Tuesday, August 10, 2010

Is Weighing Necessary During Pregnancy?

A while ago, we discussed whether routine weighing at medical appointments is really necessary. 

I reminded people that if weighing bothers them, is triggering to them, or is just against their principles, then routine weighing can be opted out of because you have the right to informed refusal of any test or procedure.  I also reminded people of the times when weighing can be medically necessary versus when it's simply a matter of routine policy, and that the two should be differentiated.

But what about weighing during pregnancy?  Is it really necessary to weigh a pregnant woman at each visit?

Unfortunately, this question is not as simple to answer.  You can make a case both for and against routine weighing at every prenatal appointment.

For the most part, though, the question is moot, because most care providers require weighing at each appointment. You can question its necessity all you want, but most providers are going to require it.

If you are a woman of size who wants to bear children but prefers not to be weighed, the sad truth is that you are either going to have to:
  • find a way to make peace with the weighing requirement, or
  • be prepared to go outside traditional attendants to find those who are more flexible about routine weighings
Weighing = Standard of Care?

Among OBs in the USA, prenatal weighing at every appointment is considered standard-of-care.  If an OB were to not weigh a woman regularly and she later had a problem and sued, that OB could have his/her feet held to the fire in court for not weighing her. 

So, beneficial or not, for most care providers, the "standard of care" argument trumps all the other arguments against routine weighings.  It is simply what is expected medically and legally.

However, it's not "standard of care" in all countries to weigh.  Some doctors in other countries do not weigh pregnant patients at all, even fat ones. Others do not weigh average-sized patients, but will weigh patients regularly who weigh outside the "norm" --- that is, very thin or very fat patients. 

Midwives vary more in whether or not they weigh clients.  Many midwives (especially the ones in hospitals who practice with OB colleagues) do weigh women regularly, but not all do.  I have heard from several hospital midwives in other countries who do not regularly weigh their clients, and I have heard from others that do.  Much depends on the standard of care in that area, and whether or not the midwife practices within the medical model or not. 

Many homebirth midwives here in the USA and abroad do weigh patients routinely, but will let you opt out of it if you prefer.  I found a midwife like this for my fourth pregnancy. (Bless her heart forever). 

But basically, in the U.S., unless you are interested in the homebirth route and have a very flexible midwife, you are almost surely going to be weighed at each prenatal appointment. 

So what are the pros and cons of weighing pregnant women?  Why do it or not do it?

Arguments For and Against Weighing During Pregnancy

There are a variety of reasons providers give for weighing during pregnancy.  Some of them are very legitimate concerns, and some are more dubious.

Monitoring Pregnancy Weight Gain

The reason most commonly given for weighing routinely in pregnancy (and the reason I find least compelling) is to be sure patients don't gain outside the weight gain recommendations.

The main problem with this is that what is considered the "proper" weight gain in pregnancy changes over time. In the 50s, 60s, and 70s, women were told to strictly limit weight gain, to the point that many babies were being born underweight or premature. So then the weight gain guidelines changed, encouraging more weight gain to try and lessen these complications (which they did).

Recently, the more generous weight gain guidelines have been challenged, with many researchers contending that women gain too much weight now, putting themselves at increased risk for a "too-big" baby, a higher rate of cesareans, or retaining too much of the weight after the pregnancy is over. 

Both of these arguments have data to back them up. There is some research that suggests that really large gains are harmful in pregnancy, resulting in extra-big babies and more long-term obesity in the mother.  And there is definitely research that shows that a too-small gain is associated with prematurity and/or too-small babies, even in "obese" women. 

So obviously, a happy medium is the ideal.  But what is considered the "optimal weight gain" is still under debate.  Currently, the latest recommendations from the Institute of Medicine (IOM) are: 25-35 lbs. for "normal" weight women, 28-40 lbs. for "underweight" women, 15-25 lbs. for "overweight" women, and 11-20 lbs. for "obese" women. 

So while what is considered the "correct" weight gain is trendy and changes over time, you could certainly make a case that preventing the extremes of weight gain (too low or too high) might prevent complications, or catch them early enough to intercede. 

On the other hand, weight gain doesn't give much reliable information about a woman's actual nutrition or general health.  Some women have a gain within "normal" limits, yet do so eating mostly junk food.  Some women gain "too much," yet have perfectly good nutrition.  Weight gain as a proxy for a woman's nutritional intake and health is a shaky concept at best.

Furthermore, weight gain doesn't correlate all that well with outcome either.  Some women gain a large amount in pregnancy, yet have perfectly healthy babies and great outcomes.  Some gain less than optimally, yet the outcomes are still good.  Some women gain within the guidelines and have poor outcomes. Pinning too much importance on weight gain amounts is not a reliable indicator of outcome.

Personally, I think far too much importance is placed on the numbers on the scale instead of on the actual nutrition and habits of the woman.  The medical community relies on weight gain as a marker for appropriate nutrition and predictor of outcome, and I think these associations are weak at best. 

However, given the very short appointments most OBs have with patients and the difficulty this can lead to in knowing how a woman is eating, I can understand them wanting some way to monitor the pregnancy's progress.  Not all women are truthful about their nutrition to their providers, and a too-high gain or a too-small gain could be an early warning of someone who is having difficulties managing their food intake.  It could be a marker for the need to intercede early, so I can understand a provider's wish to weigh patients on that level.

Still, isn't the better option the midwifery model of care, which takes more time in each appointment so the care provider knows the client better and understands her particular needs and concerns? 

The midwifery model is the one that takes the time to really emphasize proactive care (including good nutrition) in preventing many complications. It takes time to thoroughly go over general nutritional principles in pregnancy, and it tailors nutritional advice to each woman's individual needs.

While some midwives do weigh their clients routinely to watch for any alarming trends, most de-emphasize the scale in favor of emphasizing the importance of excellent, proactive nutrition and exercise.  To me, emphasizing nutrition seems far more important to me than how much weight a woman actually gains (or not) in pregnancy. 

Most of the time, routine weighings to monitor weight gain as a surrogate for monitoring nutrition or predicting outcome is a weak argument at best, and  besides, judgments of the what is the "proper" amount of weight gain tend to change over time. 

In my opinion, a better approach is to emphasize excellent nutrition and regular exercise and trust the woman's body to gain the amount it needs.

Monitoring Fetal Growth

Another reason many  providers like to weigh women regularly in pregnancy is to monitor fetal growth closely.  As noted, research shows a too-large gain may predict a big baby, and a too-small gain may predict a premature or underweight baby, both of which are associated with risks.

Really large gains can be associated with macrosomia (big baby), and this raises the specter of shoulder dystocia (where the shoulders get stuck).  Although most of the time this is resolved without problems, sometimes this can cause damage to the baby, to the mother, or in rare cases, result in the death of the baby. It is one common reason for lawsuits in obstetrics, which is why doctors worry about it so much.

However, weight gain is only moderately associated with macrsomia. Many women gain average amounts in pregnancy and yet still have "big" babies.  Some people gain a lot in pregnancy and have average-sized babies. Some of us (me!) gain almost nothing in pregnancy and still have big babies.

I am dubious of the idea that weight gain is a really reliable marker for discovering macrosomic babies.  I think research does show that a really high gain increases the number of macrosomic babies but taking a large gain as a guarantee of a big baby amd acting in fear accordingly may cause more problems than it solves.

In fact, monitoring weight gain can backfire because a large gain often triggers an early induction or a planned cesarean for a "big" baby, only some of whom will actually be big, and many of whom will have poorer outcomes because of the interventions.

Research clearly shows that these interventions do not improve outcome and often worsen it, regardless of the size of the baby.....so monitoring weight gain closely and planning interventions based on large gains may actually cause more harm than good in many cases.

On the other hand, weight gain can be a good marker for small-for-gestational-age (SGA) babies.  Research consistently shows that poor weight gain in pregnancy is associated with SGA and/or premature babies.  A very low rate of weight gain, especially in a woman who is already on the thin side, is a marker for strong concern and could be considered a good reason to weigh pregnant women regularly.

However, in "obese" women, the relationship between weight gain and fetal size is more tenuous. Many of us do not gain much weight at all in pregnancy (or even lose a little) and yet still have babies of average or large size.

Yet it's important to remember that even in "obese" women, there is a relationship between low weight gain and SGA/premature babies. It's not as strong a relationship as in smaller women, but it is there.  This is one of the reasons why the push for very little or no weight gain in "obese" women is troubling.

So you could make a case that a woman of size who is not gaining much should have fetal size monitored, just in case.  Chances are that everything is fine in a woman of size with low gain, but it might be helpful to check baby's growth curve periodically, since SGA babies tend to be at higher risk for stillbirth and prematurity.

However, weight is not the only way to monitor fetal growth; measuring the height of the top of the uterus (fundal height) is pretty universal among care providers.  If a problem is suspected via fundal height, then more close supervision of the mother's weight gain might be appropriate, along with other measures of fetal growth. 

Estimating fetal size by ultrasound is also an option.  It's not that accurate at predicting a too-big or too-small baby, but it does fairly well in identifying babies that are average-for-gestational-age.  In other words, it has difficulty accurately identifying all the babies at the extremes of growth, but it's better at ruling out extremes of growth for many babies and reassure everyone that all is well.  This is not a perfect solution, but it is another option.

The argument for weighing women to monitor fetal growth is one that has some merit, but it also carries risks as well as benefits.  If a large gain is used as a marker for more intervention, chances are the risks will outweigh the benefits.  However, if it is used selectively, and particularly to watch for women with too-small babies, the benefits may outweigh the risks.

Pre-Eclampsia

Another major reason for weighing in pregnancy is that a sudden large gain can be a potential symptom of Pre-Eclampsia (PE). In PE, fluid retention is common, and one of the first clues to PE can be a sudden jump in weight gain.

Because PE is a very serious complication of pregnancy and a potential killer, this is one logical reason for monitoring weight gain closely in pregnancy.

The problem with this is that women don't gain weight uniformly each week in pregnancy. Some weeks there are bigger gains, some weeks there is very little gain. Unless there's a huge jump, a bigger gain one week does not necessarily indicate pre-eclampsia.

Yet most doctors measure gains on a diagonal line of "average" gain per week, and some overreact to any deviation from this average...especially in women of size. Realistic providers understand that gain is not always even week to week, yet it's unfortunately very common for women to be hassled about even a small gain above the average "permissable" gain.

While a really big, sudden weight gain jump can be used as a marker to indicate possible PE, even a small gain is often over-reacted to in women of size. Many providers believe that all fat women will develop PE, so they are quick to react to any gain above what they think "should" be taking place. Combine that with the lack of consistency about using a larger blood-pressure cuff in women of size, and many providers are quick to diagnose PE in fat women when there may or may not actually be a problem.

Routine weighing can be advantageous in that it may be one of the first signs that PE is developing, but it also often results in major interventions and hassles, particularly for women of size.

Iatrogenic Harms

What many providers fail to realize is that while regular weighings in pregnancy can sometimes spot complications early on and prevent them from becoming worse, they can also result in unneeded intervention and harm.

In many providers' eyes, a woman with a large prenatal weight gain is a cesarean waiting to happen. They assume that a large gain means a big baby, and so they are more likely to induce labor, do a planned cesarean before labor, or have a very low threshold for proceeding to a cesarean during labor because they are afraid of shoulder dystocia.

In fact research shows that a larger weight gain is associated with a higher risk for cesarean, even when the baby is not big.  Is this because something physical about the bigger weight gain prevents vaginal birth, or is it more about the provider's fear levels and anticipation of trouble?  I think there is a strong case to be made for the latter.

This is one of the problems with monitoring a pregnant women's weight gain closely.  Too often, it's not just neutral information, designed to prevent complications, but instead becomes loaded information used against the woman to instigate interventions at the slightest provocation. 

Are the majority of interventions used around weight gain monitoring really justified?  Do they truly improve outcomes?  Or do many of the interventions put into effect when a woman has a gain outside the norm cause more harm than good?

This is the question that researchers are not examining closely enough.  The medical model is good at helping the small amount of women who truly need assistance during pregnancy, but it is typically very poor at recognizing and changing its own physician-caused (iatrogenic) harms. 

And monitoring weight gain so closely that the care provider freaks out over every little ounce is a very common iatrogenic harm these days.

What If You Prefer Not To Be Weighed In Pregnancy?

Weighing women in pregnancy at every visit is the standard of care in the U.S.A. and in many other countries as well.  Even those places that don't weigh most women may want to weigh women of size regularly in the belief that this might prevent complications (or catch them early). 

Therefore, if you are a person who finds weighing triggering or have a strong philosophical objection to weighing, it can be difficult to find a birth attendant who will honor that objection.

Women of size who wish to avoid regular weighings should look into an alternative-style birth attendant, like a homebirth midwife or a birth center midwife. Although most of these care providers also weigh regularly, they are less likely to be adamant about it and may be willing to work out a compromise position.

Make questions about regular weighings part of your interview process when trying to find a provider.  Share honestly with them the reasons that you prefer not to weigh, and ask them frankly whether or not they could be comfortable avoiding the scale.  Offer to weigh yourself each week and keep track of your own gain, and to let them know if you see a big jump in gain or loss at any point, or if your gain is too low or extremely high overall.  

Reassure them that you care very much about your nutrition, offer to keep food diaries to reassure them that you are getting good nutrition, and note that you will be open to nutrition counseling as needed if it's non-judgmental and reasonable.

Some midwives who normally weigh will be comfortable with avoiding weighing under these conditions.  They just need reassurance that they will be told if there are any disturbing trends in weight gain, and that your nutrition will be consistently good. 

Some midwives will never be comfortable omitting weight gain in prenatal appointments, and in that situation you will have to decide just how important it is to you (or not) to avoid prenatal weighings.

Handling Weighings If Your Care Provider Insists On Them

If you have chosen a high-tech birth attendant who insists on weigh-ins and it bothers you to be weighed, you do have some options. 

Many women find it easier to endure weighings if they take control of the process themselves.  Some choose to turn their backs while being weighed.  Others request that the med tech weigh them without comment and write down the numbers without saying them out loud.

You can share your concerns about regular weighings with the care provider and ask them to let you have some control over the process, or at least to be careful about the kind of comments they make to you about weight gain.

At no time should you ever put up with shaming body talk or critical comments about your results.  Providers who indulge in that kind of talk will not be size-friendly during the birth process and are likely to see you as a disaster waiting to happen.  If you hear negative or shaming comments when weighing or about your weight gain, it's time to find a new provider.

Or you can do what I do when there is a medically-necessary weighing; I don't passively let someone else weigh me, but instead I tell them I can do it myself and they can watch to verify it. I move the scale to about the right number (so there's no long process of over- or under-estimating and adjusting), and I adjust the balance until it's correct.  Somehow it's not so bad or quite so threatening if I do it for myself. 

Sometimes I get a med tech who is very threatened by the idea of me weighing myself (I think they assume I must be trying to fudge the number), but most of the time they are fine with watching me do it.

Mind you, I still hate being weighed by strangers....it reminds me of all those diet program weigh-ins, all the judgment that went with those, and all the living and dying emotionally based on what the scale was doing...but I find it less offensive if I am the one in control of the process. And I never let them make comments about the results.

This was how I handled being weighed in my first 3 pregnancies.  Although I refuse routine weighings when not pregnant, I didn't realize there was any choice when pregnant and so I went along with the weighings the first 3 times.  It wasn't too bad.

Since I'm okay with what I weigh, check myself regularly at home, and don't have an eating disorder (some people with eating disorderes find weighing to be a trigger), I could make peace with the idea of weighing in order to rule out pre-elcampsia or a too-small baby.....but I can't say I ever enjoyed the process.  I just gritted my teeth and got through it. 

Best by far, though, was finding providers who did not require that I be weighed during pregnancy. In my fourth pregnancy, I found birth attendants who were okay with me opting out of weighing. They knew me well enough to realize that they could trust my nutrition and they knew I kept track of my own weight and would report any big gains or losses, and any pre-eclampsia symptoms.

So they were completely fine with me not weighing at ALL in the whole pregnancy, and I have to say, that was SOOOO incredibly freeing! What a breath of fresh air.

They may never realize what a gift they gave me by letting me opt out of that, but blessings on them forever for being flexible that way.

Conclusion

Weighing during pregnancy has many pros and cons. 

On the plus side, it can catch some cases of inadequate weight gain that may lead to a higher risk for a premature or too-small baby, or it may catch an incipient case of pre-eclampsia before it gets too serious.  A too-large gain, caught early, may allow intervention to improve nutrition and perhaps prevent some cases of macrosomia. 

On the minus side, weight gain measurement is often used against women (and especially women of size), leading to more interventions and risky procedures like inductions and cesareans.  Furthermore, it is a poor surrogate for predicting nutritional adequacy or pregnancy outcome. 

A more sensible approach would be to emphasize nutrition over weight gain.  Alas, in today's short appointments, meaningful nutritional counseling is difficult to do and weight gain becomes the stand-in measurement of nutritional adequacy. 

Therefore, to most U.S. maternity care providers, weighing during pregnancy is an absolute requirement. If you have decided to go with a typical OB or hospital midwifery practice, you will almost surely be weighed at every appointment. Find a way to deal with that process proactively so it's not bothersome to you. 

Beware the care provider who is highly restrictive, shaming, or overly-interventive based on your weigh-in results.  That is a classic sign of weight bias and will likely lead to a highly-interventive and high-risk birth.  Better to switch providers than have to put up with that kind of bias during pregnancy.

And if you really object to being weighed during pregnancy, remember that there are some birth attendants who do not require regular weigh-ins. If it's something that really bothers you, you might want to check out one of these providers and see just how freeing it can be.

*I'm interested in hearing YOUR experiences, in or outside the U.S.A.  Where are you from? Do care providers usually weigh women in pregnancy in your area?  Why or why not?  Do they weigh women of size more?  Do they recommend restrictive policies or use shaming comments? Do you think weighing was helpful or hurtful in your case?  How did you feel about being weighed?

If you are a provider, I'm interested in hearing about your reasons for weighing or not weighing, how you monitor nutritional adequacy, and if you weigh, how you help women through an experience many women (of all sizes!) find nerve-wracking. 

13 comments:

Ruth said...

I'm a mom of three (three kids in four years). I weighed over 200lbs when I got pregnant with my first and I'm now over 300lbs 2 months post partum. I live in Canada and it seems to be standard practice to weigh pregnant women here too (three different OB's, three different clinics, all in the same city).

My first pregnacy the anestheisiologist informed me I was "too fat" to get an epidural (I had wanted to do a natural birth but due to complications unrelated to weight I had to be chemically induced, this often makes contractions much stronger) and the nurses had to convince him to "at least give it a go". During the procedure he grew very impatient with me and told me to "hold still, it's hard enough doing this with so much fat in the way". It was a horrible experience and made me very wary for my next pregnancy (which was thankfully at a different hospital).

During my postpartum care with the first baby, (I had a very bad tear as my son's head is HUGE and being induced he came out faster than expected), the nurse refused to help me change my dressings (not even making this up) curtly telling me I'd have to "do at home on my own anyway, might as well learn now". I don't know if she was rude to everyone or just fat women.

On my third I refused weighing and was still seen by my OB. Later, an unrelated disagreement I no longer felt "safe" and refused to go in for visits as frequently as they wanted me to. The only "high risk" part of my pregnancy is my obesity which didn't cause any complications in the first two.

All three suggested gaining next to no weight for the pregnacy despite the fact that I eat my most healthy during pregnancy and nursing (which basically means I've been eating the best ever for the last four years straight). All three made shaming comments and referred to BMI charts and quoted "studies" about diabetes and high blood pressure. (All three of my glucose tests, which are standard regardless of weight, were the "high end of normal". I was required to take all three of them again "because your extra weight means you are at higher risk for gestational diabetes" and "the tests may not have worked right if you ate too soon before the test". The assumption being that because I'm fat I can't control my eating habits before a controlled test.)

All three of my children are 90th or higher percentile in height and weight (my heaviest was 9.75lbs and 21.5 inches and male, the smallest 8.75lbs and 21 inches and female). I'm currently nursing exclusively and now I'm being told that I'm "forcing" my baby to "eat too much" because she's "too big" even though she's remained consistantly the same percentile since birth. I guess the assumption is that as a fat mother I'm "teaching my kids to have fat habits" or something.

Sorry, I know I answered much more than your actual questions. Obviously I'm a bit riled up over my treatment :D

Adirondack Autumn said...

Even the Pre-E argument has me scratching my head, at least in the office setting where you're only seen every 1-4 weeks. If the weight gain is uneven then there is nothing to tell them if those 4 pounds came slowly over the last 4 weeks (no big deal)or just came on since yesterday morning (sign of pre-E)

Now if you are hospitalized for pre-E, that's when daily weights are useful, otherwise it's still a questionable standard of care. Especially when those weighing you have such poor interpersonal skills. (their fat shaming behavior popping up your blood pressure and causing a cascade of interventions.)

I'd like to see all medical profs learn one simple thing. FAT SHAMING DOES NOTHING POSITIVE!!

Heidi said...

I do not know how much I gained or did not gain in pregnancy - I suspect not very much. I went to a specialist antenatal clinic in the UK for women with endocrine problems (for me, PCOS and hypothyroidism) and they did not weigh me even once. If I had shown any signs of pre-eclampsia, they might well have done so, but as it was, in my almost-entirely-normal pregnancy, it appeared to be a non-issue.

My son was 6lbs, 9oz, which is roughly in line with the birth weights of my siblings and I, and my husband and his siblings as babies, so despite being somewhere around the 300lb level, I had no issues with too large a baby. The midwives seemed to think he was on the small size; I don't know the average size of UK babies, so can't say!

Back in the US, I feel so sorry for women who give birth here, because it seems to be so obsessive. I will never have a baby here! I'd go back to the hospital in Manchester in a heartbeat. Although they refused me a waterbirth because of my size (I would fight that harder the next time around), they were among the most size-blind practitioners I've ever seen and did not make an issue out of my weight at all.

naomi said...

Both my babies were born at home, completely uneventfully. With my first pregnancy (250 lbs), my midwives weighed me occasionally, but were much more interested in my nutrition and exercise, which were excellent. I hardly gained any weight, but it wasn't for lack of eating! My son was 7.5 lbs.

With my second pregnancy, my midwives gave me the choice of weighing myself, or not being weighed at all, and I chose not to. Again they were interested in my nutrition. Mainly, I would say, my midwives provided emotional support - my second pregnancy happened during a particularly difficult time in my life. I don't know that I gained a lot of weight, although my body shape was very different. My son was 6.5 lbs.

I'm wondering a little about the "big baby-shoulder dystocia" connection. Didn't I read somewhere that the size of the baby can't predict the possibility of shoulder dystocia? I got the impression that this was one of those areas where doctors were making incorrect associations based on fear.

I also thought that pre-eclampsia was supposed to be diagnosed by a triad of symptoms: sudden weight gain, blood pressure increase, and swelling. My feet swelled horribly with my first (summer birth!), and I was concerned, but I remember my midwives telling me not to worry because everything else was normal.

Anonymous said...

I gave birth to my daughter in 2009 in Ontario, Canada. We had a homebirth with a midwife attending. Our midwifery practice policy is to let the client decide whether to weigh in at the office every visit, or to weigh themselves at home and then bring the info to the next visit. Interestingly, though, I would often "forget" to weigh myself before the appointment, and I found that my primary midwife didn't really care that I didn't have the number, just that I was keeping track, and that i would report any discrepancies to her. Now, I'm not overweight, and only gained 40lbs during the pregnancy, but I've talked to other women of different shapes and sizes (and birth weights) and the practice seems to be common.

But my real question is, why does weight gain during pregnancy have such a SOCIAL stigma, regardless of whether you gain a lot or not? Why did so many other women ask me "how much have you gained?" while I was pregnant, and after I gave birth, why did so many women say things like, "wow, you don't look like you were ever pregnant." Why do we do this to ourselves?

Ashley said...

I live in downstate Illinois and had an unlicensed homebirth midwife (Illinois refuses to license them) who was amazing. I don't own a scale and she didn't bring one, and my weight never came up. I'm obese and have PCOS, and overall my weight gain was alarmingly stable. I had HG but only lost 3 pounds, and by the end of pregnancy was up about 30 pounds (I weigh at friends houses occasionally). The fact that she paid more attention to how I was feeling and what (little) nutrition I could get in meant I had much better care. I can only imagine a doctor telling me my vomiting wasn't that bad because I only lost 3 pounds, or freaking out when I put on most of my weight in the last 3 months.

I did start off that pregnancy seeing an OB and they weighed me every time. I just started refusing weighings at regular appointments and the nurse fought me on it.

Anonymous said...

I'm a 5f8 mom of two. I was 130lbs before my first. While being preggo with baby # 1, I moved from Spain to Canada and my diet changed completly. I didn't even knew what to buy and stopped working, there my 60+lbs gain... I got fristrated with the weight at every appointment and got really depressed over the growing numbers. 13 months after having my daughter, I got pregnant with my son, changed care from OB to midwife and asked them NOT to weight me. I didn't see the point to weight me and get upset over it, it was just a number. My midwife NEVER weighed me, and I had a wonderful homebirth. Now, a couple of years after, I?m at 145lbs and feel great about those extra 15lbs. Weight doesn't mean anything anymore as long as I feel comfortable about my body :) Thanks for your post

Amanda said...

My first pregnancy I went to an OB, and I was weighed every time. I went through three seasons (winter, spring, and summer) in which I changed shoes, and they freaked when it appeared I had lost weight when I switched from VERY heavy boots to sandals. (It wasn't a lot of weight, but the shoes were a very heavy one, and they wouldn't listen to me about it being the shoes). The OB told me to eat candy bars (?!?!) to get extra calories to gain weight. Nice advice. (Although I do love candy bars...)

This pregnancy, I am going for a homebirth and am using a homebirth midwife (a CPM). She has never brought up weight with me and as far as I know, does not weigh any of her patients. Occasionally I will weight myself at my parent's house, but I don't know where I started, so I'm not sure how much I've gained. My weight gain for these two pregnancies has all appeared to be just belly, nowhere else, so a lot of people think I'm too "tiny" (a comment that really pisses me off...my fundal heights have been ahead, never below). I don't think I am and have a very good diet, so it doesn't bother me that weighing hasn't occured.

Christie B. said...

I'm having a homebirth with a CNM (Ashley is right that Illinois doesn't license CPMs, but there are a few CNMs who will do homebirths here and are licensed to do so). I do get weighed at each visit. I thought I'd get a lot of questions about having lost weight so I brought in a food log to my last visit. The junior midwife at the practice talked about having learned from the senior midwife to be less concerned about the actual numbers and more concerned about the woman seemed to be doing nutritionally and not to worry unless there seemed to be other signs that would together indicate a problem. It was really encouraging to hear about healthy and reasonable practices surrounding weight spreading among health care providers. I had always really hated being weighed at doctor's offices, but this place is fabulous about changing the atmosphere around the process and I don't mind at all now.

Cassandra said...

I'm 33 weeks along now, started my pregnancy at 393 lbs, immediately lost 15 lbs, gained 5 back and have maintained a weightloss of 10 lbs since before 20 weeks. A couple weeks before my 20 week ultrasound I had transferred care from an OBGYN to a birth center and it wasn't until 28 weeks that I decided to weigh myself.

I've had 4 appointments at the birth center and not once has my weight been brought up, not even a tiny comment. They don't even have a scale that goes up to my weight and they don't care. I had to go to my PCP clinic to have it checked, and I only did it out of curiosity because I thought I was losing weight. Well I was, but the baby was getting bigger and it was evening out.

What they do bring up at every appointment? Nutrition. Every time they (midwife and her apprentice) ask what I'm eating and offer suggestions for things I'm struggling with. None of the women I've been seen by care about my weight or have any concerns about fetal growth - they just want to make sure I'm getting enough of the right foods. It's an amazing experience. At nearly 400 lbs, you can only imagine the kind of BS that's been hurled my way by medical professionals.

To put my birth center in better perspective - I wasn't happy about their lack of an extra large BP cuff when the large one started reading really high. I had remembered long ago seeing a self-referral for a midwife at a birth center in my town on the Fat Friendly Health Professionals site and found out this birth center was where she was at. I popped off an email to her and politely asked if she wouldn't mind bringing up the BP cuff issue to the center owner because although I could have my BP checked regularly somewhere else, it did need to be monitored during labor too and I hoped she would understand where I was coming from. At my next appointment I was told cuffs had been ordered for me, to be available at both center locations they had! And the wonderful midwife I had emailed ended up being assigned as my back-up midwife (everyone gets two just in case) and I couldn't be happier.

It's amazing! Just amazing.

Tanz said...

I live in New Zealand and I've had two sets of twins, weighing about 130 kilos (give or take, I don't weigh myself routinely) each time. During my first pregnancy I was cared for up until 33 weeks by an independant midwife (standard care in NZ, but multiples are considered high risk and so are required to at least have an OB overseeing things) and she never weighed me at all. At 33 weeks I moved to another area and under their rules was required to have an OB from the hospital as my main carer. They did weigh me at each visit but made no comment on the weights. I was diagnosed at 38 weeks with pre-eclampsia (elevated blood pressure and protein in the urine, plus swelling) and was induced because of it. Interestingly I've never heard of weight gain as a PE symptom; our brochures and baby books over here don't mention it. My weight was mentioned just once, but the anethetist who worked out my BMI and on the basis of that advised me to have an epidural/spinal if I ended up having a c-section (as opposed to a general). He was matter of fact about it and I didn't feel that he was looking down on me at all.

In my second pregnancy I began with an independant midwife until I found out I was expecting twins, when I was transferred to the hospital team again. Interestingly *this* midwife mad a big deal of my weight, even telling me to not gain any weight during my pregnancy (and remember, I was carrying twins!) She didn't weigh me but didn't have to - I felt bad already. By contrast the hospital team - OB and midwives - weighed me at every visit but I don't know why they bothered because no-one ever mentioned my weight (except for the OB's fill-in who, after my c-section, advised me to have weight loss surgery, but she was the exception; even the surgeon was happy with the way things had gone).

I'll check with friends and family but as far as I'm aware weighing during pregnancy isn't usual for midwives, and most pregnant women have one.

N'Gina said...

I am pregnant with my second child. By the BMI standards I am overweight. And I'm sorry, weight control for this pregnancy is VERY important to me. My family history of heart disease and diabetes and death due to both has me concerned. Before my first child I weighed 140lbs, I'm 5'4" and after the birth of my son I retained 35 extra pounds for three years. I don't freak out about being weighed at appointments. My doctor doesn't even tell me my weight unless I ask.
With my doctor I can sit, and have, in his office for 30 minutes to an hour if I want asking questions. I researched my doctor before I got pregnant to make sure he was a right fit for me. Maybe more women should take the time to do so.
I'm sorry but I don't have insecurities about getting on the scale. It is what it is. If you are truly happy with your weight, then proudly get on the scale. Society pressures us to be many things but a strong individual doesn't give into that. I am black and after 32 years of deciding to having chemically straight like the girls in the magazines, I said I'm just going to let it do it's own thing. It's not always cute, but it is what it is.

erinmidwife said...

I don't routinely weigh pregnant women unless I am concerned about them not gaining adequate weight to grow a healthy baby and placenta. As for preeclampsia, weight gain is a very poor indicator of underlying pathophysiology and no one should make making any assessments gain alone. Moderate edema is so common in pregnancy and is usually normal. In the presence of true preeclampsia, by this point there would be much more valuable signs and symptoms that we would go on.