"You and the Baby are About 85% Likely To Die on the Table"

The hype around the risks of pregnancy and obesity is so extreme at times that some doctors have developed an exaggerated fear of the possibilities of deadly complications in "morbidly obese" women.

In particular, some have begun to routinely tell very fat women  that they are quite likely to die during pregnancy or birth.  This is their way of bullying them out of further pregnancies or at least scaring them into massive weight loss.

Sigh. Here we go again.  We've seen the Dead Mama Card before.

Some women of size have been told that they are so fat, they'll surely have a heart attack and die during labor, that they or their baby will probably not survive a pregnancy, that choosing to be pregnant while fat is committing suicide by pregnancy, or they have been pointedly asked about their funeral arrangement preferences before surgery.

There was yet another blood pressure-raising example of this from My OB Said What?!? recently, where one OB said to a "morbidly obese" mother:

I can't believe I have been put in this position!  I absolutely resent that I am now responsible for your life and delivering this baby, you have no right thinking you can safely deliver a child when you are so overweight.    

In the comments section on the My OB Said What?!? website, the original poster gave some more details behind the case. The mother weighed in the upper 200s in her pregnancy and had had a healthy pregnancy.  At one week overdue, she had a slow leak of her amniotic fluid (normally not a big deal, but in this case it had leaked out enough that contractions were pressing on the baby's umbilical cord and interfering with his heart rate).  They took her back for a cesarean, where the on-call OB began to berate the patient and her husband with the above statement ─ and more:

This was the LEAST of the horrible things he said to my husband and I.  He lectured my husband so severely that my big tough husband started to cry.  He told us that I and the baby were about 85% likely to die on the table during the surgery and it was all hubby's fault because I am SO fat. 

What the hell.....??!!!  Where does this doctor get off treating a patient, ANY patient, no matter her risk factors, like this?

Now, up to a point, I can understand the on-call OB feeling put on the spot at having to do what he perceived as risky surgery on a larger-sized person.  This wasn't his patient, but because he was on-call, he ended up having to the surgery on a patient whose risks he was uncomfortable with.  Fair enough, even though really, that's the nature of being on-call for another doctor's patients.

But this doctor had such an exaggerated sense of fear around the pregnancy and cesarean of this woman of size.  An 85% chance of dying during the surgery?  Really?  What orifice did he pull that statistic from?

Did he really believe that statistic, or was he just trying to scare and bully this woman?  Or maybe a little of both?

Now, to be fair, some research does suggest that obesity is over-represented as a risk factor in the very few women in developed countries who die during pregnancy or birth.  It does look like it is a risk factor for some cases of maternal mortality and near-misses. And that's a legitimate cause for concern.

However, the part that gets ignored by the media is that obesity usually is a co-factor along with other factors like low socioeconomic status, non-white ethnicity, cesarean surgery, pre-eclampsia, or receiving substandard medical care (like inadequate prophylaxis against blood clots, or faulty intubation during general anesthesia).

But of course, it is often obesity only that gets the focus instead of seeing it as just one of several co-factors, and rarely do authorities seriously examine how substandard care for obese women contributes to maternal mortality.

And of course, the only cure is always seen as pushing weight loss before pregnancy instead of the more uncomfortable task of looking at how poor care for obese women has impacted outcomes. Far more effective would be studying how to improve care in obese women (by improving blood clot prophylaxis, by improved recognition of pulmonary embolisms, by more careful follow-up postpartum, by doing fewer damn cesareans in women of size in the first place).

Also conveniently ignored in the media hype is that the risk of dying during pregnancy is actually extremely small, even in women with risk factors. 

So this doctor telling this woman that she (and her baby) had an 85% chance of dying during the c-section is total and unadulterated bullsh*t.  

As I said, either this doctor has a distorted-in-the-extreme sense of risk around c-sections in obese women, or he is trying to bully this woman ─ or more likely, a bit of both.

Typically, what docs like this are trying to do is shock fat women into either losing massive amounts of weight (usually through weight loss surgery....funny how that surgery is not seen as "too risky" eh?), or to frighten them out of ever daring to have a baby again.

This kind of over-the-top scare tactic is a major exaggeration of the risks around obesity and pregnancy and is a new form of Medical Bullying.  It's trying to scare women of size out of having babies, rather than giving nuanced and evidence-based counseling about possible risks and reasonable ways to mitigate those risks.

There are so many ways that this type of tactic is wrong, but one of the things that bugs me most is that they are trying to become the gate-keepers for who is "allowed" to procreate, and they have deemed fat people unworthy of procreating.  This far exceeds their mandate as physicians, and worse, it smacks of eugenics.

It's deeming some types of risk factors (like type 1 diabetes) as worthy of having babies despite the risks, and other types of risk factors (obesity) as unworthy of having babies.

But it's not up to doctors to decide which patients with which risk factors should procreate.  

Rather, it is up to the couple to look at their particular risks and make an informed decision about having children or not. Reasonable risk counseling is appropriate, medical bullying through risk hyperbole is not.

Thankfully, most care providers do not use extreme tactics like this with women of size, but the fact that some do (and get away with it) is a terrible stain on the medical profession.  I've said it before but I'll say it again.....this is a unique and insidious form of eugenics and IT MUST STOP.


**I have a more in-depth piece about obesity and maternal mortality in the works, but seeing this entry on My OB Said What?!? necessitated a quicker response.  Stay tuned for more on this topic in the future.