Monday, June 30, 2008

Fat Acceptance and the Kid Movie Dilemma

Not only do I want to write about pregnancy and birth in women of size, I also want to start some dialogue about fat parenting and the dilemmas that can arise for parents of size. And one of the more delicate issues to navigate is what to do with negative media messages about obesity, especially in programs aimed at kids.

All my kids (from teenager to toddler) love animation and silly movies. So do we, their parents. So my kids are all jonesing to see the latest movies this summer, including Kung Fu Panda, Wall*E, and Get Smart. But all three have fat jokes in them. Should I let my kids see them or not? It's a difficult choice.

Both of us parents are fat, to one degree or another. Our kids are not fat, but you can see the genetics at work...there's a tendency towards "well-roundedness" there, and it may increase as they age, especially if my daughter ends up having my PCOS (a very significant weight gain in late teens/early 20s is a common symptom, one which I definitely experienced). I don't know yet if my kids will end up fat, but regardless of whether they do or not, I want them to be accepting and respectful of all people's bodies, including mine and including their own.

So over the years, I've tried to insulate them from the worst fatphobic messages out there. If there was a diet ad or a TV show with fat jokes, I changed the channel, hit the mute button, or turned it off. When the kids' teachers scheduled a play that had a fat joke in it, I took my concerns to the teacher; she was shocked that I had a problem with it (!) but she agreed to take it out. We only keep size-positive or size-neutral books around the house. We've talked about how people's bodies naturally come in a myriad of differences. So I think we've done a pretty decent job of trying to insulate or at least water down the fat hatred out there.

As my two eldest kids have gotten into their tween years, we've started talking more frankly about fat jokes and why I dislike them. My kids don't quite "get" it though. They see those jokes as mostly harmless and think I'm being "oversensitive" about it. Even my husband, who is not a small person, thinks I'm being too overprotective/uptight about it.

I don't. Hate language is hate language; biased messages are biased messages. I won't expose them to that kind of prejudice and pretend like it's okay.

But alas, real life is often more "gray" than not. That's when parenting gets tricky. Sometimes you go see movies that make you squirm a little but you try to discuss the things that you don't like with your kids. It's an opportunity for discussion and consciousness-raising. But there's also a line you some point the "opportunity" for discussion is exceeded by the sheer offensiveness or negative messages of the piece and it's not worth seeing. So where does that line fall in fat acceptance? Frankly, I find this line difficult to navigate.

We did recently see "Get Smart" with the two older kids. I was unaware of any fat jokes in the film so I didn't even think twice about going. Overall, it was a mixed bag. I *loathe* the skinny-actor-in-a-fat-suit gag. There was the "I lost 150 lbs" bit, making it seem like anyone and everyone can do this if they just try hard enough, when the real-life stats are a LOT different. I hate that.

But then there was the dance scene with the fat chick. It actually was more respectful of the actress than I would have thought, and in some ways it was more of a "You go, girl!" kind of scene....she really danced up a storm and it was kind of her showing up the snotty skinny girls on the side, so I was kinda won over by that. But at the same time, at the end he does a lift with her and struggles to hold her up and the laughter for that was not nearly so understanding and kind, you know? So I really had mixed feelings about "Get Smart."

So now we are looking at "Kung Fu Panda" and "Wall*E" and trying to decide what to do. The reviews on the fatosphere are that Kung Fu Panda isn't so bad and actually is kinda empowering, despite a few obligatory obnoxious fat jokes. So we might consider that one.

I'm really torn on "Wall*E" because it's hard to tell from others' previews just how bad it is or not. I'm leaning towards not taking the kids, my husband thinks I'm being oversensitive, and my kids are resenting me for censorship. They tell me that fat jokes don't bother them......and that bothers me the most. Fat jokes SHOULD bother them, they should bother ANYONE watching. The fact that they don't bother most people shows just how accepted the size bias is, and how far we have to go.

So now that I've enabled comments on my blog, I'm asking others (parents or not) to contribute their thoughts on this dilemma. How do you protect your children from fat jokes and size bias in the media, and how far do you go in trying to do that? Will you/would you take your kids to see the three movies above? Why or why not? Speak up and share your thoughts.

Thursday, June 26, 2008

Scapegoating fat women once again

Here we go again. A country's cesarean rate rises, and who do they blame? The fat women. Cause you know, anything that goes wrong has to be blamed on teh obeeeesity, right?

Or perhaps it's because if you do blame obesity, no one will question anything you say, because obesity is such an easy villain for every problem these days. Blame it on the fat chicks and everyone will cluck and shake their heads but not ask anything more. Blaming it on obesity is the slam-dunk of avoiding responsibility and further investigation.

Here's the background on the story. Canada's cesarean rate has risen to an all-time high of 26%, as written about here. That means that 1 in every 4 babies born in Canada are born surgically, which means higher healthcare costs and higher risks to cesarean moms in subsequent pregnancies.

To their credit, the Canadians are sounding the alarm about the steep rise in cesaran rates, and are pointing out the many dangers of cesareans done unnecessarily. This is in contrast to the United States, where the cesarean rate is even higher (31% at last count) and yet hardly a voice in the mainstream medical community is raised against it.

So the Canadians are getting some of this right, and bravo to them for raising a ruckus about it. So they should, and maybe they will lead the way for the United States to start re-examining its own skyrocketing cesarean rate, eh?

But while I applaud the Canadians for trying to curb the rise in cesareans, I decry their scapegoating methods. To wit, primarily blaming women for the rising cesarean rate, instead of the way that doctors manage birth these days.

If you believe the press release, it's as if the doctors are being held hostage, tied to the operating room table against their will, tragically forced into cutting by factors beyond their control. Puleeeeze!! Far from it.

It's so much easier if you can blame WOMEN for the high rate of cesareans (they're too fat, they're too old, they want elective cesareans, they'll sue us if we don't do a cesarean, blah blah blah) and thereby avoid all question of having to look at your own misguided management policies. Note how neatly the doctors shunt aside the blame in their press release, avoiding any suggestion that they might play a role in the rising cesarean rate. Conveniently, it's all due to factors outside of their control.

Doctors said several factors are driving the push for surgical births, from fear of pain during childbirth and the convenience factor to the growing proportion of expectant mothers who are obese.

Twenty-three per cent of women of childbearing age in Canada are obese, and the obesity rate has doubled among 25- to 34-year-old women - the group that gives birth to more than 60 per cent of babies born in Canada ever year - in the past 25 years....

Obese women tend to have bigger and chunkier babies, as well as longer labours, which increases the risk of a C-section.

The fact is that obese women are twice as likely to have their labors induced, and induction strongly increases the risk for cesarean. One study found a 19% cesarean rate in obese women in spontaneous labor, versus a 41% cesarean rate in obese women whose labors were induced. The typical management of obese women strongly increases the chances of cesarean.

Yes, as a group, bigger moms tend to have bigger babies. It's called GENETICS. But it's the high induction rates and the FEAR of big babies that is largely driving the high cesarean rate in obese women, not medical necessity. Most big babies can be born safely, and studies show that interventions done when a big baby is suspected often actually cause more harm than benefit. But unfortunately, that has not changed the way doctors manage women who they suspect might have a big baby, especially fat women.

It's the high rate of induction in obstetrics today that has the MOST to do with the rising rate of cesarean in ALL groups, not just the obese women. But by blaming it on the fat women, the older women, the women having multiples......and by pretending there is a huge influx of women demanding an elective cesarean.......they are able to deflect any questions about their own management practices and how THEY are a big part of the high cesarean rate.

Doctors are not innocent bystanders in the rising cesarean rate, forced into higher rates simply by changing demographics and riskier mother profiles. Older women and fat women have been having babies vaginally for years. It is only recently that the cesarean rates in these groups have become so high. It's how they manage these women that has changed, not their inherent ability to give birth normally.

Although most doctors mean well, they are simply not acknolwedging to the public....or to much of the rising cesarean rate is due to their OWN PRACTICES and their own fears and their own convenience factors.

Shame on them for blaming women instead of having the courage to critically examine their own practices. As I said in an interview about an article I wrote for Our Bodies, Ourselves:

It's time to stop scapegoating women for the high cesarean rate. Changing demographics may play a role, but providers need to acknowledge that the way they manage births has been a very significant factor in the tremendous rise in the cesarean rate. They need to take responsibility for their own contributions to the cesarean rate.

Monday, June 23, 2008

High Cholesterol Equals Cesareans in Fat Women?

Ah, medicine. Want to hear the latest excuse for the high c-section rate in fat women?

It's because we all have high cholesterol, dontcha know, and high cholesterol might impede the ability of the uterus to contract efficiently!! So therefore, let's give all fat women statin drugs in pregnancy and that'll lower the c-section rate!!

I swear, ya just can't make these things up.

This was based on a couple of studies recently that supposedly found that obese women's uteri "have poorer contractility." The researchers concluded that this may be why labor in obese women went slower and they had more cesareans. They hypothesized that high cholesterol levels might impede the contractility and that might be why the cesarean rate in women of size is higher.

Oh puleeeeeze. This is ridiculous and objectionable on SO many levels.

First of all, all fat women do NOT have high cholesterol at all. The fact that they assume we all do is symbolic of the usual assumptions researchers make about obesity and fat people, and how it impacts their ability to reach reasonable and sound conclusions. Some do, some don't. Especially during childbearing years, many fat women have perfectly normal cholesterol levels.

Second, did they do any studies to see if the fat women who delivered vaginally had better cholesterol levels than the ones who had cesareans? Did they study thin women with high cholesterol and see if they had more cesareans or slower labors? Nope. As always, it's all just based on ASSUMPTIONS about fat people and not on any real detailed study or logical questioning of their theories.

And of course, they are already pre-marketing this idea to the media aggressively without having yet proven their case or the safety of their proposed solution. Disgraceful.

Third, please note that the part of the study done on fat women's uteri, showing "poor contractility," was done on women having planned cesareans with no labor. How again does this prove how they might have labored in real life? They took samples of the uteri before labor even started, and then did some lab tests on them, testing "contractility" in the lab.

Sorry, this is hardly indicative of real-life labor and birth, and since they did pre-emptive cesareans on these women whose samples were tested, how can they prove that these in vitro "contractility" tests really have any relationship to how labor would have gone had these women been allowed to go into labor? There is just no way that this proves conclusively that there is something wrong with fat women's uteri.

Furthermore, they did not look for any other causes. Studies show that fat women tend to have longer menstrual cycles and longer pregnancies. IF the study indeed were able to reliably show poorer contractility in obese women's uteri (and IF they were able to then show that this were reliably predictive of how they might do in labor), it might simply show that their uteri were just not ripe and ready for labor yet, not an underlying defect in ability to contract.

Remember, planned cesareans like the ones in this study are usually done at 38 or 39 weeks, and if the obese group would normally tend to go into spontaneous labor closer to 42 or more weeks, doing such an early cesarean would not reliably show whether their uteri were "less contractile." Rather, it would suggest that these obese women were simply not even close to spontaneous labor yet and therefore less responsive to stimulants.

Finally and MOST importantly, the spate of news stories recently about this dubious study and follow-ups suggesting that perhaps putting fat pregnant women on statins might lower their cesarean rate were just plain irresponsible.

Statins are CONTRAINDICATED in pregnancy; they are category "X" and may cause birth defects. Cholesterol and lipids play a very important role in fetal development. There is a reason why a pregnant woman's cholesterol rises during pregnancy; the baby needs it for development. Artificially lowering these levels may have devastating effects on the baby.

Critics would respond that they are "only" suggesting putting fat women on statins in the last few weeks or so of pregnancy, so therefore there would be no risk of birth defects. But if these drugs can be so dangerous in early pregnancy, who knows what kind of harm they might cause late in pregnancy as well? There are other harms that can be caused to babies besides birth defects during organogenesis.

No one knows for sure what critical roles cholesterol and lipids play during late pregnancy. Pregnant women's cholesterol levels rise through pregnancy, suggesting that it has an important biological role even in the end of pregnancy. Putting women on statins at the end of pregnancy may be just as harmful as at the beginning of pregnancy, just perhaps with more subtle problems than birth defects.

What it boils down to is that they are proposing using fat women's babies as lab rats to experiment on. This is UNACCEPTABLE.

There is completely insufficient evidence to support that high cholesterol is the "cause" of the high cesarean rate in fat women, and the safety of statins in pregnancy at ANY stage is highly questionable. To suggest treatment with statins for anyone during any stage of pregnancy is completely speculative and based on BAD science.

Furthermore, to be running stories in the media even suggesting statin use in fat pregnant women at this point in the research is highly irresponsible. It smacks of a few researchers looking for a "hook" to gain name recognition and funding for research, rather than serious and responsible scientists pursuing a legitimate investigation.

You can read more about the story in much more detail at Sandy's Junkfood Science site here. She does an excellent job of dissecting the original studies and their conclusions, and of showing just how important cholesterol can be to fetal development.

It is time for researchers to stop jumping to conclusions about fat women and pregnancy, time for them to examine their own faulty assumptions about obesity and how this distorts their research, time for them to stop using fat women's babies as lab rats for their own personal theories, and time for researchers to stop prematurely "spinning" the media on preliminary research in order to get name recognition and research funding.

Shame on these researchers. SHAME. And shame on the media outlets that picked up and ran with this story without questioning it further.

Monday, June 16, 2008

Gina Marie's Story

Today we reprint excerpts from a birth story of a supersized woman who was horribly treated by her care providers during the birth of her son.

Although this is one of the more egregious stories of fat bias in pregnancy I have read over the years, size bias in pregnancy and birth is distressingly common, and many fat women hold deep emotional wounds from the treatment they endured during what should be a most blessed time in a woman's life.

"Gina Marie" sent me her birth story in order to help other fat women, stating:

I didn't have a good, normal birth story. In fact, my son's birth was absolutely horrible. However, there are some important things that I learned afterwards that I think large women need to know and need to be on the lookout for.
It is in this spirit that we reprint excerpts. You can read the full story on my website.

Gina Marie hired midwives because they seemed the most size-accepting. Even so, they induced her at 37 weeks because her baby looked "big" and because she was developing symptoms of pre-eclampsia (BP issues with complications). Her baby was not yet in an optimal position for birth so labor did not progress. With her IVs, she developed severe swelling, and eventually a decision was made to do a cesarean.

The back-up OB then came in and proceeded to pressure her into having her tubes tied so she would not have any more children. [This is unethical; sterilization decisions should not be made in the middle of labor and certainly not as the result of pressure from a health-care provider.]

When Gina Marie would not agree to having her tubes tied, the OB was furious:
When she came in to discuss my surgery, the OB sat down and asked me if I wanted my tubes tied while she was in there. I was shocked and told her no, that this was my first child, and I didn't want to make decisions like that at the moment. And she countered with a speech that boiled down to 'You are too fat to have any more children, you shouldn't even be having this one, and if I had anything to do with it, you wouldn't be.'

Then she discussed general anesthesia, and the dangers. Granted, fat people do sometimes have problems with general anesthesia. However, it was a little heavy-handed for her to instruct me to discuss funeral arrangements with my husband before I went into surgery. She asked me if I was an organ donor, and then said it didn't really matter. (I don't know what the hell this was supposed to mean. I guess she was implying that my organs were probably not acceptable or something.)

During the surgery, the OB used a "classical" incision, a huge disfiguring up-and-down incision, instead of the customary side-to-side incision done just above the pubic bone. [Many doctors have been taught that a vertical incision is better in obese women---less chance of wound infection and complications if the incision is not under the belly. However, recent research has shown that a vertical incision is actually TWELVE times more likely to have wound complications.] Afterwards, the OB informed her that this classical incision meant that she should not have any more children.

The hateful OB informed me that the kind of incision that they made in my uterus will make it incredibly dangerous for me to attempt another pregnancy...a subsequent pregnancy could cause the uterus to rupture and I would die horribly from a hemorrhage.
The OB found another way to prevent further children, even without a tubal ligation.

During the surgery, Gina Marie had significant blood loss. This caused severe anemia, which no one thought to test for until days later. She didn't see her son at all for 24 hours, and not often even after that. Breastfeeding failed because of supply issues due to the anemia, undiagnosed thyroid problems, and lack of breastfeeding opportunities with her son. Not only did she lose the opportunity for a respectful birth with her son, she also lost the emotional healing that many women with bad birth experiences find in breastfeeding.

Gina Marie continued to struggle with recovery after the cesarean, experiencing infection, severe edema, seromas, and eventually an abscess. The harassment and hate talk about her size continued while she was trying to recover in peace. She writes:

While I was in the hospital...every doctor in the whole evil practice came by my room to bitch at me for being fat and to talk about diets. Some were less aggressive and insulting about it than others, but they all felt it was completely important to tell me that I am too fat. "Have you ever considered dieting?" was how they all started out. Like any fat person in America could possibly get to be 30 years old without dieting at some point. Like I haven't been informed by family, friends, strangers, and doctors that I am fat fat fat fat fat and I need to diet for my entire life. As is this was a completely new discovery.

I felt particularly betrayed when the lead midwife came in and gave me the speech. When I first became pregnant, I told her that I was worried about my eating habits and I wanted to take care of myself and give my baby good nutrition. I kept a food diary for two weeks and showed it to her on my next visit. It was a faithful diary. She praised me for the variety and content, told me that I was doing a good job of eating healthy low-fat foods. She suggested that I eat more protein, but otherwise did not criticize my eating habits. So it was a shock and a betrayal when she came in and told me that the best plan for my life was a really strict diet.

The bitchy cruel OB got in on the act, which is hardly a surprise, and laid it on with a trowel. Not only did I need to diet, but if I did not do so, I would be dead before ten years, because women my size don't live past 40. My child would never love me because he would be so ashamed to have a fat mama. Fat women are bad mothers who can't keep up with their children, and their children suffer for it. By obstinately continuing to be fat, I would show myself to be an unfit mother.

Gina Marie was greatly traumatized by her whole experience. She concluded her story with a few final words of warning to women of size:
  • If you use a midwife because she is size-accepting, check out the back-up OBs as well, so you won't get a nasty surprise like I did
  • Ask about the [c-section] procedures, even if you plan on a natural birth. I found out later that doctors can and do perform "bikini cut" incisions on women with belly aprons
  • Thyroid disease is commonly underdiagnosed in women, and it can interfere with breastmilk production. It can also interfere with fertility, cause miscarriages and some birth defects (thank God this didn't happen to me)
  • An easy pregnancy can lull you into a false sense of security, and leave you unprepared for a bad birth

I would add a last proviso about the importance of finding TRULY size-friendly care. Just because a care provider seems size-friendly on the surface doesn't mean they actually are. Many have protocols (well-intentioned or not) that result in poorer outcomes in women of size.

Women of size must take time to really educate themselves about pregnancy and childbirth issues and ask lots of questions of their providers. Many are lulled into that false sense of security during pregnancy that Gina Marie mentions, only to be shell-shocked when their providers change their tune at the end of pregnancy and pressure fat women into intervention after intervention. Fat women CAN birth vaginally and gently, but in this climate, they have to be well-educated about birth and fierce advocates for themselves and their babies first.

Sunday, June 15, 2008

Pressure for Abortion for Obese Women

Another outrageous form of discrimination that some fat women are subject to is pressure to abort their baby.

They are told that pregnancy at their size is soooo dangerous they need to abort now to save their own lives, or the doctor strongly implies it is too dangerous to continue the pregnancy. Or they are told that the baby is sure to have birth defects and so it's better to just end the pregnancy now, or that being pregnant while fat would likely kill the baby anyhow so they might as well take care of it now.

Of course, fat women have been successfully having babies for YEARS. But you'd never know it by reading the typical scare tactics on the internet, or the scare tactics that some doctors use against their fat patients.

Here are excerpts from emails or stories I have read over the years, slightly edited for grammar, spelling, or identifying information:

  • "I also was told I could not have kids. Then when I got pregnant I was told by various doctors for various reasons that I should abort."
  • "[The doctor] even suggested that we consider having an abortion because the likelihood was great that this was going to happen....We had 2 weeks to decide about the abortion because legally you have up to 24 weeks to abort the baby."
  • "[The doctor said:] 'No fat woman can ever have a healthy pregnancy. Besides, if you did get pregnant, I'd order you to have an abortion. But that's a moot point anyway, because you're too fat to get pregnant.' "
Sometimes the pressure to abort comes from families instead of medical professionals. Many families have their own psychological weight issues (ironically, sometimes the most fat-phobic treatment comes from people who are fat themselves) and so subject their family members to horrific tactics and bullying when they want to have children.

  • "I am severely overweight and was terrified about possibly needing to abort. My family has been worried also, so they are not excited about this pregnancy. I have been sobbing for days, worrying about possibly ending this pregnancy. I have yet to see the doctor. I just made an appointment today, and I promised my family if he leaned towards terminating the pregnancy because of my weight, I would do it."

And these are only the stories women have written to me about. How often does this happen and go unreported?

I do not believe that most fat women experience pressure to abort......but it is horribly appalling and TOTALLY INEXCUSABLE that some do.

Monday, June 9, 2008

The Business of Scare Tactics

Sandy at Junkfood Science posted an interesting entry recently about how doctors and the media target fat women of childbearing age for scare tactics. She deconstructs several of the most recent studies to see what they really found.

Several years ago I wrote an article about plus-size pregnancy for Without Measure, an e-zine for the International Size Acceptance Organization. Here is an excerpt:

The Business of Scare Tactics

Many websites with information about pregnancy at larger sizes are actually supported by weight loss surgeons or diet companies, hardly objective parties. They recognize that many of their clients are women of childbearing age who have been told that they "must" lose weight before they have children. They know this a market ripe for the picking and that their best sales tactic is fear.

So these websites publish distorted risk summaries, highlight only the studies that show the worst outcomes, imply that complications are inevitable for most fat women, and tell worst-case scenario stories as if they were everyday events. Some authors even suggest that obesity during pregnancy is akin to child abuse.

It is a misperception that fat women must lose weight in order to have a baby. In reality, many women of size have healthy pregnancies and healthy babies without losing weight first. This is the underground truth that the Profiteers in the War On Fat don't want you to hear.

Sunday, June 8, 2008

Fat Pregnancy Equals Death?

Over the years, I have gotten many emails from women about fat-phobic care from doctors during pregnancy, or read similar stories on birth and parenting forums. This is the first of a continuing series about examples of fat-phobic care during pregnancy and birth.

Of course, one of the biggest things doctors can do is scare women of size out of having a pregnancy in the first place.

One of the best ways to do that is to tell them that they will die if they dare to have a pregnancy at their size, to imply that "obesity" in pregnancy is practically a death sentence.

I remember the first story like this I heard. I did not save the email, alas (this was early in my internet days), but this mother basically was told that if she went into labor, she would have a heart attack and "die on the table." I remember that phrase specifically, all these years later....because, you know, obese people are all walking time bombs and will keel over from a heart attack at any kind of stress, so of course labor would kill us.

Funny how I went through labor FOUR times and am still here to talk about it, then.

Anyhow, here are some excerpts from stories I have read, slightly edited for grammar/spelling or to take out identifying details:

  • "I went to see a doctor today...He basically made me feel my baby is a death sentence...In his "honest opinion" I am going to die during labor/delivery or recovery."

  • "I used to go to a really Fat phobic doctor; he was so awful he told me that I couldn't even consider the idea of having another baby or I would die for sure (due to my weight)."
  • "[My doctor] was appalled when she heard I was not on any form of BCP [birth control pills] and said that "at your age and with your size" that either the baby or I would die."
  • "According to him I'm probably going to die of a heart attack sometime during my pregnancy or shortly after."

  • "That's when she hits me a barrage of insults, the selfish speech, and that I will be dead in 15 years therefore I am not even responsible enough to have kids because I won't be there for them or my husband. The baby could be at risk because (a list was rattled off)...[and] I could die trying to have a baby."
  • "After scolding me for even allowing myself to get pregnant at my weight, he told me that even if I could carry the pregnancy, he had doubts about my ability to deliver or survive a c-section!"

To me, this is one of the most monstrous kinds of fat bias. I wonder how many fat women have been scared out of having a baby at all because of treatment like this. I know that many fat women have been scared into Weight Loss Surgery with arguments like these, and that many others simply decided long ago not to even consider having children.

I also think that this has to do with doctors trying to become the gatekeepers of who they think should procreate and who should not. If they don't think you "deserve" to have a baby or if they don't want to see your fat genes passed along to future generations, they subtly or overtly discourage you from children.

Barring that, they pressure you constantly to have your tubes tied during that cesarean you are "destined" to have, or try to make your birth experience so awful that you decide not to have more children. [Oh no, that's not just hyperbole; I have stories like that in my collection.]

Most of the time, fat-phobic behavior from doctors and other healthcare providers is more subtle. Most fat women don't hear the "you're going to die if you try to have a baby" speech. But it's important to document that this kind of egregious treatment DOES exist and to roundly condemn it.

Monday, June 2, 2008

Cesarean Rates in Women of Size

One subtle form of discrimination against fat women in pregnancy is the high cesarean rate.

When a c-section is needed and life-saving, it's a very wonderful option to have......and no woman who gives birth via cesarean should be made to feel "bad" or "guilty" or "less of a mother about it......but when cesareans are done routinely or unnecessarily, it adds a lot of risks to both mother and baby.

Nationwide, our cesarean rate in the U. S. has risen from about 5% in the early 1970s to about 30% in 2007. And that's for women of all sizes.

Some recent studies have found that the c-section rate in "morbidly obese" first-time moms is nearly 50%. That's about 1 of every 2 big moms, undergoing major surgery with all its attendant risks.....and that's just in the first-time moms.

The repeat cesarean rate is even higher in this group. Although studies vary on exact numbers, some studies show that between half and three-fourths of "morbidly obese" women have their babies today by cesarean. This is totally unconscionable!

The stories I hear suggest that many doctors consider being fat incompatible with vaginal birth, despite the fact that in the past, most fat women had their babies vaginally. More and more, doctors are just scheduling non-labor cesareans for women of size.....even though cesareans are more risky in women of size.

Or they induce labor early "to get a smaller baby".....which actually strongly increases the risk for cesarean, while also making a harder, more painful labor for the mom. Unfortunately, few women of size know to question these decisions.

I recently published a major article about the cesarean rate in women of size on the Our Bodies Ourselves website, discussing ways to lower this rate. It's a very evidence-based article and was reviewed by a number of doctors and midwives, but it is written in language understandable by the average reader.

I also gave an interview about why I wrote the article to the Our Bodies Ourselves blog. Appropriately, they titled it, "Fat Women Can Give Birth Vaginally." It gives further perspective on the issue and why more dialogue is needed on the topic.

I hope readers will check out the articles, blog about them, and put a link to them on your blogs. This would really be helpful in raising the profile of the article so we can get this information out there to women who need it.

This is such an important topic, and one that is so ignored on both activism the birth field, fat women are blamed for their high cesarean rates and told to lose weight (by weight-loss surgery before pregnancy if necessary!).....and in the fat-acceptance field, there is little awareness of birth-related issues for women of size and therefore few fat pregnant women think to question their inductions and cesareans.

The issue of unnecessary cesareans is not just a one-time issue. Their health implications may go well beyond a woman's first c-section pregnancy. Research shows that each successive cesarean puts the woman and any future babies at risk for more complications, sometimes life-threatening ones (Silver, Obstetrics and Gynecology, 2006). The placenta in subsequent pregnancies can implant dangerously low, risking severe bleeding and death, or it can even grow into or through the uterus itself, putting the woman at risk for hysterectomy and even death. Some studies report a higher rate of stillbirth in pregnancies after a cesarean. Furthermore, internal scar tissue from the surgeries may cause long-term pain and bowel problems later in life.

And recently, health insurance companies have even begun to deny coverage to women who have had cesareans! If 1 in 3 childbearing-aged women have had cesareans in the country, that's a lot of women potentially being impacted. For fat women, the impact would be even more disproportionate, giving insurance companies yet another reason to deny healthcare coverage to women of size.

In a society that increasingly sees cesareans as "minor" and "just another way to have a baby," it's important to realize that a high rate of cesareans has potentially major implications, sometimes in ways that it is difficult to foresee. We cannot be complacent about it, not in women of average size, and especially not in fat women, who, with such a high cesarean rate, are being placed at disproportionate risk for problems.

Wherein the Fat-Acceptance and Birth Worlds Collide

The purpose of this blog is to create an intersection of the fat-acceptance and birth worlds, two realms that rarely seem to overlap in the blogging and advocacy worlds.

Much of this blog will be devoted to topics on fat-acceptance, Health At Every Size (HAES), size bias/discrimination, and related stuff. There will also be lots of posts about birth-related issues, breastfeeding, and parenting. In particular, there will be lots of posts about the intersection of these two issues, like what is truly size-friendly care in pregnancy, strategies for lowering the risks for complications, the importance of lowering the cesarean rate in women of size, PCOS and breastfeeding issues, parenting children of size, etc.

Of course, sometimes there may also be some stuff totally unrelated to any of these topics, like my favorite media shows or cute kid pix or whatever. It's my blog; I can talk about whatever I want! Whoohoo!

Fair warning to the fat-acceptance folks...there may be naked birthin' pictures and videos here sometimes. Girly bits may get displayed at times.....but always in the context of birthin', and always in a tasteful and respectful way, of course!

[And won't it be refreshing to finally see some fat chicks pregnant and birthing? The pregnancy books and videos never show women of size. News flash, folks.......fat people DO have sex and we do get pregnant....and dammit, we look GLORIOUS doing it! It's time for fat pregnant women to stop being invisible and start claiming our space! Fat people have babies too, and we're not going to hide it anymore!!]

And fair warning to the earthy-birthy folks....there will be lots of frank fat talk here. If you find that challenging, it's good that you are here. Perhaps this is an opportunity to examine your own preconceptions about fat people, about our habits or our needs, about our ability to birth or to parent, and how best you can serve our needs. This will be a good place to do that.

It's TIME for the birth and the fat-acceptance worlds to start interacting more. These two groups rarely dialogue with each other, and there is often surprisingly strong resistance from each towards talking with the other. [That's a topic for whole 'nuther post!!] It's time to open the dialogue up.

Come on, folks, fat people have babies too. Even if you never plan to have a baby (or are done having babies or are post-menopausal), your "fat" niece or your "chubby" cousin or your "zaftig" daughter or your "obese" friend might. Or even if you aren't fat, you may know someone who is fat and having a baby, or be called upon as a birth professional to serve one of these women.

Fat women often face unbelievable discrimination and disrespectful treatment in the birth world. Fat activism and birth activism should not be just about whether this issue affects you personally; you should care because it affects someone and no one deserves that kind of treatment. Believe me, the stories I've heard are pretty awful sometimes. This issue MATTERS.

That kind of discrimination won't change until we have more honest dialogue about the issues, and it won't change unless fat women and their childbirth professionals know what size-friendly treatment really is like and start demanding it, both in and out of the birth world.

Fat people are real human beings. We have the same hopes and fears and dreams for our babies and our children as anyone else.

Treating us with respect also means honoring our desires to become mothers just like anyone else. It means working towards the most empowering and life-affirming birth possible. It means realizing that the ability to love and nurture---not size---is the most important qualification for parenthood. And it means respecting that the miraculous magic of making a baby---and birthing that baby---can happen in a lush and well-rounded body too.

Let the blogging begin!!