Your Weight Alone Means You Are Probably Going to Have a Cesarean

Another iconic entry from My OB Said What!?!:

“You are grossly overweight. I need you to realize that your weight alone means you are probably going to have a cesarean section. Your previous weights in other pregnancies are irrelevant.”  

- OB to mother with two previous uneventful vaginal deliveries and currently now 32 weeks pregnant with her third

This is such a frustrating entry. It's a classic case of fat bias predisposing towards cesarean delivery.

In multips, prior vaginal births are highly predictive of further vaginal births. Not that a woman can't have vaginal births and then have a cesarean, of course; fetal distress happens, poorly positioned babies happen, unforeseen medical circumstances may necessitate a cesarean, etc.

But generally speaking, one of the best predictors for vaginal birth is a previous vaginal birth.

Yet apparently not for fat women. Certainly not with this doctor.

This woman had not just one but TWO prior vaginal births (so obviously it wasn't just a fluke or random luck), but none of that mattered to the OB, who had the preconceived notion that a high weight almost certainly means a cesarean section and that's that.

And the sad thing is, for many care providers, expectations become a self-fulfilling prophecy.

Whatever happened to a caregiver expecting normalcy?

Although it is prudent to be aware of possible complications with women of size, the best course is to expect normalcy in fat women, too.

Yet the extreme perception of danger around obese pregnancy means that many care providers expect "abnormalcy" in this group, in virtually every case, even when multiple prior pregnancies have been healthy and normal in every way.

Sadly, people generally find what they want to find...or create it.