It’s not something many of us like to think about, but weight discrimination during pregnancy is a real thing — and is much more common than you might think. Think about it: almost all women (of all sizes and shapes) have had unwelcome or disparaging comments made about their weight while pregnant. I know I did, and I can recall many of my friends who experienced the same.
And many times, this happened right in the doctor’s office.
Take Annie, a 40-year-old first time mom. Speaking with Scary Mommy, Annie says that she’d always been self-conscious about her weight, and when she became pregnant, she asked that her OB not discuss her weight with her unless completely necessary. Luckily, her OB – whom she loves – was on board.
“I honestly have no idea how much I currently weigh, because I refuse to look at the scale at my appointments, and I ask them not to tell me,” she tells Scary Mommy. In fact, she recalls that she recently “sheepishly” asked her OB if she’d gained too much weight.
“She looked at my chart and said, ‘No. Relax, you’re doing fine.’”
But all of that comfort and assurance was blown to bits a few days later when Annie went to get an ultrasound scan for the baby. Annie remembers that the sonographer was struggling to get a good image of the baby.
“The ultrasound tech almost broke me in half, pushing even harder into my stomach than I would have thought possible,” she says. “She kept saying ‘Sorry, I have to push so hard. The baby’s not moving into the right position.’”
This kind of thing had happened at previous ultrasounds, and Annie didn’t think much of it.
“Yeah, my doctor often says that the baby tends to prefer one side,” Annie responded.
That was when the ultrasound tech leaned in and told Annie: “I’ll tell you a secret… they’re just saying that to spare your feelings, because it’s really about your weight.”
“I wanted to die,” Annie says. “How in the ever-loving fuck do you speak that way to a patient when you supposedly work in a human service field?”
Annie says that even though the incident is over – and she will obviously never book an appointment with that sonographer again – the bad feelings have lingered, and the whole incident really crushed her self-esteem.
Sadly, Annie’s story is all too common. And experiences like Annie’s can have a strong, lasting, and sometimes devastating impact.
Weight bias in the maternal care field can negatively effect not only a woman’s self-esteem and pregnant body image (which, in extreme cases, can lead to disordered eating and eating disorders during pregnancy), but it can actually result in poorer overall medical care, which can be harmful to both mothers and their babies.
This is especially true for women who are considered overweight by their doctors, says Crystal Karges, a Registered Dietitian Nutritionist and Board Certified Lactation Consultant who frequently works with pregnant and postpartum mothers.
“Within an already fragile healthcare system, mothers in larger bodies may encounter obstacles that prevent access to unbiased medical care,” Karges says. Doctors often make “dangerous assumptions that may influence a misdiagnosis,” Karges explains, including a higher likelihood of induction and higher C-section births. Some mothers might even receive delayed treatment because of their size, or inadequate prenatal care, says Karges.
“Lack of adequate and supportive medical care during and after birth can be a contributing factor to the declining maternal health care in the United States,” she surmises.
Research backs this up. A 2013 study published in BMC Pregnancy and Childbirth looked at weight bias in Western maternal care, and found that the stigma placed on women in larger bodies is pervasive – and very concerning.
“Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women,” the study authors conclude. “Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women.”
Doesn’t this absolutely make your blood boil?
Karges says she sees this kind of damage in her own practice frequently, where larger women are given dangerous and misguided advice from their caregivers.
“There have been several instances where moms that I work with have been advised to go on a diet or try to lose weight during pregnancy, which is completely unethical and not evidenced-based practices,” Karges says. “These types of recommendations can create a sense of chaos for a woman when it comes to her body and how she eats, making her feel that she cannot trust herself or her body.”
Can you imagine? This truly is unacceptable, and is much more pervasive than you might think.
I personally remember being told that my four-pound weight gain was “unnecessary” at 8 weeks pregnant, and that I really needed to slow down my eating. I promptly fired my OB and switched to a midwife. But that feeling of judgment and critique stayed with me.
Like many women, I had spent my teens and 20s with a bad case of body dysmorphia, and this kind of thing did not help. If anything, it made my eating less healthy, because it spiked feelings of depression and shame in me.
Again, nothing about my case, Annie’s case, or Karges’ patients’ cases are unusual. And in addition to the risk of inadequate medical care for women who face weight discrimination during pregnancy, there is also the very real threat of mental health issues being triggered.
“Pregnancy and postpartum are already vulnerable times for women due to the number of changes being experienced, including physically, socially, and more,” says Karges. “Experiencing stigma on top of this can be overwhelming and serve as a trigger for worsening mental health function.”
So what to do about all of this? First, educate yourself about it all. If you are able to (I know it’s easier said than done!), educate the medical professionals around you by expressing how their criticisms make you feel. If you feel that you are receiving sub-par care because of weight discrimination, definitely file a formal complaint.
And if at all possible, switch doctors. It is possible to find compassionate, body positive, supportive care – and we all deserve nothing less.