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!


Theresa said...

Eat only vegetables??? Don't you need protein to make a baby??? On what planet does that make sense? Delusional planet in the city of Denial?

Zoe said...

I'm 12 weeks into my first pregnancy, and as a fat lady, these issues have been causing me A LOT of anxiety. So far my providers have been respectful with not telling me my weight; I've had severely disordered eating in the past and I think knowing would trigger that. (They probably think binging, but I'm referring to restricting.)

Anyhow, my bad experience has come from a hospital based program called BLOOM, a wonderful program which will help you gain less than 5kg (11lb), which is best for you and the baby! *vomit* All women with a BMI over 32 are sent an invitation to join the program (my BMI is over 45). I did ask to see the dietician a few weeks ago because I'm vegan. (But how? You're fat!?) I appreciated the visit, I realised I wasn't getting enough calcium. However, I have now been signed up to the wonderful BLOOM without my permission. So, how do we stay wonderfully healthy and make sure our babies are wonderful? We eat less than 1600 calories a day!! I was speechless!! I still can't form the sentences to articulate how furious it all makes me. The newsletters (yes, newsletters to my home!) are patronising beyond belief. Needless to say I'll be asking so be removed from the program.

I realise I just wrote an essay, but I wanted to thank you for creating a safe space where I can exist in my own body. I don't feel safe at hospital, but of course a home birth is out of the question, fat women don't get choices here in Australia.

Anonymous said...

At my first midwife appointment I was told in no uncertain terms that I was not allowed to gain weight while I was pregnant as I was already far too overweight. By one week post-partum I weighed 21 pounds less than I did when I got pregnant and I totally ignored the advice on what to eat. But I'd also had heaps of stress that my baby was going to be "huge" as my fundal height measurement was too large - but they didn't take a base reference early in pregnancy so it was completely irrelevant and my son was 8pound 5oz which is not exactly "huge"!

Clarice Wynter said...

With my first child [who is now a healthy 18 year old] my OB told me I should eat 'nothing but steamed vegetables, not even fruit!' after my first trimester. I told her that wasn't going to happen. For my 2nd child [now 15] I changed doctors and was told 'pregnant women gain weight, that's how it goes.' Needless to say, I never went back to the 1st doctor.

Dre said...

My mother (who weighed 90 lbs when she was 9 mos pregnant with me) told me when I got pregnant that hopefully I would lose weight like my aunts did, due to morning sickness and "eating right" for the baby! As if I ate horribly before. Thankfully my OB was kind and respectful of my obesity.

E. L. said...

Four out of the ten comments were made to me (the first three and the last one), all by the same midwife (over three months). I switched midwives, BTW, and have had a much more positive experience. I don't have GD (something the original midwife was CONVINCED I'd have, just based on my size - 200 lbs starting off), and at 34 weeks I'm only up 11.8 lbs, eating precisely as I was at 6 weeks, 12 weeks, 20 weeks, and before I was pregnant... I gained and lost in spurts - up 4 lbs in a month, down 2 the next - and I'm convinced it was just my body deciding what it wanted to take from what I was eating... I ate extremely healthfully and walked at least 5 days a week. But there was constant pressure from the first midwife to not snack (I rarely do), not eat junk food (I don't), not gain weight (whatever)... I'm measuring perfectly (exactly on the dot) and have all the way throughout (even when I lost weight). It's so frustrating to hear things like this all the time. But it's SO nice to be able to look back at 34 weeks of healthy pregnancy and laugh at the stupidity of providers.

Derekatesmom said...

My ob staff was supportive of my weight (cannot say the same of my rheumatology staff), with my son I did well not gaining that much weight, my glucose came back fine and I still c-sectioned a 12 lb 13 oz full term boy. I insisted on a second glucose with my daughter and at 37 weeks she was 8 lb 1 tiny sister in law tested diabetic with both her pregnancies, her boys were both under 8 lbs....what the heck is that...

Anonymous said...

The fat vagina theory never made sense to me. If being fat makes your vagina narrower, wouldn't men go looking for fat women WAY more often? Wouldn't "Urban Myths" about fat women being better in bed abound (much like the ones about black men)? Wouldn't skinny be incredibly unfashionable in this society that measures everything by your sexual performance?

Obviously the whole fat vagina idea was created by someone who didn't think things through.

I'm Katie. said...

This is all disgusting. I mean... oh, jeez. I started out allllmost overweight with pregnancy #2, gained 35 lbs by 9 months along, FREAKED OUT due to the hype around weight gain I'd received from OBs with pregnancy #1. My midwives talked me down. They did a finger prick- at my insistence. At every turn they insisted that they wouldn't blink an eye at 50 lbs weight gain, let alone a healthy 35. I am incredibly grateful for their level-headed, well-educated support.

And BettySue? You cracked me up. Hells yea.

Anonymous said...

I don't know if you will see this comment, but on "The Mindy Project" s1 ep 17 the opening scene is telling a woman of size she is too fat and needs to lose weight WHILE pregnant! Citing the increase risk of complications. The bit would have been funny if it wasn't so blatantly wrong, perpetrating the belief that fat women can't have a healthy pregnancy.

Jen said...

I just found this blog post after a particularly disheartening first visit to my midwife and felt so encouraged by it. I am (obviously) well aware of my status of overweight despite the fact that I eat 80% organic foods much of which is grown in my own backyard or comes from my own free-range chickens. I have always struggled with my weight and despite eating a clean diet I continue to. At my first appointment (with my 5th baby) I was told to "avoid eating too many hot dogs" (I NEVER eat processed foods like that) and asked if I EVER exercise. As a mother of four kids under 9, I can assure you I am far from inactive. It was so frustrating that she assumed I spent my days covered in bacon grease and parked on the couch when, in fact, I work very hard to make sure my family is fed healthy real foods. Thank you for your words of encouragement and for your fight against these offensive assumptions of larger moms.

psychsarah said...

Wow-this is so sad. I'm even more grateful that I have wonderful midwives. I'm obese, and gained about 12 pounds in my first pregnancy, as I walked daily and ate reasonable. I lost weight my first trimester due to nausea! The only time they asked me to weigh myself was right at the end on the wee off chance I changed my mind and wanted an epidural (i.e., the anesthesiologist would want to know my weight and it was easier to take it now than during labour). They wrote down the number and that was that. I'm so sorry that others don't have similar experiences. I've had hideous physicians make idiotic comments in the past, (after losing 85 pounds by eating carefully and exercising a lot, I was still 15 pounds above the so-called "healthy" BMI, my then GP told me I had to lose another 20 pounds. I told him this was not possible without me being unhealthy i.e., restricting or over-exercising. He asked me if I ate a lot of bread and potatoes. I nearly walked right out of his office without another word. Found a new GP post-haste). Thankfully this didn't happen during pregnancy. With the strong emotions I experienced with the hormones, I might have given him quite the rant to deal with...