Obese and pregnant

My husband and I recently found out the good news that we're expecting our first child. Exciting news for anyone, and anxiety inducing news in even the calmest individual. Now, we had been planning it for a while, and a part of my ongoing quest for health has been to prepare my body for birth and my stamina for keeping up with a toddler. So when we found out that I was pregnant we shared the mixed emotions of every parent in history. It went a little like this, "Man this is awesome! Oh crap, I wish we had had a little more time to organise everything... I am creating a human as we speak! What if it is sick or worse off because of my size? This is completely amazing! I really hope I can still walk around at 8 months and 150 kgs... But, wow, I'm seriously making a person right now, and it's going to be ours."

Flash forward a few months and a few thousand times of me telling myself to listen to myself. Because, if I'm completely honest, I can tell it's all going to be okay. So why do I have to tell myself that so much, you ask? Because nearly every single pregnancy/obesity article in the English speaking world has been warning us of the DIRE CONSEQUENCES of being obese and deigning to bring a child into this world. I could have gestational diabetes! I could have a "big baby"! I could have pre-eclampsia! I could explode in a thousand pieces upon delivery, causing the universe to implode and space and time to collapse! Okay...a little dramatic (and most likely completely incorrect scientific terminology)...but you get the idea.

As you can hopefully tell by now, I'm not a fan of taking medical advice on obesity at face value, so I dug into my pregnancy research with my usual vigour and tenacity. What I found was not suprising; the scare tactics surrounding being obese and pregnant are just that, scare tactics. The reality is that the data regarding conditions I am "high risk" for is not that scary.

Gestational diabetes: yes, actually a much higher risk. From 1% up to 7% (average. This increases the higher your BMI so mine is actually on the high end). But guess what? Gestational diabetes actually poses very little risk to mother or child when controlled.

Pre-eclampsia: yes, a statistically significant increase in risk from...wait for it...2% to 4%. Whoa!! Quick someone get the blood pressure cuff and pee cup so I can test myself every week!

Other complications/risks are either mainly negated once you are past 12 weeks (neural tube defects and spontaneous abortion) or related to delivery issues.

The delivery issues are where it gets tricky. Obese women are more likely to deliver via C-section, have problems with epidurals and anesthesia management, postpartum weight retention, and birth injury. Now, the important thing to remember here is that correlation does NOT equal causation. What do I mean? Well, obese women are also more likely to fall prey to high levels of cascading interventions which actually DO cause all of these issues so the big bad obesity may actually have very little to do with it.

A worst case (and yet seemingly typical) scenario would look something like:

  1. Mother is obese: screen for "big baby"

  2. The baby is big, advise C-section necessary

  3. Mother wants to birth naturally anyway (because size of baby screenings are EXTREMELY inaccurate)

  4. Doctors induce early to avoid the dreaded "big baby"

  5. Mother has long second term of labour:

  6. Because obese mothers often naturally have labour that does not fit in to Friedman's graph, a standardised method of judging labour progress based on 50 year old data that does not include obese women

  7. Because labour was not ready to start anyway, hence the requirement of induction

  8. Doctors "must" intervene to prevent risk to mother and child

  9. C-section is advised necessary

  10. Anesthesia problems & excess bleeding likely

  11. Baby born

  12. Mother has more trouble breastfeeding due to C-section

  13. Mother keeps on pregnancy weight as cannot breastfeed

  14. Mother more likely to develop postpartum depression as cannot breastfeed

This is my biggest fear. Like...actually my biggest fear. So I research all I can to be ready to tactfully but strongly ask as many questions as possible during my appointments. Wait...appointments? Well yes, as a pregnant woman you see the doctor. A LOT. And not just one medical professional either. We're talking new obstetrician, new ultrasound tech, new midwife, new nurse, new dietician, new physiologist, I could go on and on. This is obviously really good for me considering I have been traumatised by ill-treatment from medical professionals due to my size for years....

So what do I do when I'm anxious? I'm a compulsive eater people! What do you think?! Yep, I got back into the binges in a big way. My body was suddenly disgusted by my favorite foods, excited by some really weird ones, starving one second, and nauseous the next. The food plan that has been my lifeline out of this addiction became null and void almost overnight. And since I'm terrified of the doctor (particularly one who basically has carte blanche to talk about my food patterns and size in any way they see fit) I've been afraid to go to the dietician and get a pregnancy appropriate food plan.

Isn't that irresponsible, you say? I ask myself that every. single. day. Pair the excruciating guilt of possibly harming the baby with unhealthy food with the already horrifying pain of letting go of my values, standards and common sense by slipping back into my addiction and you've got one pretty messed up mama. I've bucked up my courage enough to have made the appointment now. I want my baby to have a strong mother. One who doesn't back off when things get scary. Could I have tried harder? Gone earlier? I honestly don't know. I feel like I have done the best I could have under the circumstances. One can only handle so much bucking up and having the courage to go to all the doctors, talk endlessly about my body, and navigate the changing relationships and expectations around me while working full time have put a pretty heavy strain on an already hormonal and exhausted body. So I'm going. But, do I understand why some women wouldn't? You bet your ass I do.

Anyway, this wasn't meant to turn into a lengthy diary entry about my supremely high level of anxiety. But, hey, I am completely honest on here because a) that's who I am and b) I hope that somehow me being able to be honest brings someone else somewhere a tiny slice of understanding or peace.

So here I am both extremely happy and excited about this new chapter in our lives and extremely anxious because of how societal perceptions about my weight could now not only hurt me, but also hurt my baby. This is not okay. It's just not okay anymore. If this makes me fight harder for evidence based treatment and an end to weight discrimination then so much the better. It's just a horrible horrible reality that it has to come at the cost of our health until the tide turns.

P.S. The totally awesome shirt on this post can be found here on Etsy.

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