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Navigating Pregnancy as a Fat Woman

Megan Davidson, PhD and Sarah Lewin, LMSW

When I got pregnant, my midwife insisted I take the gestational diabetes test repeatedly because she couldn’t believe my blood sugar was normal. The extra testing proved over and over that my baby and I were healthy, but my midwife never seemed convinced. —Anna 

Being pregnant in a sizeist culture presents unique challenges to all people adjusting to their growing bodies, and these challenges are amplified for fat people. Healthy fat women are routinely subjected to increased monitoring at every stage of their pregnancy, including extra prenatal appointments and testing, and repeated screenings for gestational diabetes. Many women are even advised to lose weight (although dieting in pregnancy is not recommended) and given extensive warnings about the risks associated with their weight. Shift your focus away from weight and towards other indexes of health such as blood pressure and the health of the baby. Question why a care provider is recommending tests or interventions, particularly an induction or a Cesarean birth based on your weight or estimated size of baby. 

I started this pregnancy in a new city and the first OB I met was nothing like my previous doctor. My first OB was relaxed about my size, focused on my overall health, and confident that I could have a normal birth (and I did). This OB began rattling off risks associated with my BMI and throwing around statistics about stillbirth, Cesareans, and birth defects. It was like he couldn’t even see me, just numbers and risks. —Darcy 

Some care providers, when faced with a fat patient, may cite statistics such as stillbirth rates three times as high, a pre-eclampsia rate four times higher, a 50% chance of having a Cesarean birth, increased risk of preterm birth, and three times the average risk of developing gestational diabetes. Additionally, fat pregnant women might be counseled that their babies are more likely to have neural tube defects and congenital heart disease. Facing this list of risks and complications can be overwhelming and intimidating. It can be easy to believe that your body is dangerous. Don’t be scared of the statistics; you are not a statistic. The studies behind them are transparent about how much is still unknown. Remember, fat healthy women overwhelmingly have healthy, safe pregnancies and births. 

I know that I am really big and have made less healthy choices for my body but I also deserve respectful care during pregnancy regardless of my size or the reasons I weigh what I do. I am not asking that someone celebrate my body, I am just looking for a doctor who can see my body and not freak out. —Maria 

Our cultural understandings of how size affects health, as well as a generalized fear of fatness, have circumscribed the clinical care that fat women are getting. Much of the data on maternal weight gain and obesity is riddled with holes, questions, and assumptions not grounded in evidence. Women are being advised about risks that might be caused as much by the bias against fat people as by the fatness itself. Find a body positive birth team to affirm and support you! If you don’t feel that your care provider is the right fit, consider switching or connecting with a body positive doula who can give you extra support. Respectful care is deserved at every size. 

All of the images of pregnant women—at the doctor’s office, in magazines, in stores—were women who looked nothing like me. Finding online communities for fat pregnant women saved my sanity and gave me so much more confidence. —Pam 

Studies show that about half of the pregnant women in the US are clinically overweight or obese. We are saturated with images of thin pregnant women, but that does not reflect the diversity of pregnant bodies. Seek out community that affirms you and your pregnancy in the body you are in right now. Plus Size Birth is a fantastic resource for connecting and building community. 

Sarah Lewin, LMSW is a labor doula, lactation counselor, childbirth educator, and social worker. She is the author of A Doula For the Mother and the Self: Exploring the Intersection of Birth and Body Culture, and is passionate about creating body positive community. Megan Davidson, PhD is a labor and postpartum doula, a breastfeeding counselor, and a childbirth educator who has worked with over 1,100 new parents in NYC. She is the author of Experts in Birth about doula care in the US and is currently writing a how-to guide for having a positive birth. Together they have authored two forthcoming essays, “Eating for Two: The Threat and Fear of Fatness in Pregnancy” and “Dangerous Bodies: Imagining, Monitoring, & Managing Fatness During Pregnancy.” They are guest bloggers for the National Eating Disorders Association and offer body positivity trainings and mentoring for birth workers.  

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