In our current healthcare model, it’s easy to fall into the trap of seeing weight and BMI as the most important measure of health. Prenatal care is no different and the focus on weight, weight gain, and the weight of the baby too often take center stage. This often has more to do with cultural beliefs about body size than evidence-based research and it can negatively impact an individual’s ability to care for their body throughout their pregnancy. Pregnancy is not one-size-fits-all and a weight-neutral approach in prenatal care is essential to increasing the health of pregnant people at every size. Here is some information to help us shift the paradigm:
1. Weight gain in pregnancy is not only normal, but a sign of health
Although weight gain during pregnancy is typically a sign of good health, mainstream anxieties around body size contribute to close weight and food surveillance during pregnancy. Standard prenatal care includes routine weigh-ins, prescriptions for low-fat or low-carb diets, a lengthy list of restricted foods, and non-evidence based hospital policies that routinely forbid eating (and sometimes drinking) during labor. It’s valuable to remember that a healthy pregnancy includes weight gain.
2. Clinical body shaming is never okay
It is not uncommon for pregnant people of all sizes to be chastised for their weight gain by care providers. They are told they are gaining too much or that their baby is growing too large. Often this is followed by unfounded criticism masquerading as food advice. If you do not feel comfortable with how your care provider is speaking about weight and food, or if they’re overly focused on the scale, explore alternate providers who might be a better fit.
3. Advice on food and weight can be more cultural than medical
Care providers are instructed professional organizations to address weight, size, and diet often without being trained in how to navigate these conversations and what they should be advising. This often results in confusing and non-evidence-based nutritional advice based on personal (not clinical) understandings of nutrition and weight. If you are looking for nutrition help in pregnancy (or beyond), connect with a body positive nutritionist. Health At Every Size and the Association for Size Diversity and Health are both great resources for finding a nutritionist in your area.
4. Demand better care
Instead of relying on BMI and scales as a primary index of health in pregnancy, care providers would do better to have meaningful conversations with patients about wellness and the importance of self-care during pregnancy. Questions such as, How are you feeling physically, emotionally? How are you feeding yourself? Are you eating to hunger and stopping when full? Are you getting enough protein in your diet and eating ample amounts of vegetables? Are you getting regular physical activity? If your care provider is not approaching your care this way, try redirecting the conversation or find a more supportive care provider.
5. Talk back
Pregnant people often find themselves the target of endless unsolicited comments about their bodies: “Are you expecting twins? You’re HUGE!” “You are way too tiny!” “Your face doesn’t even look pregnant.” “You must be about to pop!” While most people imagine they are offering light-hearted conversation, it can be really frustrating to be fending off unwanted body comments every day. Part of decentering weight in your pregnancy might mean developing scripts for responding to comments and developing affirmations for yourself. For example, redirecting the feedback from your appearance to how you feel or saying affirmative things like, “I am having a really healthy pregnancy.”
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.