Ten years ago when Pamela Vireday found out she was pregnant for the first time, she experienced conflicting emotions. She was thrilled, but she was also scared because, as a plus-sized woman, she wasn’t sure how her size might impact her baby.
“Back then, I could find no information on what it meant to be plus-sized and pregnant, and I was full of fear about what my size might mean for pregnancy and birth,” says Vireday. ” My doctor had very little information for me and was generally full of scare tactics. So while I was thrilled at the thought of being pregnant, I also felt like I was out on a limb, all by myself. I knew I couldn’t have been the only fat woman in history to be pregnant, but it sure felt like it at times.”
In fact, she wasn’t the only one, as she found out very quickly when, in an effort to inform other women in her situation, she started The Plus-Size Pregnancy Website. Vireday is quick to note that there are risks inherent in a plus-size pregnancy, but she also wants to show that many women of size do have healthy pregnancies and births.
Bias or Caution?
Vireday now has four healthy children, ages 9, 7, 4, and 6 months, but it took some empowerment on her part to have a positive pregnancy and birth experiences. The doctor who delivered her first two children felt that his obese patients needed extra intervention, which Vireday feels led to two unnecessary Cesarean sections. With her last two children, she found a size-friendly midwife and doula and experienced vaginal births in a positive, caring environment.
Dr. Paula Bernstein, co-author of Carrying a Little Extra: A Guide to Healthy Pregnancy for the Plus-Size Woman (Berkley Publishing Group, 2003), agrees that doctors need to be more sensitive in communicating necessary information to their heavy patients, but she also suggests that sensitivity on the part of the patient may play a role in how heavy women take the information.
“Because weight is such a sensitive topic, it is often difficult for a physician to bring it up in a way that sounds non-judgmental to the person who is listening,” says Dr. Bernstein. “Yet, because weight does increase risk significantly in pregnancy, it would be bad medicine to ignore it completely. A woman who would never feel ‘discriminated against’ if her physician told her she had high cholesterol and needed to change her diet and take medication, or if she was told she had poor bone density and needed extra calcium and exercise, can respond very differently if told that she is significantly overweight and needs to eat a diabetic diet during her pregnancy. All three of these are objective, health-related pieces of information, yet the one that deals with weight can feel very hurtful to a woman when it is not meant that way.”
It’s important for a plus-size woman to find a provider that she feels treats her in a non-biased manner. However, it’s also important for her to realize that there are certain conditions that a heavier woman is more prone to and to be vigilant about guarding against them for her own health and her baby’s health.
The most common complications in a plus-size pregnancy are increased risks of both gestational diabetes and pregnancy-induced hypertension. While gestational diabetes affects 3 to 5 percent of pregnant women of normal weight, it affects 35 percent of overweight pregnant women. If left untreated, both gestational diabetes and pregnancy-induced hypertension can put the pregnancy and the long-term health of the baby and mother at risk.
Dr. Bernstein says that, while she certainly doesn’t want every overweight woman to be scared she’s going to have a horribly complicated pregnancy, she prefers that her patients fall into the 65 percent bracket, rather than the 35 percent. Therefore, she takes a proactive approach.
“The best way to deal with these conditions is to avoid them in the first place,” says Dr. Bernstein. “Ideally, if a heavy woman is planning to get pregnant, she would be screened in advance for any early signs of diabetes and hypertension. That way, if they are already present, I’ll treat that immediately, and she’ll have a much better outcome.”
Eating for Two
Dr. Bernstein also sends all her overweight patients to nutritionists such as Netty Levine and Marlene Clark, the co-authors of her book. The idea is not to put them on a “diet,” because that’s not a good idea no matter how heavy an expectant mother is, but to help them make the best food choices for their body and baby.
Levine says there is no “one size fits all” eating plan for a woman who is pregnant and already struggling with weight issues. The important thing is to balance nutritional needs based on the individual and eat as healthfully as possible. Also, regardless of size, a pregnant woman should not lose weight. Any weight loss should be brought to the attention of her doctor. However, depending on the woman’s pre-pregnancy BMI (body mass index), she is encouraged to aim for a weight gain of no more than 15 to 25 pounds.
Clark also notes that, while she specializes more in anorexic women, the weight gain fears of heavy women are not far off those of thin women. Levine agrees.
“Just because a woman is heavy doesn’t mean that she welcomes pregnancy as a way to justify that,” says Levine. “Most of the overweight women I see are worried they’ll put on a lot more weight [during pregnancy]. We try to reassure them that they will be much more likely to lose their pregnancy weight if they aim for a reasonable gain.”
Wearing It Well
The good news about being heavy and pregnant is that the majority of those pregnancies proceed smoothly and without complications. Also, there are more companies that cater to the special needs of plus-size pregnant women – especially when it comes to maternity clothes.
Charlotte Senno is the founder of Baby Becoming Maternity, a store that caters to sizes 1X to 6X. She founded the company after encountering difficulty finding maternity clothes that fit her well when she was pregnant with her daughter.
“I pick our fabrics for usefulness because I know there are some fabrics that simply don’t work for heavy women,” says Senno. “Our patterns are also engineered very specifically for the difference in a heavy woman’s body.”
What isn’t different, says Senno, is that all pregnant women are beautiful. “Women come here and I fit them and fuss over them and they just glow,” she says. “All pregnant women are beautiful, and it’s a miracle regardless of your size.”