Monday, September 29, 2008

Suicide by Pregnancy?

I recently received yet another story of tremendous size bigotry from an OB, who basically tried to scare this poor woman to death about being pregnant at her size, and who more or less told her she had committed suicide by daring to be pregnant at her size.

I can't tell you how much stories like these infuriate me; NO ONE should have to put up with this kind of bullsh*t treatment. People in the healthcare professions should be ASHAMED that this kind of medical bullying occurs. Yet sadly, it is all too common with women of size, especially in obstetrics.

I have permission to quote her email; I have edited it slightly.

I am 31 years old and I weigh 400 pounds. The last time I was pregnant, which sadly ended in miscarriage, I weighed 350 pounds...I've overcome as best as I can and I want to try for a baby again.

My current OBGYN says he can get me and my baby safely through pregnancy, and that he has lots of history with obese women and pregnancy. I want to believe him, but I worry because of what another doctor told me.... and because of what I've been brainwashed for years to believe.

Anyway, when I was pregnant, I went to a doctor who CONDEMNED me the moment I walked into the office. He told me that I wasn't going to make it alive through my pregnancy and that they would "have to take drastic measures to try save me before they would even attempt to save my baby" etc.

He kept saying I shouldn't have gotten pregnant, that I had in a sense, committed suicide! He told me that my heart was going to give out, or that I was going to stroke out while attempting to push my LARGE baby out, therefore I was going to have a c-section. He told me that I was going to have massive blood clots in my legs and severe pre-eclampsia.

I left his office completely panicked and in tears. I was shaking so bad I could hardly walk and all he did was look at me and said in a cold voice with no emotion at all, "It's really scary, isn't it."

I regretted all the years of trying and numerous fertility treatments (I have PCOS) to get pregnant. It was 4 days later that I lost my very much-loved baby. I believe it was a good part due to the stress and fear that he caused me.


I'm sorry; this kind of treatment is INEXCUSABLE.

Yes, statistically there are more risks in pregnancy with obesity, and yes, these risks probably do go up somewhat as BMI increases, but at NO point do they reach 100% or even remotely close. Being at increased risk for a problem does not mean you will inevitably experience it, and in the meantime there are proactive things you can do to lessen your risks for problems. Even if you do experience a problem, most of the time there are treatments that will help. Most of the time things are fine.

Let me say it once again. MOST women of size have healthy babies just fine.

"Even" in the 400 lb. size range, I know of a NUMBER of women who have had healthy pregnancies and babies. Most in that size range are not "allowed" to labor (or the doctors induce their labor early and then they end up with a cesarean) so the cesarean rate in this group is very high....but I DO know women of that size range who have had vaginal births too. None that I have known have died or even come close. None have stroked out during labor or birth; none have had heart attacks or any of the other dire things this doctor said would surely come to pass.


The largest-sized woman I have come upon so far in case reports in the medical literature was around 500 lbs. She did NOT experience gestational diabetes, she did NOT experience blood pressure issues, she did NOT have blood clots, or any of the other terrors this doctor would have said she obviously would get. The only complication she had was asthma, and she and baby were just fine. As is so common with obstetrics, they did pressure her to have a cesarean, and surgery on a person of that size is more difficult and challenging.....but it went just fine. There were no complications at all.

Although certainly there is more risk for complications, it is NOT a bygone conclusion that bad things will happen, even in women of very large sizes.

Medical bullying is a blight upon the profession. That's not to say that doctors and midwives cannot share that obese women are at increased risk for some complications; they would not be doing their jobs adequately if they didn't share these possible concerns. However, HOW you discuss these things makes all the difference in the world.

You can present possible risks without implying that they no doubt will happen; it's important to present the risks in proper perspective. The truth is that they do NOT happen to the majority of women of size, and the worst-case scenario very rarely happens. You can also present them in a neutral way, without the judgment and harshness and condemnation so often used on women of size.

Furthermore, you can present ways to be proactive that can help lessen the risks for complications. Excellent nutrition (not dieting) and regular exercise go a long way towards lessening the risks, and for women at particular risk, there are other options too, such as using metformin prophylactically or considering low-dose aspirin (with medical supervision). These are all things that can be discussed calmly and reasonably, without having to resort to hyperbole and scare tactics.

The kind of over-the-top BULLYING shown above is a total exaggeration of the risks, and basically amounts to trying to scare women of size out of having babies rather than giving her reasonable counseling about possible risks. It is a unique and insidious form of bullying and eugenics and IT MUST STOP.

13 comments:

Kate217 said...

What the hell ever happened to "first do no harm?" That doctor should have his license revoked.

Scattered Marbles said...

That is heartbreaking, that poor woman, Gah it makes me wanna damage that Dr.

Lindsay said...

I would strongly advise that letter writer to make a call or three to the AMA (American Medical Association) if they're in the States (i'm not sure who they'd contact in other countries) to report that hideous doctor. The AMA are the folks who give doctors their accreditation, and IIRC, enough complaints about a given doctor will generally warrant an investigation.

Doctors like that need to be reminded that they're they're to HELP people - not inflict more damage. Grr.

Elizabeth said...

I'm glad you use the word eugenics, because I think it is that. I doubt many doctors would cop to it overtly, but if you put it to them more like: "well, isn't it better NOT to have more fat children growing into fat adults?" they'd be right on board. And the policies of many OBGYNs and Reproductive Endocrinologists do act as a form of eugenics, whether or not they intend them to.

Melissa said...

When I got pregnant I was around 200 pounds, so I didn't have any initial bullying about weight. I actually had no idea that it mattered (which it really doesn't).
During my pregnancy though I found out that when you're heavier and you gain lots of weight, that generally doctors don't think that is good.
I kept getting comments from my doctor like, If you weren't pregnant I'd be putting you on a diet with how much you weigh you know. Comments like that had me totally depressed throughout my pregnancy, and there wasn't anything I could do about the weight gain to be honest. It got so I was terrified to step on the scale during my weekly visits at the end because I knew I was going to leave so depressed and he was going to be judging the weight gain. In the end I weighed *gasp* 246 pounds roughly and mentally they had me thinking I was doomed because he kept telling me that as a bigger woman I should have only gained 15 or 20 pounds, and that it would be hard for me to rid the pregnancy weight.
Well I am back to prepregnancy weight esentially, but I went through a year of total depression post partum because of the weight thing.
It was hard and it's why when I go to the doctors I refuse to get on a scale so they can sum me up because of a number.

Sorry so long just had to share my experience.

Rosa said...

Thank you for the safe pregnancy stories. I had pre-eclampsia, was on bed rest for 5 weeks, and had a 34 week c-section. I'm fine, my son is fine, I didn't get any guff from my midwife or doctors.

But since I've had him, I've had a number of people tell me I got pre-eclampsia because I am fat. I was 180# when I got pregnant. A week after giving birth, I weighed 170#. I'm up over 200 now.

Hearing about women in the 200, 300, 400 and 500 pound ranges who didn't get pre-eclampsia makes me feel so much better, you can't believe it.

Well-Rounded Mama said...

Rosa, I'm sorry these unkind people were trying to guilt you, and I'm sorry you went through such an anxiety-producing time. I'm glad you and your child are okay. PE can be a very difficult thing.

I weigh quite a bit more than you and am an older mom to boot, both of which put me at significant risk for pre-eclampsia on paper....and yet I never had a problem with pre-eclampsia in four pregnancies. None.

No one knows quite what causes pre-eclampsia; that's what makes it so difficult. The larger you are the higher the percentage of pre-eclampsia, generally, but it's a correlation, not a causation thing, because even at very large sizes, many fat women do NOT get pre-eclampsia.

It may have more to do with underlying insulin resistance issues, or in some cases, other problems like blood clotting disorders, kidney issues, etc. It's a very complex disease.

If you decide to have more children at some point, you can discuss things with your doctor you can do to try and prevent a recurrence of the pre-eclampsia. Many first-time moms who get PE do not have it recur, although the fact that it started fairly early in your pregnancy means it could well come back and you should look at whatever you can do to try and prevent it.

One thing that has seen some success in research in preventing a recurrence of PE is a daily low-dose aspirin (must be done with medical supervision). Although it's not been studied adequately in research, some women have found success with acupuncture as well. And there are other things you and your doctor can discuss trying.

Between pregnancies, you might want to be tested for blood clotting disorders, just as a precaution. Some research has found that these may predispose towards problems such as PE etc. Might be good to rule those in or out as well.

But in the meantime, jettison the guilt over your PE. No one knows why it happens to some women and not others. Docs have been researching it forever, trying to figure out why it happens, and they still don't know. Plus-sized women are at increased risk for it, but most (like me) do NOT get it, even at much larger sizes than you. So just let that worry go and concentrate on what you CAN do to help prevent a recurrence.

Blessings on you and your family!

Melissa said...

Rosa

I have to add to the pre-clampsia info.
At the end of my pregnancy I had high blood pressure and was border lining pre-clampsia.
However I have to say that this had nothing to do with my weight, it was genetics to be honest.
My mother was 110 pounds when she was pregnant with me and 139 at the end and she ended up in the hospital for a month with pre clampsia.
So women of all sizes can get it!

Rosa said...

Thank you again for your kind comments.

And you know what? Thinking about it, I realize that my mom was about 250# when she had me, and she had a perfectly lovely pregnancy.

Nobody gave me any guff when I actually was pregnant (partly because I was constantly nauseated, which I think made me look pretty hostile, and partly because at the end I was so ill people worried I was going to die). I need to be less accomodating of random jerks who are judgemental of my birth experience.

I read some of the birth stories at your web site, thank you for collecting them, they are wonderful - I was able to point a friend who is interested in water birth there.

eulogos said...

I just wanted to say that there was a woman who lived next door to me when I was growing up who was extremely heavy; I would imagine that she was over 400 pounds. She was not aware she was pregnant and had a baby at home alone. She had laid down because she thought she was having gas pains, and gave birth to a healthy baby who was around seven pounds. They took her and the baby to the hospital (for some reason) but they never had any problems and came home three days later.

I think women would probably want to know they are pregnant and have someone with them when they give birth, so I am not at all saying this was ideal. But it is an example of a very large woman growing a perfectly healthy baby and giving birth without difficulty. Reading these stories, I can just imagine what she would be told if she were pregnant now and went to the doctor!

Susan Peterson

Marion said...

I am now 400 pounds, had both my babies while overweight. I did have complications, but they are the same complications that happened to skinny mamas. And get this...both my children are very healthy and thin. I thought "Fat mama's have fat kids". I'm so sick and hurt by the media's implication that all fat people are pigs who eat themselves sick! I eat way healthier then most anyone I know, and I do strenuous cardio exercise 3 hours 3-4 times a week! And yet I'm still treated like a disease when I go out into public. The nurse during my last pregnancy told me that if I dared to get pregnant again, my baby would be born too early to survive, and we would both probably die. It must be great to be able to tell the future! Fat bashing...the last frontier for haters!

Anonymous said...

I have to tell you i needed to find this site more then i knew. Today at the obgyn pretty much that i was a hopeless case and that in no way would any doctor want to take care of me if i got pregnate. As i sat there with my husband it took everything in me to hold back the tears. I have had a very hard life and have over come more then I even thought I could, I am a 30 year old who weights 400ibs. I do have high blood prussure but everything comes out that i am healthy. I really never even get sick. my whole life have missed 3 days of work. i am on my feet almost 50 hours a week and have never let my weight get in the way. and for this doc to brush me off like there was nothing they could do for me she even brought up lapband without me even asking about it. so right now i have a broken heart and given up hope that i will have my little hanna that i have dreamed of since i was a little girl. but i am now a little more encouraged to know that there are people who have had babies even at my size,

Sara said...

I weighed 300 pounds (I'm 5'6) when I got pregnant with my first - I had NO complications WHATSOEVER. My doctor never bullied me...the ONLY comment he made about my weight is that since I came in almost half way through my pregnancy, and he didn't know for SURE if I was bigger or smaller (i gained NO weight in the first 5 months) and couldn't tell if I was all baby. (I was...I was HUGE) The only complication I had was an unnoticed UTI that I had during pregnancy, that became a worse infection which was treated in the hospital after I had my son. I had to be in the hospital for 7 days (booo.) (I did have a big baby though 11 1/2 pounds - but big babies run in our family. Most of our family members were 8 pounds plus...my DH was 9, I was 10...he has an aunt that was 13 pounds) I am now 350 pounds and am pregnant with my second child. I am worried about gaining weight and getting up to 400 pounds, but I'm just trying to eat healthy. In my last pregnancy, I did nothign but eat junk (ice cream and cheese its to be exact) the last two months because that's all I could stand..I ended up gaining 25 pounds. (WHOA) I didn't have diabetes...pre-ecclampsia or anything at all. My 120 pound friend had high blood pressure and pre ecclampsia pretty badly. I understand that weight CAN affect pregnancies and those 'bad things' but there are those of us that are just fine. :D If a doctor EVER bullies me, I'll tell them to stick it where the sun doesn't shine.