or gestational diabetes (needless to say I didn't) . Luckily for me I had the option of using the local hospital team instead (as a multiple pregnancy is considered 'high risk' in and of itself) and apart from one fill-in OB suggesting (after birth) that I should consider stomach stapling there was no comment passed about my weight or size.

But the worst part is that when I talk about my midwife and why I quit her service with other, ordinary mothers they tell me off for discounting her opinions, because as they say "but she's right - fat mums have bad pregnancies and risky labours!". Despite the evidence to the contrary people still believe we fat women are about to drop dead at any minute and that's compounded during pregnancy.

Anna Geletka said...

I can't believe no one else has brought this up...

Hysterectomy after three c-sections? Jaw. Dropped. And the size bias here is particularly egregious. By the way, when I lived in the UK I would subtract one size to match to a US size. I wear a 12 in the US and a 14/16 in the UK.

So if this woman is a UK 22/24, that is a US size 20/22. Extra-morbidly obese? First off, what does that even mean, secondly, what!?!? A US size 20/22 is "extra-morbidly obese"?

Obstetrics said...

I live in the US and received the best care I could ever imagine for myself and my baby. We however have our own insurance in the US not run by our government. Pricey as it is I think that keeps the doctors doing their jobs like they should, keeping the comments to them selves. We are also able to see any doctor we wish so the option of going somewhere more friendly is an option. I feel for this lady yet I also can see if doctors try to get her on a diet plan for the health of the baby. No reason for the rude comments and hall appointments though. Don't they have a privacy law in the UK?

Mary said...

What a hideous story. As a Brit, it makes me feel so ashamed such things can happen. One thing I would like to point out though, is that in the UK you can change doctors and choose which hospital you give birth in (although in an emergency situation the ambulance would take you to the closest one) with relative ease (less easy if you live in a remote location). I gave birth in London where there is a huge number of GP's and hospitals (all free) and spent a long time searching to find which one was right for me. I had a very positive birth experience, although during my initial pregnancy there was some chopping and changing between providers. I second "the Singing Doula"'s comment about making a formal complaint - the treatment of this mother was abusive and totally unacceptable and shouldn't be allowed to happen again.