Tuesday, September 18, 2012

Childbirth Education Experiences in Women of Size

Readers, I need your input and stories.

I've been asked to write an article for childbirth educators on how they can make their classes more size-friendly for plus-sized women. I have a number of ideas, but I'd like to solicit your feedback on this too.

In articles like these, it's good to start off with some real stories from women of size.  Storytelling is useful in bringing home advocacy messages in an emotionally powerful way.  So for those of you who have been pregnant and have taken a childbirth education class (of any sort*), please tell me about your experiences as a woman of size, both positive and negative:

  • How were you made to feel welcome (or not)?
  • Did you feel you had any special needs or concerns as a women of size in the class?  If so, were they met?  
  • Was the equipment/environment friendly for a larger person? 
  • Did you feel pointed out or ostracized as a woman of size?
  • Do you feel you could have asked specific questions about your concerns as a woman of size, either privately or during class?  
  • Were you given any list of resources that might address the needs of diverse people in the class (lesbian women, single moms, women of size, etc.)?

If you haven't been pregnant (or haven't been to a childbirth education class), think about what you would like in such a class as a woman of size:

  • What special needs might a woman of size have in a childbirth ed class?
  • How can a childbirth education teacher make the class more size-friendly?  Consider classroom design, chairs, equipment, images, films, mobility and positioning concerns, content about nutrition and exercise, breastfeeding information, etc. 
  • How can a childbirth educator help women of size feel more welcomed, respected, and listened to? 
  • What resources specific to women of size should childbirth educators know about? 

For example, let me share a few stories from my own experiences:
One thing that was a problem for me in my first pregnancy was the lack of information and resources available for women of size.  There were no maternity clothes or nursing bras in my size in that city then, and no one had any clue about how to help me find any. It would have been helpful if my childbirth educator or care provider had been able to give me a list of resources for pregnancy in women of size.    
One of the most trying things for me as a fat woman who practices Health At Every Size® principles was the nutrition diary. After years of having every stinking thing I ate nit-picked and judged, I found freedom in returning to a more natural, intuitive way of eating. When extensive food diaries were expected in childbirth classes, that was very stressful for me. Would they even believe what I wrote? Did they think I was lying when junk food wasn't in my diary?  Would they have hyper-restrictive standards for me as a woman of size? I honestly found food journaling quite an ordeal. I can only imagine how triggering it must be for women with eating disorders.   
There was also very little information about breastfeeding when well-endowed. The football hold was never mentioned in my breastfeeding class, and it was only through The Nursing Mother's Companion that I realized that this might be helpful for well-endowed women. If I hadn't learned about the football hold, breastfeeding would have failed for us, because the cradle hold did not work for me.  Childbirth educators need to remember breast diversity and address different positions and techniques.
These are some of the experiences I remember being challenging in the childbirth education classes I took over the years.  Most teachers were welcoming to me as a woman of size, much more welcoming than some of the doctors and midwives I saw, but still, there were a few things that could have been improved.

How about you? What were your experiences?  What things could have been improved in your classes?  What would you most look for in a class if you were to take one?  What advice would you give to childbirth education teachers about making their class size-friendly?

I'm also interested in hearing about the childbirth ed class content that was most useful to you in general, not just as a person of size.  For example, one of the best classes I ever took was one where we did an extensive labor rehearsal with our partners, rotating through various laboring positions and coping techniques for a prolonged period of time.  This brought those techniques out of my intellectual memory and into my muscle memory, making them easier to remember and utilize in labor.

How about you?  What was the best or most useful thing you learned in class?  What do you wish they had done more of?  What was not useful?

[You can share your comments and ideas either via a direct email to me (kmom *AT* plus-size-pregnancy *dot* org), or in the comments section of this post. Please understand that if you comment here or send me an email, you are giving me explicit permission to quote you as needed.  If you don't want me to quote you, please say so.  If you are okay with being quoted, please use a name that is okay for attribution.  Finally, remember that I retain the right to use, not use, or edit any story as needed.]

Thanks for your help.  Birth workers (including childbirth educators) are hearing the message that women of size deserve more respectful care.  Here is our chance to spread that message even more.

*What kind of childbirth ed class did you take?  A hospital class?  A Lamaze class?  BirthWorks?  Hypnobirthing?  Birthing From Within? Bradley? Others? 


Brenda said...

I had a Lamaze class in a Montesorrie school. Small chairs fitting a large imbalanced body. I followed Adelle Davis and had four healthy children. Nobody taught me how to breast feed nor take care of babies being obese. I showered with my babies instead of giving them bathes. My children weren't sick until age of four. The class didn't talk about c sections much . Spinals done on fat woman should be done expertly because they couldn' find my spine the first time nor the second.

Midnight Agenda said...

Chairs with arms are the absolute BANE of my existence.
Being the only person in the room to get stuck in one is absolutely more mortifying and traumatic for me than a stranger calling me fat.

I think it would be magnified 5X if I were the only pregnant woman in a class who still got stuck in the chairs.

Midnight Agenda said...

I think overall just having an educator who is empathetic to the changing factors that would hinder pregnant women of diversity is really the most important thing.
I know that is really general, but with that in mind the educator can survey her room, her methods and her tools to see how they might affect other women.

I think someone who is knowledgeable of alternative positions/holds/concerns for bigger sizes would be great.
What's a good birthing position to help relieve stress on big belly, which side is easier to catch your own baby, what angle is going to give my provider the least squish and the best view?
I don't know these things, I haven't been through it before. But MY DR./MW SHOULD KNOW and be prepared for accommodating me. Since most of them wont, it would be really nice if a CBE could tell me about this and make some suggestions for me to keep in mind when the time comes to get down and dirty with my birth director.

I do like your list from personal experience. I've been watching for maternity clothes when I go out, and I already know I can't afford a whole new wardrobe from motherhood maternity. But I know Old Navy still has plus sized clothing, why don't they offer that with maternity clothes? Are there any other local or online places with cute clothes that will fit me at reasonable prices?

How will my size affect the guidelines for my recovery after birth?
How about dosage guidelines for medications related to pregnancy and birth, who do I ask for that info? What website can I go to to make sure that my provider is correctly dosing me with safe medications?
Are there any extra concerns for belly support? Does Cocoa/Shea butter really work on stretchmarks?
How can I prevent suffocating my baby with my airbus sized boobs?
What are some alternative bf positions for what sizes?

Food journaling, have you taken my exercise habits into consideration with my eating habits? How about my actual calories burned per day? For larger people we actually burn more calories at rest that average sizes.

Are you going to subconsciously/intentionally dismiss things I say just because I look like a lazy slob?

Sorry for the massive amounts of text, I tried to break it up a bit to make it easier to read.

Elizabeth said...

Despite there being no out of hospital classes in my town, I didn't want to take a hospital based class on how to be a good girl at the hospital so I used the Hypnobabies Home Study program. I also took the hospital's breastfeeding class late in my pregnancy, and the Base (my husband is active duty Air Force) Baby and You that wasn't required but was strongly encouraged during my first trimester.
To the best of my memory, the Hypnobabies program made no mention of weight at all other than, I think, a reprinting of the suggested weight gain guidelines. I listened to most of my weekly tracks propped up in my bed, so plenty or room, lol.
The Baby and You class we took was mostly an overview of Base services for families, how to register your new dependent with the military, Tricare maternity coverage, and then some very basic childbirth info. Other than the weight gain guidelines, I don't remember any real mention of weight. It was held in a conference room with chairs without arms. The childbirth information was fairly superficial, though they did give out a birth plan check sheet that from things I've read elsewhere seems to be standard on military bases. It was fairly mainstream in it's perspective of childbirth.
The breastfeeding class was very informative, though there wasn't very much that I hadn't already seen in books or online. It was also held in a conference room at the (civilian) hospital and the chairs were armless. The lactation consultant did suggest the football hold as being good for women with large breasts. The biggest benefit I got out of the class was that the lactation consultant remembered me when she came by my room after my daughter was born. She never made any comment about my weight; and the only comments on my body were in agreement that between the c-section and my large cup size the football hold was probably best, and asking permission to touch my breast so she could help me with positioning.
While I never felt judged for my weight, any issues related to me specifically as a fat pregnant woman were just kind of glossed over like we didn't exist. I know much of the natural birth resources (including Hypnobabies) advocated using a birth ball during labor. However when I went to look for one, I found it almost impossible to find one. I think I finally found one at the fourth (and second sporting goods specific) store. I'm a petite (5'1) fat woman so I needed a ball with a smaller diameter, but finding a ball with a weight limit over 300-350 lbs was difficult. Even the 350 ball worried me enough to pass over since I was hovering right at 300 when my daughter was born and I didn't want to worry about it bursting while sitting on it, especially in public.
For future pregnancies, I want to take an in-person class since I had trouble getting my husband involved with the homes study class. But mostly I think it would be nice for a childbirth class to not pretend that fat pregnant women don't exist. I know it was on your site, but (and part of this was hypnobabies was focused on normal natural vaginal births) I didn't realize that the size of the needle made a difference for regional anesthesia and ended up suffering from quite a bit of pain receiving a spinal because I didn't know to ask. Most things are (or at least should be) the same regardless of size, but woman need to know about things that may need adapting.

Elizabeth said...

Midnight Agenda, I'm not sure from your comment if you're currently pregnant or planning for the future, but Old Navy used to sell plus sized maternity. Right before I got pregnant with my daughter in May 2010 they came out with a line, and it was available through my whole pregnancy. I told anyone who would listen that I wanted maternity clothes for my birthday and my dad and step-mom took me shopping at Motherhood, but most of what I bought came from Old Navy since both their prices and their styles were closer to my own ideals. While ordering some smaller (since the people who make nursing shirts seem to assume that you're only wearing nursing clothes immedietely postpartum)last summer I noticed all the plus size maternity was on clearance, and then it disappeared all together. I have no idea why since things seemed to sell out pretty quickly which makes me think there was a market. You might be able to find some used if you looked places like ebay. Also I don't know what size you wear, but I weighed 290 pre-pregnacy and was usually a 20 or a 22 depending on cut and brand, and I was able to wear some XXL from their regular line. I wore one of their regular maternity fold over skirts to the hospital. I didn't try anything more form fitted since our local store doesn't stock maternity, but I never had to send any of the straight sized stuff back. So might be an option for shirts if you don't need really dressy stuff. JCPenney has some plus sized maternity, but it seemed to run smaller than Old Navy or Motherhood. I stalk Zulilly for deals for my daughter, and they regularly tend to have collections that include plus size maternity, and while I didn't order from them Woman Within has a small maternity collection.

Futuralon said...

I've never been pregnant (just started trying). It's hard to imagine a health care scenario when I've never been hospitalized for anything. One thing that would be nice in a childbirth class is a section on patients rights and filing a complaint. Knowing one's rights and knowing what authorities to turn to if there are problems with care or a core provider would be nice to hear, a real load off. Health care is confusing enough, so making a note early on would be helpful. I heard theres a new database of medical errors that Obama has rolled out, that sort of info along with licensing board for doctors, midwives, and nurses, patient complaint ombudspersons at hospitals, procedures or "magic words" for switching providers during a hospital stay, etc.
It would also be nice to hear about any medication nuances a large woman should know about. Maybe cover the legal nuances of hospital visits and family rights for lesbians and alternative families in the relevant state.
Finally I'd like to hear about what is supposed to happen after the oft mentioned six week post partum checkup. How long does the average woman take to feel normal? Have pain free intercourse? Finish losing baby weight whether back to original size or not, for breastfeeding mums or not?
Comfort-wise I'd like to have some seating options - carpeted floor, chairs with desk, chairs with no desk. The average college classroom does not seem conducive to the sort of class I envision. I'm big but I fit in normal chairs... Maybe not forever. Maybe offer at the start of class that alternate seating can be found or requested?
Insofar as maternity clothes, I can sew my own clothes so worst comes to worst I can do that. You have previously mentioned Nordstrom Bra alterations (yay). But I did want to mention online store Simply Be has a plus maternity section It's like simplybe.com.

Sara said...

I know I'm late commenting on this, but I just found your blog, and love it!
I took a Bradley class for the sole purpose of forcing my husband to prepare for the birth, since he wasn't doing any reading on his own. It was just us and one other couple in our teacher's home, so was very personalized. We all sat on the floor (one of the Bradley Method's recommendations), but had the option to sit on the couch. I had absolutely no problems, physical or otherwise. I have a C-cup chest, was/am in good health and have full mobility, so nothing was brought up about my size. There were discussions about nutrition and exercise, but in a general and encouraging way.

I also bought all my maternity stuff at Old Navy (they have plus-size maternity online). I actually didn't need much because I didn't even start showing til about 20 weeks. I used the trick of putting elastic through my regular pants' buttonholes and wearing a "bellyband" to cover it. I also already owned a lot of flowy dresses and tops (to cover the chub), so I just kept wearing my normal clothes all the way to the end. That is one perk of being fat. ;-)