Monday, August 23, 2010

Please Document Your Stories of Mistreatment

For years, I've made it a practice to document stories of fat-phobic treatment and weight bias in fertility, pregnancy, birth, and parenting. 

I do this for several reasons.

First, I find that many health practitioners simply aren't aware of (or don't believe) the extent of discrimination that exists out there towards women of size. Documenting actual stories helps them gain a better understanding of what some women of size have been through and why many are hesitant or negative about seeing a care provider. It also helps hold up a mirror (to medical professionals in general and to maternity providers in particular) to their own attitudes and practices, and helps them understand how bias -- even unconscious bias -- can slip through and how it impacts women.

Second, I think it's important that these experiences be documented simply because all stories of discrimination and bias deserve to be acknowledged.  Fat women should not have to endure egregious treatment like this, and our experiences of discrimination and bias should be heard and honored.  For too long, we've been told that such treatment is our own damn fault, that we're "too sensitive" about these things, or that we shouldn't be questioning it --- it's for our own good because we're so incredibly high-risk.  Documenting these stories makes connections with the discrimination suffered by other groups, shows that discriminatory practices have patterns, and that weight bias is a real form of stigmatization and discrimination.

Finally, I think it's especially important to document stories like this so that the fat-acceptance movement and the birth world start to understand and grapple better with the problem of fat-phobic treatment and discrimination during pregnancy and birth, an issue they tend to ignore.  Surprisingly, over the years I've found more respect and attention to the issue of size discrimination in the birth world than I have in the fat-acceptance world, which I always find puzzling and frustrating. Much of the birth world has a long ways to go, but some segments of the fat-acceptance world (those who don't want/have children, or are young enough that it's not on their radar) have an even longer way to go.  Documenting how egregious the treatment can be in pregnancy and birth is important because it helps establish that there really is a problem here that deserves attention, regardless of whether size discrimination affects you personally and regardless of whether you have (or plan to have) children or not.

More Stories of Mistreatment

A few weeks ago, I re-posted an entry from My OB Said WHAT?!! about a fat woman being told that if she got pregnant, she'd get gestational diabetes, high blood pressure, and would probably "die anyway."  This is just one of several "gems" I've found like that on that site.

I was surprised to get a high number of comments from my readers relating similar discriminatory stories, stories I'd not heard before and didn't have documented. 

While I'm disappointed that these things are still happening in obstetrics and midwifery care even today, I'm glad to be able to document some more of these stories.

But I want readers to go further.  If you have a story like this, I want you to document it thoroughly, in multiple places

We must have a record of things like this happening if we ever want to see things change.

How and Where To Document Your Story

So how do you go about documenting your stories? 

First of all, you can always send them to me, at kmom AT plus-size-pregnancy DOT  org.  I like to keep a record of such stories; when sending your story, please give me your permission to use them as needed (i.e. on my blog, on my website, in presentations I make, etc.).  You don't have to use your own name; you can choose to be as anonymous as you wish.  Just remember to give explicit permission to use it.  [If you posted your story in a public forum like my comments section, I consider that explicit've already made it public.  But I still like to have formal permissions.]

Second, don't forget the blogs at:
The First Do No Harm site documents stories of discrimination against fat people in the healthcare world, but sadly, they have very few entries under pregnancy, reflecting the lack of crossover between the birth world and the fat-acceptance world, I think. The stories here on my blog need to get repeated there

The My OB Said What?!? site documents stories of outrageous treatment in the birth world; it's not just limited to fat folk, of course, but it's important that the birth world hear of size discrimination and weight bias and how prevalent it is.  And it's important that they hear about these stories from someone other than just me as well.  I am one of the very few voices out there talking about this; it would be great to have other voices corroborating the stories of weight bias and discrimination out there.

So if you have a story of bias or mistreatment, I urge you to submit your story and document it in multiple places.  There really is a lack of understanding and acknowledgement in both the birth and fat-acceptance worlds that such discrimination really exists and is so common, so be sure to document it in multiple places. 

Documenting our stories is one way to start raising awareness about this problem and start confronting and challenging such treatment.  We don't have to suffer in silence anymore, and by speaking up, we can start changing the status quo.

Here are just a few of the stories from the comments section of my last post, edited for length.  I thank these women for sharing, and highlight a few of their stories here because not everyone reads the comments and might have missed some of these.  [A few have beeen edited or broken into more than one story for the sake of readability.]
  • My last OB told me that I needed to lose 50 lbs during my pregnancy or else she was sure I'd need a c section and then a hysterectomy. I gained 4 lbs total, and my baby was 8lbs 6 oz. I will never see that doctor again. I refused to go to my 6 week check up because of some of the nonsense that went on during my labor/delivery.
  • I was told during my second pregnancy (I was about 6 weeks in) that I would have to have a c-section because I am fat. No ifs or buts, I simply would have to. I ended up having a straightforward natural (2 hour) labour and delivery and without any mention of a c-section.
  • I was told at the beginning of my pregnancy not to gain any weight AT ALL. And in fact to lose weight. When I asked why, he told me because otherwise, I was being selfish and putting my baby at risk. Thing is, I was stuck with him because I had no insurance at the time and the delivery (emergency c-section that I HAD to have) still gives me nightmares.
  • That I must have so much fat inside my vagina that I would not be able to give birth without forceps or more drastic interventions....That my blood pressure would shoot up in the midst of labor (despite having been perfectly normal all through my pregnancy) and I would die without IV drugs. Now, with my kids around me and the bed they were born in just a few steps away, I can laugh about it. Then, not so much.
  • My MIDWIFE told me that she couldn't feel my baby through all of my fat. Which is funny, because she would barely touch me. Her doppler couldn't find the heart rate because I was too fat too. Once she dropped me from her care, I interviewed several other midwives, all of which could feel the baby AND find the heartbeat.
  • I was mostly able to avoid the scare tactics, thankfully, but during my cesarean, after my husband left with the baby, someone said "We should just do some liposuction while we're in here."
  • In my first pregnancy, at 11 wks I started spotting heavily, and my GP sent me for an u/s to see what was happening. I ended up in the imaging department at our local hospital with a sonographer who was visibly put out with having to take care of me. At one point she told me to 'hold all that fat out of the way' so she could do her job, and how she wasn't sure she would be able to 'see anything through all the fat'. Not only was I beyond stressed over the possibilitiy of losing that pregnancy (which I did, sadly), but that 'professional' made me feel awful.
  • I was a virgin at my second gynecological exam requesting birth control for the first time and the doctor told me I needed to lose weight if I ever wanted to get pregnant. She said she would not "let me" get pregnant at my weight and that it would be too difficult for me to carry a child at my weight. I changed doctors when I found out I was pregnant a year later while on the Progestin-only birth control pill she prescribed me (I did research and that pill has a way lower rate of working on bigger women... - she never mentioned that). I was actually in fear that she would suggest an abortion or something drastic because she was so adamant that I not get pregnant at my weight. I think she thought I wasn't going to be having sex anyway at my weight or something like that. I weighed about 290. I am now 38 weeks pregnant at 305 pounds and the baby and I are doing great. No GD, no high blood pressure. We've been fine. Looking forward to a healthy baby later this month.
  • I've got a ton of horror stories. I moved to the SF Bay Area from Seattle when I was 28 weeks pregnant and spent hours on the phone looking for a doctor that wouldn't counsel immediate termination ("You or the baby will die, you are just too fat to carry to term."), "necessary" c-section ("Women of your size never have a natural labor. You will have to have a c-section.") or were anti-VBAC ...("Women with your BMI can't VBAC in our hospital. You won't find a better hospital in the area."). I wound up with a doctor that said she was comfortable VBACing who decided at 38 weeks that I needed an "emergency" c-section and called me in the middle of my grocery shopping about me "dying before the weekend was out" and generally pressured me into yet another c-section. Now I'm being told (by any doctor I can find) that a VBA2C is "impossible" at my size/BMI or at all.
  • I was told by my OB at the first office visit (8 weeks) that I needed to lose 15-20 lbs. When I asked if this would be harmful to the baby, I was told that I could safely LOSE weight during pregnancy and it would have no effect on my baby because I had so much "reserves" the baby could survive from that. Luckily I knew that was BS and ate normally to sustain my energy, stamina, and that of my baby. When he balked about my weight at every subsequent visit, I flat out told him that I KNOW how unstable I feel during dieting, and there's nothing he could say to convince me that would be healthy for my baby, he shut up.
  • On the day of induced delivery, my doctor (who had been cautioning me that I would "most likely" need a C-section because of my size) was afraid to break my water as I neared full dilation and effacement and called in the OB specialist again to perform the procedure. My doctor actually left the room during this procedure to scrub in and ensure there was an operating room available to do an emergency C-section. When the specialist was finished and labor progressed normally, my doctor was shocked. Within three hours, my 9lbs 1oz baby girl was born and proceeded to pee all over the doctor. Instant Karma.....gotta love it.
  • I am pregnant with identical twin girls. I went to the perinatologist and he lectured me for 20 minutes. Telling me I was going to have GD and high blood pressure, and that I needed to lose 20 pounds during this pregnancy.
  • I had an OB tell me (over the phone) that I wasn't "really" pregnant, since my BMI was too high for me to actually be pregnant. Her office then told me that they'd be happy to schedule me for a biopsy to determine what kind of tumor I had. I replied "The kind with two arms, two legs and a head." and hung up. (I was 28-ish weeks pregnant and had a number of ultrasounds under my belt.)
You can read more stories of size discrimination I've documented over the years here.  There are stories of fat women being pressured to abort --- simply because of their size.  There are stories of women being told that they will die if they dare to be pregnant at their size.  There are stories of women pushed to have cesareans they don't need (or intervened right into cesareans). There are stories of draconian diets and mega-interventions and abusive treatment, simply because of weight. 

Of course, not every woman of size encounters such egregious treatment.  Oftentimes the bias is more subtle than that, and sometimes arrives with completely good intentions from the provider....but it's still bias.  I encourage you to share those stories too. 

It's also important to note that some fat women DO receive truly size-friendly treatment during their pregnancies and births; if you are a woman of size already pregnant or just considering pregnancy, please don't despair.  It IS possible to get decent treatment, and of course not all OBs or midwives are horrible people or size bigots.

But size discrimination does occur and I believe it's becoming more and more common as the rhetoric in the "War on Obesity" heats up. So it's important to keep documenting and challenging these incidents, both subtle and overt, as often as possible.

Please, folks, take time to document your stories, in as many places as possible.

Health care professionals and the general public need to become more aware of the scope of the problem of size discrimination.  It's the first step towards change.


Lindsay said...

This is EXTREMELY relevant to me lately! I just saw my ob chart (from a year ago) and it had so many assumptions Im actually going to write to get things removed. The absolute best thing was when my ob told me Id NEVER be able to birth a baby vaginally again because I am 70lbs overweight. Oh I birthed my 11.5lb baby with no drugs and no tearing!!!

Jasie VanGesen said...

My first birth was with my son who is now 9 and while it was horrific and I did experience quite a lot of discrimination based on my weight, I hadn't found FA yet and didn't have a defense. I was one of the one who believed every word and internalized a lot of hatred towards myself. I was also 19 years old, which may have also had something to do with me not standing up for myself or simply knowing what they were saying was total BS.

My partner and I have finally set up a timeline for getting pregnant (next year!) and I'm determined to homebirth. I may weigh 230 and have a BMI of 40 on the nose, but I'm doing it... I'm doing everything I can do and then some. I plan to document the entire pregnancy and birth on my blog, whether I get great treatment or assholes, people will be hearing about all of it.

nopinkhere said...

When I was looking to find an OB when we were ready to get pregnant, I asked around. I got a referral, but that OB wasn't taking new patients so I tried another doctor in that practice. Pretty much the first words out of her mouth were that if I did manage to get pregnant that I'd automatically be considered high risk because of my weight. She went on to list all the things that are more likely because of obesity. She wasn't mean, just discouraging. I left the office, cried in my car, and never went back. I read the book she recommended (Taking Charge of Your Fertility) and concluded that no one should ever get pregnant. Instead I did some research, including your plus-size pregnancy site. I got pregnant quickly the first time, and I have since had two children with the midwives at a free-standing birth center. The were matter-of-fact about my weight but didn't try to scare me. They were honest about some things being more likely but explained that that meant that, for example, the risk of something was 4% instead of 2% and no big deal. I have also found an OB/Gyn that has a similar outlook if I need to see one. No one ever told me I was going to die or was irresponsible to get pregnant, but that one appointment was very unpleasant. I have also found that if you have your spouse with you, things tend to be less intense as well.

Cassandra said...

For my very first OB appt at about 10 weeks, I saw a CNM. Ten seconds after she walked in the door she told me I was high risk because of my weight. Fine whatever, I do have family risk factors outside of that. I told her that other doctors had tried to diagnose me as diabetic without any solid evidence and that I would refuse to be labeled as such without a GTT (before I knew how stupid they are). She ordered a 1hr test and it came back borderline. I was told I needed to see a nutritionist to learn how to eat properly, to which I replied that both of my parents were diabetics and I was completely aware of how to manage diabetes with diet, "I'll see a nutritionist if I'll be given pregnancy specific given information, but please don't waste my time with the same old lectures." She goes, "Well you already have a glucometer, right? Would you be willing to see someone so they can make sure it's calibrated correctly?" Ugh fine whatever. Apparently my insurance would not cover the nutritionist without a GD diagnosis so I was informed that I had to have a 3hrGTT attempt to diagnose me with something I didn't have so I could see a nutritionist I didn't actually need just to make sure my glucometer was working correctly when I actually already know how to calibrate it at home? Right. I refused and flat out told her that was the dumbest thing I've ever heard come from a healthcare provider. She then told me that I had to do a food journal for two weeks and check my sugars 4 times a day, writing all of the amounts down to give to the MD in the office so he could tell me how to eat properly...under the assumption I was lying and would continue to be eating like a pig. My response? The information to have my chart transferred to another clinic.

Lillian said...

I was barely overweight at my first appointment for my second child, BMI 25.6. I was told by the nurse that I didn't need to gain any weight during my pregnancy because I was advice. I thought better of that advice and I did my best to gain weight eating as much as comfortable. I gained 22 pounds and had a healthy seven pound baby on his due date, VBAC.

Anonymous said...

I am a 25-year-old mother of two (soon to be three) children. I was heavy with my first two - but had them vaginally. With my first I was only 18 and very sensitive, and was told by my doctor that I was measuring big due to my extra weight. Okay - it hurt then but I guess it's a fact. With my second the physician I saw told me to not eat any Thanksgiving dinner as he did not want to deal with delivering a big baby.. stay away from the mashed potatoes and gray I believe he specifically mentioned. I had actually lost weight with that pregnancy and was due around Thanksgiving. This pregnancy - I am quite a bit larger.. around 290. I was shocked myself that I could even get pregnant. Whoops! My midwife has been very supportive but she herself is heavy so that really helps.. I hadn't had a problem until I went to get an ultrasound and the tech automatically asked me (at 20 weeks) how my glucose screen was. I told her I hadn't had one and won't until 28 weeks and she couldn't understand why they wouldnt give me one in the first trimester due to my size...(I am now 30 weeks and passed with flying colors..) then she went on to do my ultrasound and told me that it was very difficult to get any pictures of the baby due to my size. She kept huffing and puffing while having me move around... Let's face it - you're a big girl. :( OKAY I KNOW I'M BIG - does everyone have to keep reminding me?!?! I feel like I have to feel ashamed of being pregnant at my size.......

Mrs. Gamgee said...

Thank you for sharing my story (the sonographer & my miscarraige). I want to share a story on the other side of the issue...

When it was determined that I was miscarrying my first pregnancy, I was referred to the OB I have now. He has never once made me feel like a loser or a bad mother because of my weight. He has seen me through two miscarraiges, several gynocological procedures, and now 26 weeks into a difficult pregnancy. The only time my weight (I am 300lbs) has come up was when I needed to go under general anesthetic for a couple of procedures (a D&C and a uterine polyp/uterine septum removal), and then it was just to ensure that I would be fully under. We have discussed keeping an eye on my weight gain, and up to this point I have only gained 1.5 pounds and baby is doing well. I confess that I could be the poster child for those who say that fat women shouldn't get pregnant because I have ended up with high blood pressure and gestational diabetes (insulin controlled), but my OB has never once made me feel that way. He ends every appointment by reminding me not to worry, that he knew we would get here (a successful pregnancy), and that he's proud of how far we have come.

He's one of the good ones.

Shira said...

I was refused fertility treatment on the NHS in 2008 due to my BMI being above 30 (it was, at the time, 39). When we went to a private clinic we found that the BMI restrictions apply everywhere, not just on the NHS, and the only way I was able to get consent for a treatment cycle was because I could prove that my high BMI was a result of my lipoedema. All but two of the doctors at the clinic absolutely refused to have anything to do with my treatment, and the two who did treat me were both fat; one of them, the main doctor who was treating me, made a really big deal of emphasising how he had alienated his colleagues by taking me on as a patient.
When the time for my egg retrieval was near, the anaesthetist sat me down and explained in a very harsh and condescending manner that he was refusing to do his job for me because I was too fat. Egg retrieval involves needles being pushed through the vaginal wall and into the ovaries repeatedly, and is either done under general anaesthetic, or local with sedative and painkillers. I had to have mine done with absolutely no anaesthetic or drugs of any kind. It was just me and my mp3 player on the table while my doctor aspirated as many of my seventy-six follicles as he could. It was every bit as painful as you might imagine.
This is just one of at least a hundred incidents of fat-based mistreatment I've experienced personally.

Sarah May said...

When I was 18 I went to my first GYNO appointment. I was a virgin... and was at my lowest weight, 190. I undressed from the waist down and waited for the DR. to come in. She came in, had me lay back. She was pushing on my abdomin and asked "what sort of surgery did you have?"...

I replied "none... why?".

She said "you have a c-section scar here"... and she pointed to the crease in my fat roll.

I laughed and told her "That is my fat roll hinge."

She then said "I will need to test you for the HIV virus... and get you on birth control. I don't appreciate lairs."

I don't remember what she said next. I was shocked... I grew up in church and had never even had a boyfriend at that point. She never even did a pelvic exam... if she did she would have seen "virginity intact".

Obviously she was not familiar with big girl anatomy... which includes various rolls and creases in odd places. I wasn't even that big when I saw here... that was 10 years ago... I wonder what she would say now that I have gained 100 pounds?!?!
When my husband and I started TTC, we went in to see the "best OB in the Greater Phoenix area. He did a variety of tests on both my husband and I. Finally after a few months he decided to put me on birth control. I was "Too fat" to get pregnant... that was his diagnosis. He didn't address my PCOS or Thyroid disease... I started the birth control...

After a few months of being on the birth control, I hounded the Dr and he reluctantly took me off of them... I got pregnant and misscarried 4 times. The Dr. would say "you just need to loose more weight"

we ended up moving to California and I went to a new Dr. Who ran the same tests as the previous Dr.

The test came back showing Antiphosphil Lipid Antibodies (among PCOS and Thyroid problems)... the birth control was clotting my blood because of the antibodies and could have killed me... My current DR. requested the tests from the previous Dr... when compared they were exactly the same. I tested positive for the antibodies before the miscarriages...

My previous Dr. was so concerned about my excess weight that the neglected the real issue. After being taken off birth control and put on a blood thinner I had a healthy pregnancy resulting in a healthy baby!

Weight Gain Stories said...

Yes i need to write a document and thanks for sharing those 2 sites