Obese and pregnant - Part 2 (progress update)

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So in my last post I was mostly working through the anxiety of medical complications due to being pregnant while obese. I talked about some of the things I was “at risk” for, how I expected to be treated, how I hoped to mitigate some of the risks, and how I was managing my anxiety and compulsive eating. These past 4 months have been more of the same. I thought I’d write an update on how things are going.

On being “high risk”:

  • Gestational Diabetes - negative. I was tested twice for this since I was higher risk and both times were fine. Yay.

  • Pre-eclampsia - also negative. Perfect blood pressure the whole time.

  • Neural tube defects and spontaneous abortion - also negative.

  • "Big baby” - Here it got a little tricky. Not because the baby is big (in fact she has been on a perfect 50th percentile of size every time we have had it checked meaning she is probably completely average), but because the way that foetal growth is generally measured is not accurate if you are obese. What?? Yeah, that’s what I thought, too.

Growth is generally measured by a ribbon tape measure that measures “fundal height” This is the distance between the top and bottom of your uterus and it is measured by a doctor or midwife putting the tape measure on your pelvic bone, pulling it up to the top of where they feel the uterus, and recording the measurement. The measurement is compared against a chart that shows standard heights by week of pregnancy.

Have you worked out the problem here yet? Standard. Obviously, women who do not have an average BMI have some extra padding on top of their uterus (uteri? uteruses?) meaning the measurements are completely useless. The midwife takes my measurement and immediately refers me for a growth scan. Cue anxiety. I have already looked into growth scans and know that they are very inaccurate at determining size of baby. I talk to the midwives about this and am told (thankfully, since I am going to an amazing hospital) that there would never be an induction or c-section scheduled due to “big baby” there and certainly not from size estimates gotten from a growth scan. They just like to check that the rate of growth is on target and the placenta is functioning properly. Whew!

From what I understand, however, this is not the norm and obese expectant mothers should be totally aware of how this can lead to inappropriate interventions and be clear with health providers regarding their wishes. Researchers probably also need to look into developing alternative methods of measuring foetal growth that do not automatically lead to obese women being scheduled for growth scans.

On managing anxiety, healthy diet, and compulsive behaviours:

  • Anxiety - I was upfront with the doctors and midwives from the start that I had serious anxiety around seeing new medical professionals. Like most obese people, I have unfortunately suffered some ill-treatment, judgement, and trauma from them in the past. I was recommended to be put into a program that assigns one midwife to each expectant mother to help with this. The obstetrician thought it was a great solution and put me forward for it. Guess what? I wasn’t allowed to be in the program because I’m “high risk”. But, I say, I have already been tested and found negative for all of the things I am high risk for!! The obstetrician agrees and says she knows and thinks it would be the best way to keep me healthy through the pregnancy but unfortunately it is not her call. This is the one and only time the Royal Women’s Hospital has let me down so I am inclined to forgive them. It is their right if they think I will not be able to get the care required. However, I do not agree that a decision based solely on BMI is one that does not lend itself to an argument of discrimination.

  • Diet and compulsive behaviours - The visit with the dietician confirmed what I already thought. What I really needed wasn’t nutrition advice (I have a good grasp of this and she agreed), but rather some more psychological support. I increased my appointments with the psych and have managed to keep the binges to a minimum since then. I still have them. Particularly before doctor’s appointments and before or after stressful events. It’s hard. Going to 12-step meetings has also been hard since I know I’m not being particularly compliant with the program so I don’t really know what to say there. I’ve kind of gotten to the point where it’s just too much to tackle right this minute and am just trying to get through to the end relatively healthfully and get back to a non-restrictive food plan once my body is my own again. Cop out? Maybe. But it is what it is. We’re both healthy right now and that’s what matters the most.

Moral of the story: it is completely possible to have a safe, healthy pregnancy if you are obese. However, as with all expectant mothers, it is important to let yourself be empowered by research and information and be clear with your health provider about your preferences and how you expect to be treated.

If you feel confused or upset after an appointment it can be good to discuss the incidents with a friend or partner first as having a (totally understandable) chip on your shoulder and excess hormones can effect your take on the situation (yes this happened to me a few times, hubby has been incredibly helpful!). If you feel you are being discriminated against or are having decisions made for your that are not appropriate or evidence-based, it is completely within your rights to discuss with the doctor, report the behaviour, or change providers altogether.

I’d like to write another post about some of the new things that have come up. These include weight discrimination leading to ill-health for ALL mothers and the physical realities of living with a giant pregnant belly on top of obesity. However, I’m due any day so that may have to wait. Stay tuned.

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