Wednesday, June 29, 2011

Blogiversary #2: State of the Blog

♫  Happy Blogiversary to me, Happy Blogiversary to me.....!  ♫

Yes, it's been 2 years since I started this blog.  I can hardly believe it.  Feels like I've been doing it a lot longer!

So in honor of the blog's birthday, let's take a moment to do a State of the Blog assessment, eh?

Purpose of the Blog

2 years ago, I started the blog to raise awareness about the issues of "obesity" and pregnancy. 

I found little awareness or comment about pregnancy issues in the fat-acceptance world and wanted to raise the fatosphere's awareness of the discrimination and mistreatment many women of size face during their pregnancies and births.  Size discrimination often starts in the womb, yet this has been a very overlooked area in the discussion about size bias.

I particularly wanted to reach out to pregnant women of size who might be looking for information on how weight could affect their pregnancy and care.  I wanted to make sure they had in-depth information about their choices, risks, common care protocols, the pros and cons of interventions, etc., and that they had information about proactive things they could do to improve outcome.  And I wanted to make sure they had a place to share their concerns and questions, and a space where they could see other pregnant women who looked like them so they would know that they are not alone

I also wanted to reach out to the birth world and further its awareness of how pregnant women of size are often mistreated, ask birth workers to question the assumptions often made about women of size, to analyze the quality of the research on obesity and pregnancy, and to open a discussion of how to improve outcomes in women of size. 

Whew. That's quite a wide-ranging mission and target audience.  This means that sometimes my posts will appeal only to one segment of my readership.  Some will really want the pregnancy pictures and birth stories, others really want the nuts-and-bolts research analysis, and still others are most interested in discussions of size bias or Health At Every Size instead.  But hopefully, even when the posts don't appeal to your particular needs, they're still interesting enough to learn something new or to be diverted by for a few minutes.

Thank you to those of you who have linked to my blog or specific posts on your sites, or who have "liked" or tweeted about them on social media networks.  It really helps increase the visibility of my blog, increase the readership, and get my message out.  Keep linking, "liking" and tweeting!

My birth friends are pushing me (kicking and screaming all the way) towards the social media world, and I have been informed that I must get a Facebook page soon.  I'm no fan of social media but I recognize its importance in getting out advocacy messages, so I'll probably be looking into this soon.  Keep your eyes peeled for it.

Blog Stats

Alas, Blogger has only had stats available for my site for the last year, so I have no data on how many readers I had in the first year or what they read the most.  But now that I have these stats available, it's been fun keeping track of them.  It feeds my inner geek and my ego too, which is always nice!

Generally I average about 20,000-25,000 hits per month these days.  That's up from the beginning of the year when it was more like 17,000-20,000 per month.  So that's encouraging.

Here's the part that boggles my mind. All together, I've had nearly 275,000 hits in the last year alone.  Whoa.  Pretty amazing!

Yeah, okay, peanuts compared to some sites, but still pretty dang impressive to me!  Starting this blog has been a big boost for getting out my message, even beyond my regular website,  I'm sure if I ever drag my reluctant backside over to Facebook, that would help boost readership even more.

Popularity-wise, my Top Five Posts of all time are:
 Of these, the Plus-Size Pregnancy Photo Gallery is by far the most-viewed post.  It has had nearly 70,000 views all on its own, compared to about 12,000 for the next most-viewed post. 

Apparently there is just a tremendous need out there for images of women of size in pregnancy and birth, because nearly all the search terms commonly used to find my blog involve some variation of "overweight" or "obese" or "plus-size" and "pregnancy" or "photo" or "belly."  So obviously, one of the most important things I've done is to try and meet that need for images and reassurance.

This is one reason why I hold my nose and still use the "o" words ("obesity" and "overweight") at times; I know those are the search terms used by people not familiar with fat acceptance.  Frankly, those odious "o" terms are how most people find my blog.  It helps me preach not just to the choir but to a lot of people unfamiliar with fat-acceptance and Health At Every Size.  It helps me reach more of my most-desired target audience ─ people unfamiliar with size acceptance and new to the concept, whether those are people in the birth world or are people of size themselves.

So while I've had many approaches to the terminology issue over the 16 years I've been writing about this topic, in the end I've decided that getting the message out to those who need it most takes priority. As a result, I use a mix of terms on the blog, from the repulsive "o" words at times, to "fat" (which is my preferred term but which alienates some), to euphemisms that tend to be a bit more neutral. This makes my blog more likely to be found by a variety of people, not all of whom are on board with fat-acceptance yet.  You can agree or disagree with that approach, but it's the compromise that seems to work best for me after many years of trying different ways of handling the terminology.

Geeky Stuff

I get a real charge out of my little "world" widget on the top right-hand side of my blog. It's always so much fun to look and see who's reading my blog right now and where they are from.   I love that!

Not surprisingly, most of my readership comes from English-speaking countries, especially the U.S., the U.K., Australia, Canada, and New Zealand, but I get a fair amount of hits from Germany and the Netherlands. I also get quite a few hits from places I wouldn't have expected, like India, Russia, South Africa, and Iran.  Very cool!

One thing I am working on for the future are reference pages with links to research studies....sort of a quick reference link page, as it were.  I think some of my readers might find that useful; I know I find it useful on other people's blogs. (Thank you Fat Nutritionist!)

I also have a major series planned on the risks of pregnancy in women of size coming soon.  We'll take each one of the risks, look at the research on it, dissect the quality of the research, and figure out the lessons to be learned from it (if any).  This will be a major series, and it takes a huge amount of time to research and write each risk category, so it will definitely be a periodic series over a long period of time instead of a continuous short series.  Still, even though it will be spread out over time, hopefully it will be of use to women of size as they try to sift through all the scare tactics and rhetoric around fatness and pregnancy.


So that's the State of the Blog─where we are right now, and some directions we plan to go in the future.

Thank you for reading the blog, for sharing links to it with others, and for spreading the message about it.  Keep doing spreading the word, please!

Thank you to the Fatosphere for being open to this unique message about pregnancy in fat women.  I know it can be hard to care about this topic if you are not personally planning to have children, but size discrimination matters, even if it doesn't personally affect you.  Thank you to those who continue to read even with no personal investment in the topic, and thanks to those of you who are affected by the topic and who share your stories and concerns.

Thanks to the many gutsy maternity care providers and birth workers who have embraced the cause of better treatment for women of size too.  It is so important that this message not be limited to this blog or to the size-acceptance world, but that it be actively discussed and pursued by those in the birth field.  Special thanks to those birth workers who have done their best to help and advocate for women of size as clients.

Finally, special SPECIAL thanks to the many brave mamas of size who have shared their pictures, their thoughts, their comments, and their stories with the blog or my other website.  Your experiences are the heart of why I do this; thank you so much for sharing.  YOU ROCK.  You'll never know what a difference you make in the lives of future women of size.

Happy Blogiversary, and I look forward to sharing many more blogiversaries with  you!

Wednesday, June 22, 2011

Because Of Your Weight, We'll Schedule Your Cesarean

Still find it hard to believe that fat women are being denied access to low-intervention care and are often railroaded into cesareans these days?

Try this story on for size, from the website, My OB Said What?!?

“Because Of Your Weight…We’re Going To …Schedule Your Cesarean.”

“Because of your weight, you’re just not a candidate for midwifery care, and we’re going to go ahead and get you to an OB to schedule your cesarean section.” – CNM to mother at 36 week appointment

Augh.  Just AUGHHHHH!!!  On sooooooo many levels.

Sunday, June 19, 2011

New Health At Every Size Resource

I'm delighted to hear that ASDAH (Association for Size Diversity and Health) has started a new, very important blog, the Health At Every Size blog.  About time!

I'm sure my size-acceptance and fatosphere readers have heard about it already, but I wanted to make sure my birth-world readers (who may not be as familiar with HAES concepts) knew about it too.

If you don't know about Health At Every Size (HAES) yet, the basic principles of HAES are:
1. Accepting and respecting the diversity of body shapes and sizes.
2. Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.
3. Promoting all aspects of health and well-being for people of all sizes.
4. Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.
5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.
Here is a summary about the HAES Files from the HAES blog's first post (I've broken it up a bit):
The Health At Every SizeSM approach is about the ways that people of all sizes can maximize their health.

This approach does not mean to give up or to let everything go. It is an active process by which people work positively with their bodies and within their lifestyles to achieve a level of health which is reasonable and above all, sustainable for them.

It means managing health within a framework of a life well lived as opposed to weight centric, thin at any cost methods.

It means managing nutrition and fitness within a global health framework that would include managing stress, sleeping well, maintaining social connectedness and much, much more. This is not passive, and it is not easy. It requires a lifetime of careful work in learning which foods nourish you and which leave you feeling unwell; in learning what forms of exercise strengthen you and energize you and which forms leave you depleted and hurting; and in learning to make positive, gradual changes based on self-care rather than self-hatred.

The HAES Files will serve as a means to push for a shift in paradigm from weight centered to health centered...

We have asked each of our bloggers to challenge us on how we address weight and diet and nutrition and physical activity and stigma and discrimination and ALL that our culture has deemed to wrap in a so-called “obesity crisis.”

We are no longer content with sitting in the back of the room, listening politely as policy makers, the media, and the food, diet and health industry dictate how this is going to play out. We are done asking for a seat at the table, we are taking one.
AMEN to that!

For those who are new to the idea of HAES, here are some more resources on it.  There is also Linda Bacon's book, Health At Every Size, excerpts of which can be found here.

I look forward to many wonderful, informative, and empowering posts from this new resource.  Go ASDAH!

Wednesday, June 15, 2011

Third Post at Science and Sensibility is up!

Okay, my third and final post at Science and Sensibility is up!

You can access it here.

This one is about lowering the risks for complications in women of size, and exploring ALL the possibilities for doing that. 

It's about not relying on weight loss, restricted weight gain, and/or a high-intervention model of care as the only ways to prevent complications in women of size.  It's about the need to explore other options as well, and what some of those options might be.

Check it out!  And give it some more link love, eh?

Monday, June 13, 2011

Second Post at Science and Sensibility Now Up!

My next post, second in the series on obesity and pregnancy, is up now at the Science and Sensibility blog.  You can find it here.

This one takes a critical look at the research for confounding factors that rarely get accounted for in the research, and suggests directions for more meaningful research in the future.

Go forth and give it some link love, "likes" and tweets!

Friday, June 10, 2011

Check Out My New Post at Science and Sensibility!

On the childbirth blog, Science and Sensibility, there is currently an ongoing series about "obesity" and pregnancy.  All the usual material is there, be warned, but to its credit, it has also solicited the views of women of size, something most of these discussions never do.

So I submitted some posts on the topic and my first one is up on the blog today.  Huzzah!

Go forth and read it, link to it, "like" it, tweet it, digg it, and whatever else you can do to increase its visibility and readership. Give it some serious love, people.  Having an alternate point of view represented is a major step forward.

I do have one request, though; if you comment on my post or anyone else's, be respectful and polite as you make your points.  It's a radical thing to have our voice actually represented in these discussions and we want that voice heard and taken seriously.

There will be further follow-up posts from me there, so stay tuned to the Science and Sensibility blog for more!

A Note About Terminology

I'd also warn FA activists that I use the "o" words in the post at times.  While I strongly dislike these terms, I've found over the years that the medical establishment doesn't take you seriously if you only use alternate terms, and the word "fat" is seriously alienating to a lot of women who aren't on board with the fat-acceptance thing yet. 

Also, it's a search-engine optimization thing; the fact is that most of the terms used to search out this blog and my website involve "overweight" or "obesity" or variations thereof.  Back in the days when I scrupulously avoided these like a good NAAFA-ite, it really limited who would find my information. Often it kept the people who MOST needed to hear it (newly pregnant fat women, those facing fat-phobic treatment and misinformation, or care providers looking for information about weight and pregnancy) from finding it altogether.

So I grit my teeth and use the "o" words at times, both here and when I write about the topic elsewhere.  Here I use scare quotes around "obese" etc. to show that I GET it and I don't like those terms either.  Elsewhere I don't always, for style reasons and to be taken more seriously by medicos. But it doesn't mean that I don't agree with the objections to these words. 

In making this compromise, I am taking my cue from various researchers and authors who write about HAES topics and have also had to negotiate a compromise between ideals and practicality.  Here's a summary from Saguy and Gruys, in their article on the way that the news media frames articles on obesity vs. eating disorders (an awesome article, BTW, if you've never read it):
The definition of “overweight” and “obesity,” and even these terms themselves, are contested. Fat acceptance activists, who advocate for civil rights on the basis of body size, argue that these terms pathologize normal biological variation and reclaim the word “fat” as a neutral descriptor like “tall” or “short” (Cooper 1998; Wann 1999). Similarly, many feminist scholars have avoided the term “eating disorder” because it situates “disorder” within individuals rather than in complex social structures. We do not use “overweight,” “obesity,” or “eating disorders” because we endorse a medical or public health framing, but because we seek to establish how these particular terms have been constructed in the news media. We note that a search for articles using the term “fat” produced very few relevant articles, which is not surprising given that this word is still taboo in most social circles in the contemporary United States. An article search using the term “eating problems” was similarly unproductive. For stylistic reasons we do not place the terms “overweight,” “obesity,” or “eating disorder” in quotations throughout the article, but we wish to be clear that this is the spirit in which we use them.
So hopefully that will explain why I use these terms at times, even as I hold my nose. 

The best compromise I've found so far is to mix up my use of terms, using the "o" words mostly when discussing medical research, using "fat" as a descriptor of size or when talking about FA things, and using terms that are seen as more neutral (like "women of size") as much as possible in between.

You can agree or disagree with that compromise, just remember that I've done it for practicality reasons only. 

Ties Into Upcoming Series

This series of posts on Science and Sensibility ties well into my upcoming series on this blog on the risks of "obesity" and pregnancy, one I've been working on for a long time but have had trouble finishing because it's so research-intensive and I've been so busy. 

For that reason, it will be a periodic series.  We'll do an overview first, then take one risk at a time and dissect the research on it, and finish by overviewing what might be done to help lessen the risk for that complication. 

As I said, it will be a periodic series; other posts on other topics will get interspersed between to allow me time to work on each installment.  I'm sure it will take me a long time to finish the whole series, but bit by bit we'll get there.

This can be a difficult subject to discuss, because the last thing I want to do is scare pregnant women or those considering whether or not to have a baby. And information about risks can certainly scare anyone considering pregnancy.  But it's also a disservice to pretend there aren't any risks, or to not discuss ways in which women of size can be proactive about risks.  To me, knowledge is power, and this is an important discussion to have.  Just keep it in perspective.

Remember that risk discussion, by its very nature, tends to inflate people's perception of risk.  Add in pregnancy, when women feel most vulnerable, and risk discussions can be a bit scary. They narrowly focus on the small minority of people who have complications, rather than the large majority of those who do not.

Just keep reminding yourself that most of the time, pregnancy goes perfectly well, and many MANY women of size have had healthy pregnancies, healthy babies, and healthy births. 

Friday, June 3, 2011

Florida OBs Who Won't Take Fat Patients

A number of people have blogged about the recent story of a group of OBs in Florida who won't accept fat women as clients because they are "too high risk" and therefore they are afraid they might get sued more. 

Their cutoff for "too" fat?  200 lbs., a ridiculously low cutoff.  There is no way the risks of complications at that size justify denying these women care across the board, and there is no way that they should be denying care to an entire group of women based on complications some individuals might develop. 

Other people have covered the story just fine so I don't feel the need for extensive comments, but I do like the coverage from The Unnecesarean.  One commenter ("Mel") there, had a good summary:
I think the point of it all, the reason this is such an ugly decision, is that this group of doctors (and many others) have isolated the risks of obesity as THE ONLY risk, right off the bat, that makes people "too risky" to serve. What can account for this?

...These are OBs, who by nature of their training, are best equipped to help people with any remotely moderate to high level of risk, right up to the sorts of very high risks that are better attended to by MFM [maternal fetal medicine] specialists. I don't see them passing on caring for multiple pregnancies, or a woman who will need a 5th c-section for instance.   
Why single out obesity as a risk factor? The only plausible answer, given the scope of their practice, is bias. Prejudice. It's an excuse so they don't have to treat people they don't like and of whom they disapprove.

...I don't buy for a moment that these doctors won't treat overweight patients because it's SO risky! I could understand a person by person decision for women with really high risks that included being very obese. But that's not what they're doing here. 
The Florida doctors use the excuse that it's more difficult to get a good quality image during an ultrasound of an obese woman, and their office machines can't handle that.

The answer to that?  Train your docs and techs in techniques that improve the image for women of size, delay the scan by a few weeks, and if that isn't enough, send the woman to a specialty center with more advanced equipment....for the ULTRASOUND. No need to transfer all of her care to a high-risk maternal fetal medicine specialist just for ultrasounds!

The doctors also complain about their potential for being sued. Now, I generally have great sympathy for doctors who are sued unjustly (as does happen sometimes in obstetrics), and I do think many docs are between a rock and a hard place in terms of malpractice insurance.

But I'm sorry, many doctors face high malpractice rates and don't deny care to fat women. Other docs (and midwives) somehow manage to care for a variety of women, not all of whom are super low-risk.

Categorically denying care to "obese" women, regardless of actual complications, is the result of an inflated perception of risks around this group and sheer outright weight bias.

Another wrinkle to this story is that not only won't they see fat pregnant women, they won't see fat non-pregnant women either now.  That's new...but it's a trend that started with obesity and pregnancy and is now extending to non-pregnant fat folk as well.  So all of you in the fatosphere who read my posts about weight bias from OBs and think it doesn't apply to you because you don't plan to have contraire.  Now it's spread to GYN care.  Apparently pregnancy weight bias is just the canary in the mine, warning of further dangers to come regarding equal access to care for all fat people.

Some in the birth world have commented cynically that the one bright spot in this story is that at least fat women in Florida know the worst fat-bigoted practices up front and will be able to avoid them. Too many doctors smile and nod and pretend to be size-friendly, then turn on the mom at term and tell her she "needs" a cesarean or an induction or whatever because of her size.

So, yeah, I suppose that's the one good side to all this. But I'm sorry, I just can't celebrate that.

This is just a further step along an ominous trend to segregate people of size into the care of ultra-high-risk docs, based on their size alone, regardless of whether or not they actually have poor health or develop complications, and regardless of whether such high-intervention care actually improves outcomes. 

It's another step along the path of denying people of size health care choices and life choices, "for their own good," and I find that extremely ominous.

We've discussed before in "Ghettoizing Fat Women" that there is an increasing trend to shunt all women of size, regardless of actual complications, into specialized "bariatric obstetrics" practices and regional high-risk hospitals, and denying them access to midwives and a low-intervention model of care. Sadly, I only see that practice increasing.  I've heard from women of size who have been denied care from homebirth midwives (despite prior births with them with good outcomes), from birth centers, from regular OBs, and even from some hospitals.....simply because of their size. 

No, these are not "super obese" women; these are often "mid-sized" fat women.  The idea now is that ALL "obese" women, pregnant or not (and regardless of actual health status and health habits), are being considered far too high risk for any care but the most centralized, most interventionist, most high-risk practices and centers─without actually proving that this sort of care improves outcomes.

And it's a very frightening step down the road of taking birth and healthcare choices away from a substantial group of women.  Where is the respect for patient autonomy?  For people having the right to choose the kind of care they prefer?  For people having a say in their own care?  For people being able to say no a style of care they don't want?

Each person needs to have their care individualized, based on their health status, their healthcare preferences, and their needs.  We should not have our healthcare choices taken from us, simply because we are fat.  And this latest story is just another step along the path of denying patient autonomy to people of size.

An ominous canary in the mine indeed.