Imagine you’re told that “people like you” have bodies that don’t know how to go into labor. You’re immediately classified as high-risk because you fit into a certain demographic. You’re lied to and coerced into an induction because the certified nurse midwife on call doesn’t like people like you. Imagine her saying, “Someone else who looked like you went in for an induction last week and was fine” because, of course, all bodies like yours are alike.
This is what happened to Rebecca, a mother of two. And it happened because she’s fat. Women with a BMI of over 40 have a 56.6% risk of undergoing a C-section, according to a study by University of Tennessee Medical Center. In fact, your risk for a C-section rises with your weight. A large, multi-state study found a 71% C-section rate in women with a BMI of over 52. Perhaps even worse, one weight bias and discrimination study found that 24% of nurses were willing to admit that they “were repulsed by obese women.” An investigation into weight bias among medical professionals found that they supported the stereotypes that fat people are lazy, stupid, and worthless. No wonder fat women don’t get the maternity care they deserve.
I wasn’t harassed into having a C-section, but having gained 100 pounds with my last pregnancy, partially due to gestational diabetes, partially due to medication, I was the victim of fat-phobic nastiness. Not from my OBs — they were lovely and never bothered me about my weight gain thankfully — but from the doctor who came to place my epidural.
He stabbed me in the spine seven times before he got the epi placed (wrong). I screamed every time. On the fifth time, he complained he was having trouble “because of all the fat back here.” I would have cried about it if I wasn’t already in tears from his bungling. I knew he placed epis in bigger women every day. He was just using my fat to cover his own incompetence.
This shouldn’t have shocked me. According to Mother Jones, a study out of Temple University reported that more than half of doctors characterized obese patients as “ugly” and “noncompliant.” A full third of them went so far as to make obese patients out to be “weak-willed” and “lazy.” You know, because there’s no such thing as a fat person who eats healthy and exercises. In fact, while I did have gestational diabetes, only half of women with gestational diabetes are overweight, and yet according to Midwifery Today, many fat women are forced to take the glucose challenge test every month during their pregnancy.
The list of indignities goes on. Women report serious pressure to consent to sterilization in the middle of labor. They’re “yelled at during prenatal checkups or humiliated during weigh-ins, and every problem is blamed on their size.” The latter is far from a shock. It’s a joke among fat people: Show up at the doctor with a hurt leg, and it’s because you’re fat. Metabolic issues? You’re fat. Ear infection? Fat. The flu? Well, maybe if you weren’t such a Fatty McFattyson, you’d be able to fight off germs better. In the birthing world, fat is blamed for everything from big babies to needing C-sections to an inability to nurse because your breasts are too big.
It’s gotten so bad that in 2011, the Sun Sentinel published a survey which found 15 out of 105 obstetrical clinics flat-out refused to take on larger patients, based on a cut-off of 200 pounds or other obesity measurements. Some said their equipment couldn’t handle women of size (buy better equipment then). But at least six said that it’s because heavier patients were high-risk. “People don’t realize the risk we’re taking by taking care for these patients,” said Dr. Albert Triana, who was apparently willing to expose himself as fat-phobic to the world at large. The office manager of another clinic flat-out said, when asked about their refusal to take on heavier patients, “This is not a high-risk practice.”
I call bullshit. With appropriate care, fat women can have healthy pregnancies. But you know, so much for the Hippocratic Oath.
In response, Midwifery Today issued guidelines about how to be a size-friendly practitioner. First on the list? Don’t assume we’re fat because we sit around and snarf bonbons on the couch all day. It’s possible to eat healthy, work out, and still struggle with your weight. Instead, care providers need to treat all fat women as individuals, ask about their case history, and tailor their care to their individual body. Because, as Becky said sarcastically, “You know all fat people have the same body.” The magazine also recommends that providers not try to “fix” patients, or force them to lose weight during pregnancy, and to realize that “the majority of fat women actually have healthy pregnancies and normal births.”
Fat prejudice, many believe, is one of the last acceptable forms of prejudice in America. It’s so deeply ingrained that Becky’s son, a 7-year-old, is ridiculed — for her weight. Doctors, who are often likely to be sizeist, can dole out some of the worst emotional blows to fat women.
We live in a society that constantly tells us our bodies themselves should make us ashamed, that we’re lazy, that we’re simply too big to be allowed. The medical community should be a safe place for us, particularly the OB-GYN community. But until women arm themselves with knowledge and call out sizeist prejudice in medicine, women like Becky and I will continue to suffer.