This comment was left on a recent post on this blog. It is a plea for help from a pregnant women in the U.K.
I am only going to address one aspect of her concerns, the one I find most disturbing; I hope others will step up and address some of the rest of her concerns.
Please please please, can someone help me. I am 10 weeks pregnant and currently have a BMI of 35.
Firstly, I have suffered with severe sickness since 5 weeks and doctor said it was ok as I 'could do with losing some weight' and refused to give me medications, and now I have had my first midwife appointment today and was told that more than 50 percent of maternal deaths in pregnancy and childbirth are obese mothers and that I will have to have special monitoring and won't be allowed to have a natural birth at the birth centre and will have to be under consultant care and be constantly monitored throughout labour (meaning no water birth, no moving around, no getting into positive positions to birth).
I am so scared and disappointed, I feel like I am an unfit mother already and feel that the drs think I do not care about the health of my unborn baby. Now I know that this will not go down well with some people but I am considering a termination so that I can lose more weight before carrying a child (I have currently lost 70 pounds).
I came across this blog and I am aware that you are based in the US and I am in the UK so some things are different...for instance I can't actually choose a provider and am stuck with who I have :(...but please, any advice would be so appreciated. Both myself and my partner are concerned and do not know what to do.There are so many things to cover here, it's hard to know where to start. Please comfort and reassure this woman that she CAN do this. She needs to hear from many people, not just me. Please leave some encouraging comments at the end of this post.*
In the meantime, here is my response. First, dear Reader, please don't terminate this pregnancy over these scare tactics or your fears. Chances are that everything will be okay. Many MANY women with a BMI well over 35 have had healthy pregnancies and babies. My BMI is 48, far over yours, and I had 4 healthy pregnancies and babies, and am none the worse for wear for it. I know so many women your size and far larger who have had healthy happy babies. You can read some of their birth stories here and here.
No, no one can promise you with 100% certainty that you and this baby will be fine, but the odds are certainly in your favor, "obese" or not. Most obese women have healthy babies; some do have complications like GD or high blood pressure, but even then, most of the time, these conditions are able to be treated and everyone is still fine. So don't panic over the scare tactics they are giving you.
To be fair, the doctors and midwives are trying to do what they think is their job, to apprise you of possible risks associated with "obesity" and pregnancy, but the problem is that they have gone so far overboard in stating these that they are frightening women unduly, making them think that almost no women of size have healthy pregnancies or babies, when in fact, most do.
In some cases, care providers lay on the scare tactics so strongly that they bully women into weight loss surgery, risky diets, over-intervention, and even terminating the pregnancy. That is NOT good health care, that's medical bullying. And for God's sake, this poor woman has already lost 70 lbs., but despite the fact that she followed typical medical advice to lower her BMI before pregnancy, she is still being punished and scared half to death. Where is the justice in that?
Yes, there are some risks associated with pregnancy in obese women, but NO, the answer is not in scaring women into terminating an established pregnancy until they reach a "normal" BMI.
Shame on these providers for laying the scare tactics on so strongly that someone would even consider terminating a pregnancy simply because of their weight.
Yes, among those rare women who have died during pregnancy or birth, obese women are overrepresented somewhat. That does NOT mean that 50% of obese women who are pregnant die during pregnancy─that's a misunderstanding of what the care providers were trying to say. Death is an extremely rare occurrence for childbearing women in the developed world, and although very high BMI women are somewhat overrepresented in that group, the actual numerical risk of it happening to any one obese woman is quite low.
And the reason why fat women do die during pregnancy or birth boils down to three main causes, some of which is preventable:
- Complications from general anesthesia during a cesarean
- Complications from hypertensive disorders (high blood pressure and resulting disorders) in pregnancy
- Blood clots (usually in conjunction with cesareans)
- Don't let them push you into a cesarean you don't need. If a cesarean is required at some point, make sure they are prepared to use an epidural or spinal block instead of general anesthesia. Have an anesthesia consult ahead of time to be sure they have the equipment needed on hand if it were needed
- Make sure you are monitoring your blood pressure carefully (you can get a home BP monitor if your readings are questionable at all), make sure they use the correct-sized BP cuff so that that readings are accurate, and get regular exercise and have great nutrition to lower your risk for developing gestational diabetes or blood pressure issues
- Regular exercise also lowers the risk for a blood clot during pregnancy; for certain people, low-dose aspirin therapy (only under the supervision of a care provider) is sometimes advised. If you have a cesarean, discuss with your provider the use (and proper dosage) of blood thinners, and be sure to move your legs around and walk as early as you can tolerate after the surgery. There are also special wraps and cuffs that can help reduce your chances of a blood clot after a cesarean; make sure to request these if you have a cesarean, and note any increase in shortness-of-breath to your providers
There are, of course, private midwives that you could hire from outside the NHS system, and it seems to me like this would be well worth the money to do if you can manage it. I bet we could find a private midwife who would take you on as a client and who would work with you to find a way to make it financially feasible. I know there have been women of size who have had great out-of-hospital births in the U.K. with private midwives.
But if that's absolutely not an option, then you will have to work within the system, and the way to do that is to push back against the care providers who are giving you a hard time. I'm hoping some of my U.K. readers will pop in and leave some suggestions about how to do that.
At the very least, one of the best things you can do is to find a Pregnancy Buddy, an advocate familiar with size-friendly care practices, who will come with you to appointments and help you speak up for quality care and question fat-phobic practices. A doula who really "gets" weight stigma and has a Health At Every Size approach could be a great help for you in advocating for more size-friendly care.
Best wishes to you, and I sincerely hope you will not let your fears (and the scare tactics of the providers) keep you from enjoying this pregnancy and this baby. Be as healthy as you can in your habits without obsessing over them, find a Pregnancy Buddy or Size-Friendly Doula to help you speak up for yourself, and don't be afraid to push back against the bias of your providers and even report them to their superiors if necessary.
Pregnancy is one of the best times to learn how to advocate for yourself, your baby, and your needs (whatever size you are), and you deserve to have loving, respectful care, regardless of your BMI or whether you lose enough weight to fit into their narrow definition of "normal". Start demanding that care now, and don't settle for second-best. You and your baby deserve no less.
*Please keep your comments civil and kind and aimed towards helping this woman's specific situation or about commenting on weight-biased scare tactics, rather than about pushing a particular point of view on abortion. This is not a forum for abortion debates, and I will be vetting comments before I publish them. Please stay kind and helpful in your words. Thank you.