The Plus Size Birth

By Denise Bolds MSW, CD(DONA) February 15, 2016

Curvy, thick, stacked, built, fluffy, fat, plump, big-boned,
hefty, obese, chunky; there’s a ton (pun intended) of monikers for plus size women. I support
many women as a birth doula; quite a few are plus size women who are
pregnant and seeking doula support. It is time to welcome plus size pregnant
women to the table of maternal health. 
Many plus size women are healthy and in healthy relationships; they have
healthy pregnancies and births. They are involved in passionate, loving
relationships regardless of what is portrayed in movies and the media.  Not all plus size pregnancies are high risk. There’s
one client in particular that stands out in a situation that occurs in many
plus size births in many institutions.

Carrie is a vibrant, full figured goddess who is happily
married to Carl; they have two adorable daughters with the third on the way.
Carrie works full time and attends the local college along with being a wife
and mother, Carl also works full time and helps with his daughters while Carrie
is in class. She hired me to support her through her second VBAC.  Carrie’s
already full figure became more voluptuous as she carried her pregnancy to
term.

I was happy to learn from Carrie that she would be giving
birth at one of my favorite hospitals. This hospital is known for their
friendly and supportive environment. I’ve had nothing but wonderful birth
experiences there. Carrie went into labor; as VBAC protocol, we went to the
hospital as instructed. During fetal monitoring the midwife came and introduced
herself from four feet away from the bed as she asked Carrie questions about
her weight. The nurse returned and asked Carrie about her weight and if she was
legally married to Carl.  I witnessed
Carrie shut down; she was not going to give birth with this midwife or this
nurse. Carrie’s labor subsided as I predicted, and we were sent home.  What I witnessed during this triage was the
tip of the iceberg.

We returned the next morning and Carrie was triaged again;
this time the nursing staff had changed; the nurse triaging Carrie asked the
same devaluing questions: “Are you currently being treated for hypertension or
gestational diabetes? Are all of your children from the same father? What is
your weight?”  Carrie answered all the
questions confidently and was adamant that she maintained a healthy diagnosis
free pregnancy verified by her prenatal provider. The nurse asked another
question: “Are you sure you were here for a VBAC and not a cesarean?” The nurse
went to get a larger blood pressure cuff; taking Carrie’s blood pressure five times; each time Carrie’s pressure
reading remained normal. She was then placed on fetal monitoring and after
evaluating the baby, Carrie insisted on getting up and walking to help her
contractions progress.

We all walked in the hallway together: Carl would stop with
Carrie and support her through her contraction; every time we stopped a comment came from the nursing staff about Carrie walking ‘at her size.’ As we
walked, the comments continued: the nurses may have thought they were caring and
encouraging Carrie; in fact their comments devalued her as they focused on her
size: “Look at you doing all that walking! I’m surprised you can do that
much!”….  Carrie would also squat during
her contractions; all with comments from the nursing staff as she did so. 

Carrie went into transition, dilated fully; soon it was time
to push.  She was once again asked about
gestational diabetes and hypertension in her pregnancy.  The comments about her size also continued.
Carrie got into position to push: grabbing the back of her knees as instructed:
one of the nurses remarked: “You are very limber for your size, you can pull
your knees back!”  Carrie and Carl did
awesome job; their baby girl Willow was born beautifully.

Willow weighed just over 8 pounds. The nurses wanted to test
Willow and her blood sugar.  Carrie became
upset and explained again that she was not a gestational diabetic in her
pregnancy and her baby is fine. I supported the new family making sure they
were stable and had their Golden Hour; then I went home. I didn’t know how to
process what I witnessed from the L&D staff for over 10 hours: it was evident Carrie was labeled because of her size. She had a normal, healthy pregnancy; as a plus size woman, the
clinical staff repeatedly attempted to label her high risk simply by visual
assessment. I spent a while thinking how to address this obvious stigmatizing
that was a constant presence in Carrie and Carl’s birth.

I returned to the hospital the next day to check on the new
parents. Carrie had done beautifully with her second successful VBAC. She was breastfeeding as well.  I offered the couple an apology
for what happened during the labor and birth. Both Carrie and Carl went on to say;
they discussed through the night every single comment the clinical staff made
about Carrie’s weight; they believed she was stereotyped because of her size.

I was devastated. It was my hope that Carrie would not have
recalled all that was expressed by the clinical staff during her labor. Carrie
had received glowing recommendations about this hospital from both her prenatal
provider and myself.  How many other plus
size pregnant women experience what Carrie went through while in labor? I am
sure there are many. This is not about me; it’s about the mother facing this type of behavior that simply doesnt have to happen.

I am a proud doula and member of Plus Size
Birth, founded by Jen McLellan. There is an understanding of risks associated
with obesity and pregnancy. There are also very healthy plus sized women who
have awesome pregnancies, births and are lovingly supported by their partners. For
my plus size clients I provide respect as well as a can-do attitude to support
labor and birth. Every one of my plus size client’s work in a team
attitude with L&D staff to have a healthy pregnancy and birth.  The stigmatizing and stereotyping of plus
size births has to end if the goal of best birth outcomes is to occur. Having
compatible equipment that accommodates plus size women with sensitivity
training for clinical L&D staff are paramount.  The link to Plus Size Birth is: http://plussizebirth.com when planning
workshops, conferences and in-services, this topic is an excellent choice in facilitating
training to clinical staff.