Plus-Sized Pregnancy

Although the obesity rates in the USA seem to be leveling off somewhat, rates are still high. About 35% of women in America are obese. ¹ That's a lot of us, and some of us are in our childbearing years. Overweight and obese women face particular challenges with pregnancy: obesity related diseases, mobility issues, diet concerns, and sadly, sometimes bias on the part of caregivers.

Having completed three pregnancies while seriously obese, I'd like to address these challenges and pass on experiences and information that has benefited me in my pregnancies.

Health
Although it may be hard to come to terms with, there are in fact genuine medical concerns with pregnancy in obese women. Statistics cannot, of course, be rigidly applied to all women. But the fact is that with obesity comes a myriad of potential health problems. Obesity is connected with incidence of disease like high blood pressure and diabetes at rates several times higher than those of normal weight.² Whether caused by obesity, or co-symptoms with obesity, any caregiver of an obese pregnant woman will have those concerns on their mind.

Like it or not, the average American diet and sedentary lifestyle are major contributors to the obesity epidemic in this country. Pregnancy is not a time for radical dieting and attempted weight loss. Your body and your baby need excellent nutrition.³ However, if eating habits have contributed to weight problems, there is no better time to switch to a healthier way of eating, as the well-being of both mother and child may hang in the balance.
Likewise, if a sedentary lifestyle has contributed to excess weight, pregnancy is not a good time to begin training for a marathon. However, it may be the perfect time begin daily walks and mild exercise. Many women find swimming to be a particularly useful and comfortable form of exercise in pregnancy.

For a woman who desires a natural birth, obesity in pregnancy may present some serious hurdles to that. If she develops high blood pressure or gestational diabetes, she may find herself "risked out" of more natural minded facilities like birth centers or the care of a homebirth midwife, and pushed into a hospital delivery. Pre-ecclampsia can follow high blood pressure and cause tremendous damage to both mother and baby. ⁴ While gestational diabetes is treatable, it can cause immediate problems (such as extremely large babies) and long term problems for both mother and baby.⁵ An obese mother should be aware that her weight and health may affect the type of prenatal care and delivery options that are available to her.

Bias and Discrimination
Although health concerns related to obesity are indeed valid, it is unfortunate that many women also experience bias on the basis of their weight. People are prone to making assumptions and painting with a broad brush, so that a woman whose obesity is a complex matter may be viewed as just another TV-watching, potato-chip munching, lazy person. This has been my experience throughout my childbearing years. Although it is true that a large part of my weight problem has to do with ingesting more calories than I burn, I am not actually a person with severely unhealthy habits. My diet is not standard American fare, and I eschew soft drinks and most heavily processed foods. I exercise daily, and have the physical activity level of a much thinner person. Still, I'm fat. Very, very fat. So, throughout three pregnancies, every single appointment, my caregivers (who I loved) would express surprise that my blood pressure was perfect. They knew me, they knew my diet and activity, they knew I never had high blood pressure, but that didn't compute with the generalization that fat women have blood pressure problems in pregnancy. The same thing happened with gestational diabetes testing. I never came up positive, to the extreme surprise of those who thought I needed the test. And although two of my three children were born very large, they did not have the blood-sugar issues that affect children born to untreated diabetic mothers.

My experience with bias was mild, however, compared to that of some women. Websites like My OB Said What?!? provide gems like this one: "If you get pregnant, you will get gestational diabetes, have high blood pressure, and oh, you will probably just die anyway." -Gynecologist to a young, obese woman who was not pregnant at the time of the gyn exam. The comments that follow reveal more experiences with this type of biased scare-mongering of obese women.

In spite of all this seeming gloom and doom about obesity, a healthy pregnancy and a healthy baby are perfectly possible. It may take some extra caution, and require careful nutrition, and may even involve standing up to bias and assumption, but an obese woman can survive and thrive during pregnancy and childbirth.

¹Obesity Rate Leveling Off, Nancy Hellmich,USA Today
²Side Effects of Obesity, eCureMe
³Creating a Pregnancy Diet, WebMD
⁴High Blood Pressure in Pregnancy, National Heart Lung and Blood Institute
⁵Gestational Diabetes Causes, Symptoms, Treatments and More, WebMD