The Fat Vagina Theory Strikes Again

Here is a story someone left as a comment on my post on Soft Tissue Dystocia.  The story, unfortunately, is all too common.

As I explain in the Soft Tissue Dystocia post, some care providers believe that very fat women have so much fatty tissue in the pelvic area around their vaginas that a baby is unlikely to get out safely. 

Officially this is called "Soft Tissue Dystocia" but sometimes in the birth world we cynically call it the Fat Vagina Theory, based on a term that has actually been used by some doctors to explain to women of size why they had a cesarean.

Unfortunately, Fat Vagina Fear is yet another factor helping to drive the high cesarean rate in women of size.

Attack of the Killer Vagina

As I note in my previous post, there's little scientific evidence about soft tissue dystocia; it's mostly a dogma that has been taught to care providers over the years as if it is a hard-and-fast truth.....without the inconvenient detail of actually having proof.

But it's a dearly-held dogma, and one that care providers rarely even question. And the belief in it leads to many questionable interventions in women of size.

Providers who subscribe to this dogma believe that vaginal birth in very fat women is unlikely because of so much soft tissue in the way, or that the combination of a big baby and this "compromised" pelvic space will cause the baby's shoulders to get stuck, resulting in injury and lawsuits.

Therefore a common response to Fat Vagina Fears is to either schedule a cesarean or to induce labor early while the baby is theoretically more able to fit. 

Unfortunately, research shows that inducing early for a big baby leads to a higher rate of cesareans, not a lower one, and may actually increase the rate of shoulder dystocia. 

Let's say that again.  The intervention they use to supposedly lessen risk may actually cause the very outcomes they are trying to avoid─yet they still do it anyhow.

The results are no better for a planned cesarean before labor.  Babies don't do any better and moms' outcomes are worse.

To be fair, some of these care providers may have good intentions.  Those who routinely section high-BMI women often do it because they are convinced that labor is likely to end in a c-section anyhow, and because they feel it's better to do the "inevitable" c-section under planned conditions instead of emergency ones. 

Those who induce big moms early often do it because they feel inducing at least gives the mother a chance at vaginal birth, and because they feel they are less likely to get sued if they can show they took proactive measures ─ like inducing early.

Their intentions may be benign, but their interventions are not.  They don't improve outcomes, and often cause MORE complications than they avoid. 

Yet early inductions or planned cesareans with "obese" patients remain a very common practice, often with "soft tissue dystocia" as part of the reason.

Some providers are even beginning to be hassled if they don't follow these practices with women of size, as if they are behaving dangerously by not inducing or doing a cesarean.

One Mother's Story

This story sadly illustrates this scenario. The mother was induced at 37 weeks because of her size and the doctor's fear of shoulder dystocia. 

Not surprisingly, it led to a cesarean.  However, because the baby was not ready to be born, he had to go to the NICU and the mother didn't get to even hold her baby─for nearly a week. 

Although most care providers now wait longer than 37 weeks to induce for suspected macrosomia, the story often ends very similarly.  Mom's body is not truly ready for labor, baby is not in a good position yet, a long hard induced labor follows, and the mom ends up sectioned for "failure to progress," fetal distress, or fear of infection after a prolonged induction.  Women are told their babies were too big, their vaginas too fat, or their pelvises were too small ─ but the real reason was that inducing before the mother/baby dyad is ready often ends in cesarean.

Afterwards, Mom and baby are often separated, sometimes for hours, sometimes for days, which is one of the most difficult and heartbreaking things for a new mother.  Breastfeeding often gets off to a rocky start, and mother has to try and learn to care for her new baby while she is recovering from surgery.  Not a recipe for an easy transition into motherhood, and one which probably negatively influences the rate of breastfeeding in women of size.

Alas, the Myth Of The Fat Vagina is alive and well in obstetrics, and combined with Fear Of The Monster Baby, helps drive the cesarean rate in women of size. 

I had a c-section with my first baby seven years ago.

I was "warned" by my OB that since I was so big, 330, and had more fatty tissue in my vagina, that I could put my baby in jeopardy trying to deliver him naturally. She told me that i could break his collarbone, dislocate his shoulders or he could just get stuck.

I went against my gut and allowed myself to be induced 3 weeks early. When my doctor came in to check on me after the first couple of hours, she broke my water without my consent and the clock started ticking. After 24 hours of labor, I was so close and my doctor ordered me into an emergency c-section because my water had been broken for too long, putting my baby at risk.

Adding insult to injury, I had not had any pain medicine (I'm kind of granola). The anesthesiologist came in to give me the epidural and took one look at me and said that it is really tricky to do on such a fluffy girl. I begged for her to try. She told me that she was going to give me some oxygen before she started and put me to sleep. I woke up so confused. And worst of all I feel I missed the birth of my son.

He was very sick and had under developed spots on his lungs, he was taken away to the NICU immediately. I didn't get to hold him until he was 6 days old.

I really wish that I had trusted my instincts and had had a provider who listened. I am pregnant again. I am prayerful that this time around I will be able to have a natural birth free from all of the bullying that I experienced before. I have to believe that my body, big or not, would not grow a baby that it could not deliver.

*I hope this mom contacts ICAN, the International Cesarean Awareness Network, which can help her work through her feelings about her cesarean, find a more size-friendly provider, and support her as she works towards a VBAC.