Thursday, March 28, 2013

Plus-Size Pregnancy Photos: 31 and 36 weeks!

A reader has submitted her pregnancy pictures to me for the blog.  And beautiful pictures they are, too!

Too often, women of size neglect to take adequate pictures of themselves pregnant and birthing and parenting because they are embarrassed about their size.  Then there is a void in their children's baby books and the family photo albums, because these moms can't bear to have their pictures taken.  And these moms don't have the beautiful keepsakes to remind them of those magical times when they were pregnant.

Bravo to Jen for being brave enough to take pictures, and for being willing to share them with the rest of the world.  Considering how often people find my blog looking for pictures of pregnant women of size, it's always wonderful to have some new pictures to put up.

If you want to submit your picture, be sure to send it to me with a note granting express permission to use the picture, both here on the blog and my website, and for my various speaking gigs, giving presentations on pregnancy and "obesity" etc.

Here is Jen (a.k.a. JeninCanada, from the blog, at 31 weeks. Don't you love her beautiful dress?  Great for maternity!

Here is Jen at 36 weeks.

And here is the adorable result of that pregnancy!

Don't you just love those cheeks?

Monday, March 18, 2013

Emergency Preparedness: Emergency Kits for Families and People of Size

Image from FEMA, via Wikimedia Commons

As part of our occasional series on emergency preparedness for families, we have discussed various possible emergencies and what we can do to meet them more proactively.

First we discussed fire safety for families, and the need for storing extra water for emergencies, one of the most neglected yet most important steps for preparedness.  We also discussed how to prepare for a power outage, including how to have light and how to stay warm when there's no power.

Now let's talk about preparing emergency kits for your family.

Planning an Emergency Kit

Before you do anything else, analyze the potential emergencies in your area.*

Do you live in an earthquake zone, near a dam, in Tornado Alley, or in a hurricane- or wildfire-prone area? Are you near a chemical manufacturing plant, or near a rail line or highway that's a thoroughfare for dangerous chemicals? Do you live in a flood plain? Does your area regularly get significant winter storms?

Whatever your potential disaster is dictates what needs to be in your emergency kit and where your kits need to be stored.

Emergency kits can present special challenges to families and to people of size, but there are things you can do to help prepare for this.

Mini-Escape Kit Under the Bed

Having a mini-escape kit under the bed can be a lifesaver, especially for those who live in earthquake- or tornado-prone zones.

Stepping on broken glass as you exit is a major cause of injuries in these situations.  Keeping an old pair of shoes under the bed can prevent a lot of these injuries. Inside the shoes, keep a pair of warm socks (preferably wool, as they insulate even when wet, unlike cotton).

Inside the shoes, also keep a headlamp for hands-free light to help you make your way out of the building. (Check the batteries periodically.) You may need your hands for crawling along the floor, moving debris out of the way, holding a child, etc., so having hands-free light via a headlamp is really far more useful than a hand-held flashlight.

Also keep an emergency whistle inside your shoes or nearby.  If debris traps you, a whistle can help your family or emergency personnel find you much more quickly, and is far more reliable (and long-lasting) than your voice.

Other good ideas include a pair of work gloves (to help move any sharp or broken objects in your way), and an extra pair of keys to your vehicles (so you can move them out of harm's way, access supplies in them, or have temporary shelter out of the weather in them).

All these things can be kept in the shoes so they don't take up much space or get lost.  Keep them right underneath your bed, near its head so they are quickly within reach.

A lightweight but warm jacket, fleece, sweater or robe near the bed is also a good idea in most areas.

Car Emergency Kit

A mini-emergency kit in your car is another good idea.  Floods, snowstorms, and landslides can all cause you to get stuck in your car, or you can be stranded far from home after other disasters. A car kit may be your only access to emergency supplies for a while, so it's good to have a few things stashed away there, just in case.

Always keep extra drinking water in your car, some emergency food, blankets for warmth, and light sources (flashlights, headlamps, or light sticks).  Since you can't store all that much water in a vehicle, a way to filter and purify extra water for drinking is also a good idea (water filter, bleach, water purification tablets, steri-pen, etc.), or you can end up with e. coli, giardia, or other nasty bugs. My husband got giardia once; trust me, you do not want this!

A first-aid kit in your car is a must, especially with a family.  Keep the usual things like band-aids, gauze pads, antibiotic ointment, gloves, alcohol wipes, hand sanitizer, and painkillers like ibuprofen/acetaminophen/aspirin, etc. but also consider things like Benadryl, sunscreen, and bug spray.  You don't need a lot, just mini-versions of these items.

Jumper cables and tools for changing a tire are a must for every car. A folding shovel can be helpful if you get stuck in snow or mud. Duct tape, a pocket knife, multi-tool, rain ponchos, a warm coat, a tarp, rope or paracord, signal mirror, and extra cash are all helpful additions.

If you have young ones, consider extra diapers, a change of clothes, and plastic garbage bags. A big pack of diaper wipes is invaluable for general sanitation regardless of whether you have little ones.
Our Experience: We've always kept a first-aid kit and diaper bag in the car, but one thing we learned to add over the years was Benadryl. We've had a few incidents over the years where Benadryl would've been handy and we didn't have it (sudden cases of severe hives out in the middle of nowhere, and a bad bee-sting that caused an eye to swell shut).  Now we always keep Benadryl with us, with an epi-pen as back-up, since we have children prone to allergic reactions.
Bug-Out Bag, or Extra Clothing Bags Outside

There are several emergencies that might require you to leave your home suddenly without adequate preparation.  These include house fires, wildfires, sudden floods, avalanches, earthquakes, tornadoes, hazardous materials accidents, etc.

A bug-out or "go" bag is another important item for families, and especially for people of size.  Some emergencies mean you have to evacuate so quickly that you would not have time to pack anything.  Therefore, it's helpful to have a bag for each family member (or set of family members) near the door or in the garage that you can just grab in an emergency, on your way out the door.

A bug-out bag should have a couple of changes of underwear and socks, a change of clothes, hygiene items (toilet paper, tampons, etc.), a headlamp, sunscreen/bug spray, plastic bags, prescription meds, diaper wipes, dust masks or bandannas, extra cash, some snack foods, and a mini mess kit. For warmth, include a lightweight fleece or sweater, a rain poncho, handwarmers, and hat/gloves. Paperwork should include a list of emergency contacts, a picture of your family members, and if possible, a memory stick with personal information on it (insurance information, etc.). For children, it's helpful to have a few small toys, a deck of cards, mini-notebook and crayons, or a small stuffed animal to comfort them and to keep them occupied.

Don't forget that if you have small children, you need to store things specific to their needs.  Cloth diapers can be washed and reused for a long emergency, but disposables can be very handy in a short-term situation.  Have a few of both.  Breastfeeding is best, especially in an emergency ─ but it is good to keep a small supply of ready-made formula (no water needed) on hand in case the mother is unavailable or incapacitated. Be sure to review your children's items every year so the clothing can be updated as your children grow.

Don't forget your own special needs if you are a person of size. People of larger sizes can't just borrow clothes from others, and many stores don't carry our sizes, especially those open in an emergency. If your clothes get ripped, dirty, bloody, or thrown up on, you may not have anything else to wear in an emergency.  Keeping a backpack of extra clothes and a coat in your size in your cars or in an outbuilding might make a huge difference in your quality of life during an emergency.

Overcoming the Barriers

Many people mean to prepare, but get overwhelmed and give up.

The doom and gloom tone of many preparedness websites doesn't help; many people get turned off by the extreme politics of some sites, or intimidated by the sheer volume of tasks and supplies listed on other sites.  Some feel they have to prepare for every possible emergency scenario all at once, which is too overwhelming and simply not feasible.  Or they never start because they feel their finances are too tight or their space too limited.

But really, ANY preparation is better than none.  Start small and take baby steps as your time and budget allow.

Sadly, most families have very little emergency preparation in place.  I lived in California for a number of years, near earthquake country, and I was appalled at how few people there have emergency supplies. One study showed that even after a major earthquake, less than half the people in the high-impact area most affected by the quake made any preparations for further quakes.

Clearly, there is a lot more emergency preparedness needed in our society. Often this is because of denial, apathy, fatalism, or procrastination.

"That will never happen to me" is living in denial, because there's very few places in the world where NO natural disaster ever happens. Sooner or later, something happens just about everywhere.  And even in the safest place, power outages happen.  For a few hours, that's an inconvenience, but for days, weeks, or months, it becomes a lot more serious as food distribution networks go belly-up, transportation systems break down, and bad weather makes life miserable.

Sooner or later in your life, some type of emergency will happen.  Being prepared can help your family be more likely to survive it, or at least get through it more comfortably.

"The government will take care of me" is a poor attitude to have because the government will have thousands of people to take care of in a big emergency and may not be able to help you in a timely manner.  Emergency personnel will be stretched to the limit in a crisis, so it will be important that people be able to care for themselves and their loved ones until help can arrive.

Don't depend on other people to take care of you; do what you can to prepare so you won't be so dependent on others.

"There's not point in preparing because we'll probably all be dead anyhow" is another excuse people use sometimes, but it's such a cop-out.  Sure, certain types of severe emergencies are likely to have a high body count, but even very severe emergencies usually DO have survivors. Best to have supplies in place to give you or your loved ones the best chance of being one of those survivors.

And remember, chances are that most emergencies would be the more modest, survivable type.  Not preparing because you are fatalistic about worst-case scenarios is short-sighted and unrealistic.  Prepare for the most likely emergency in your area, not the worst-case scenario. If a worst-case scenario happens, even minimal preps will give you a leg up on survival compared to those who have no preps.

"I'm just too busy to prepare"is a more understandable excuse. There are so many other things that are important in life that preparing for an emergency can really slip down the priority list.  And often other things DO need to take priority.  But do a little bit of prep at a time here and there and you'd be surprised how it will add up over time. Start chipping away at that emergency to-do list a little at a time and you're better off than you were before.  

This is not to say that my own emergency prep is all that fabulous.  Nope, mine's still very much a work in progress because I'm always so busy and because I have a limited budget for it.  But the point is that we're working on it, and we're making progress. That should be your goal too.  And what better time to start than right now?

Start with Baby Steps

The key is to pick something and get started, and then continue a little bit at a time.

Identify the most pressing needs and start there.  It doesn't all have to be done at once.  Set a goal of doing task "x" or "y" and then work from there. The important thing is to just get something ready, and then you can add to it or edit it as needed with time.

Look at what you already have before you go out and spend money.  You may just need to gather and organize what you already have. Many people have some supplies but they are scattered all over the house, or they are not sure what they do and don't have.  Consolidating them in one place helps you find them more quickly when needed, and taking stock of what you already have helps avoid duplication and identifies future needs more clearly.

If your finances are limited, remember that a lot of basic preparation stuff can be bought at Dollar Tree, Goodwill, or on eBay. Although some things are worth buying new, many things can be bought second-hand just fine.  Start with a few items, then get more in a few months, then a few more later on.  Write a little bit into your budget as often as you can.

What if you live in an apartment and don't have a lot of storage?  There plenty of apartment dwellers who manage a respectable level of preparation. You just have to get creative and prioritize your space.

Denial, procrastination, and feeling overwhelmed are big barriers to emergency preparation, but baby steps go a long way to getting past these.  Again, ANYTHING is better than nothing in an emergency.

Start with developing an emergency water supply and a way to purify other water for drinking.  Then develop a car emergency kit like the one described above.  Then stick an old pair of wool socks, some work gloves, and a headlamp in a pair of old shoes under your bed.  In time, you can develop a bug-out bag or keep a backpack of extra clothes in your car or garage for quick access.

Hopefully, you'll never need these supplies, but isn't it better to prepare and never need them than to need them and have to go without?

Do it for your family.  They are depending on you.

*For further information on emergency preparedness in your area, google your county name, state name, and "emergency preparedness."  Your local government will have more information on local preparedness efforts and suggestions for preparing for disasters unique to your geographical area.

General Preparedness Blogs and Articles

Tuesday, March 12, 2013

WLS and Pregnancy: The Risk for Small Babies

Yet another study highlighting the association between Weight Loss Surgery (WLS) and Small-For-Gestational-Age (SGA) babies.  Yes, WLS reduces the number of LGA babies, but it also increases the number of SGA babies, who are more at risk for later health issues.

Am J Obstet Gynecol. 2013 Mar 1. pii: S0002-9378(13)00241-X. doi: 10.1016/j.ajog.2013.02.046. [Epub ahead of print] The risk of adverse pregnancy outcome after bariatric surgery - a nationwide register-based matched cohort study. Kjær MM, Lauenborg J, Breum BM, Nilas L.  PMID: 23467053
OBJECTIVES: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. 
STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Medical Birth Register. Each woman with bariatric surgery (exposed) was individually matched with four women without bariatric surgery (unexposed) on BMI, age, parity and date of delivery. Continuous variables were analyzed with the paired t-test and binary outcomes were analyzed by logistic regression. 
RESULTS: We identified 339 women with a singleton delivery after bariatric surgery (84.4% gastric bypass). They were matched to 1277 unexposed women. Infants in the exposed group had shorter mean gestational age (GA) (274 vs. 278 days, p<0.001), lower mean birth weight (3312 vs. 3585 g, p<0.001), lower risk of being large-for-gestational-age (LGA) (AOR 0.31 (95%CI 0.15-0.65)) and higher risk of being small-for-gestational-age (SGA) (AOR 2.29 (95%CI 1.32-3.96)) compared to infants in the unexposed group. No statistically significant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemorrhage, Apgar score less than seven, admission to neonatal intensive care unit or perinatal death. 
CONCLUSIONS: Infants born after maternal bariatric surgery have lower birth weight, lower GA, 3.3-times lower risk of LGA and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass.

Sunday, March 3, 2013

Bad Nutritional Advice to Pregnant Women of Size

I get so tired of all the assumption around the nutrition of people of size.  Care providers often assume we eat nothing but junk food, fast food, and sugar, or don't believe those of us who say we eat reasonably.

With the hysteria over restricted weight gain in pregnancy in fat women, these assumptions run particularly rampant when you are pregnant. Here are a few examples from My OB Said What?!?.
  • Well, I don’t know how you’ve gotten to the size you are if you don’t like sugar?” – Midwife to mother who wanted to avoid the glucose drink for gestational diabetes testing and offered to track her blood sugar with finger prick testing instead. Very sugary foods typically caused her to not feel well for days. (entry found here
  • Well, you are bigger than you should be… You obviously like to eat.” – Midwife to mother who was a large woman.  (entry found here
  • Great! Now, no more snacks. No eating between meals at all. You should only be eating at mealtimes.” – Midwife to mother who had suffered from morning sickness but was now feeling a bit better. The mother was a larger woman.  (entry found here)
Many times providers will suggest that women eliminate or drastically reduce certain food groups in their diet (beyond just the usual sugar or white flour).  Here are a few examples of that:
  • If you don’t eat fruit, your baby won’t be fat.” – OB to mother worried about a large baby due to the family history of large babies, including both the mother and father weighing over 9 pounds.  (entry found here)
  • Never eat a whole piece of fruit in one sitting.” – OB to mother while discussing weight gain during pregnancy. (entry found here)
  • Lay off the carbs!” – OB to mother whose pregnancy weight gain was two pounds higher than the standard.  (entry found here)
  • You need to do Phase 1 of the South Beach Diet and cut out carbs.” - OB to mother who was extremely swollen and had a large weight gain and later was diagnosed with preeclampsia at 38 weeks.   (entry found here
  • Your weight looks great, good job! … But you should eat nothing but vegetables for the rest of the pregnancy.” – Midwife to a mother at a 20 week prenatal appointment.  (entry found here)
Come on! The pressure over prenatal weight gain restriction in women of size has gone too far when women are being told to completely eliminate fruit from their diet or to eat nothing but vegetables for the rest of pregnancy.

And even when women comply with these ridiculous restrictions, their care providers often don't believe them.  In the care providers' eyes, if you are "obese," then OBVIOUSLY you are overeating, mainlining ice cream and bread, and consume a TON of sugar.  And if you don't admit to it, well, then obviously you are lying.

Or there's the old saw that more prenatal weight gain leads to soft tissue dystocia (translation: fat vagina trapping the baby inside) and cesareans:
Whoa there! You’d better slow down on that weight gain! I totally understand though, I like to sit down and eat ice cream for dinner too, but I don’t have to push it out of my vagina afterwards.” – Midwife to mother at a prenatal visit. She had gained 2.5 lbs. in the previous two appointments, after having had SEVERE morning sickness earlier in the pregnancy, and had gained only 17 lbs. total in pregnancy. She had NOT been eating ice cream. The midwife became convinced she'd have a big baby and a cesarean, but the mother gave birth vaginally to her 7 lb. infant anyhow
And still another one along those lines here:
Nothing tastes as good as pushing for one hour less feels!” – Midwife to mother who started out at a higher weight than normal. Midwife was suggesting that the mother was eating too much.
I'm sorry, but it's nonsense that prenatal weight gain goes straight to the vagina, not to mention the stupid but pervasive myth that a fat woman has so much fat around her vagina that she cannot possibly push out her baby.  What nonsense.

And that last quote, "Nothing tastes as good as...." is a saying from the pro-anorexia movement!  How twisted is it to quote that to a pregnant mother!

I understand care providers' concerns over potentially excessive weight gain in women of size because there are risks associated with that. I know they think they are doing women a favor by cautioning them to keep their weight gain down.

But it's not reasonable to ask women to gain virtually NO weight in pregnancy, it's frustrating when people make wrongful assumptions about what you eat based only on your weight, it's hurtful when they assume you are lying about what you eat, and it's absolutely wrong to give advice that leans in the direction of promoting eating disorders.  

Providers, giving reasonable nutritional advice to your clients is fine, since excellent nutrition is the backbone of a healthy pregnancy. However, forbidding entire food groups or telling women to only eat vegetables is NOT reasonable nutritional advice, and borders on promoting eating disorders.  And this whole "fat vagina" myth has got to just STOP.  Ugh!