Birth Bias Series: Weight

I’m going to preface this by saying a couple of things. Firstly all names with an asterisk (*) have been changed to protect the privacy of the wonderful women who shared their stories with me. Secondly, the overwhelming response I had when asking women to share their experiences with me was almost heartbreaking. This isn’t a one-off thing, and we need to do better than this.

This was originally going to be a one off blog discussing all kinds of bias women experience during pregnancy and why, but the sheer volume of responses I’ve had means it’s sensible to do this in multiple posts. So stay tuned!

It may be an uncomfortable thought, but many women who experience pregnancy and childbirth are subject to a form of bias. The experience of a Caucasian cisgender heterosexual woman of a medically healthy weight will be subject to privileges they may not even be aware of.

If I’ve ruffled your feathers, good! If you can relate to this bias, I’m sorry.

Part One: How your weight affects your pregnancy and childbirth experience

Pregnancy can wreak havoc on a woman’s weight, and the use of the outdated BMI system assigning numbers which decide whether you’re allowed to gain any weight during pregnancy can cause so much stress and trauma. Whether you are underweight, overweight, or living with an eating disorder, the normal and natural weight gain in pregnancy becomes almost taboo.

On average during pregnancy, the extra weight is proportioned into 4 equal parts: baby, placenta, water, and blood. Weight gain is perfectly normal, no matter what you weigh to start with.

I was referred to eating disorder services at 33 weeks, after asking four times to be referred, and they asked ‘why did it take you so long to ask for help?’

Christina has lived with an eating disorder since the age of 13, and when falling pregnant with her first child a doctor told her the baby would “eat” her. Despite seeking support on several occasions to ensure a sensible and healthy weight gain, Christina was not referred to eating disorder services until 33 weeks pregnant.

I was compulsively sick until my throat bled because I was terrified of weight gain after pregnancy and how I would cope. I tried to control it by following advice in books which said don’t eat anything extra or you’ll get fat. Bear in mind I was taking in 85% of my calories pre-pregnancy from wine – the midwife even suggested I had a couple of glasses if it would make me eat! I never felt ill, I never thought I looked bad. I think I was 7 stone after having my daughter. I couldn’t breastfeed because I was so emaciated that I couldn’t make milk. When I had my son, I was already under the eating disorders team, but when I cried for the fifth time after being weighed they said “we’re not really set up for pregnant women with anorexia so it’s best you come back after having your baby”. I was later refused by their service because my BMI wasn’t 16 or under, and I was obviously still having periods.

With approximately 1.25 million people in the UK living with an eating disorder, and with around 75% of those being female (statistics from BEAT) Christina’s story is shocking but not unique.

Christina is now working towards becoming an eating disorders therapist, and in her current job is championing raising awareness of eating disorders in the office, and working with people with hidden disabilities. You can find her blog here and she’s also on Twitter

But what about the other end of the spectrum? With more than half of UK adults classed as overweight or obese according to their BMI, being labelled as a fat mother can also be a tough ride.

I was told I was doing so well losing weight, when in reality I was severely malnourished and dehydrated

Jenny* had a BMI of 40 at her booking in appointment with her youngest child. During her pregnancy she suffered from hyperemesis gravidarum, more information on this can be found on the Pregnancy Sickness Support website

Right from the start, I was made to feel guilty and ashamed for daring to fall pregnant without a perfect BMI; despite no other complications I was forced under consultant led care removing any chance of the relaxed hypnobirthing experience I had planned. The first time I met with the consultant she told me “you absolutely must not gain weight during this pregnancy” essentially putting me on a diet for the entire time. I was consistently reminded that I had a higher chance of miscarriage, gestational diabetes, epidural complications, and so on. The irony in hindsight is that I also suffered with hyperemesis gravidarum, and I ultimately ended up losing close to 5 stone during pregnancy. Every time I was weighed, I was told I was doing so well losing weight, when in reality I was severely malnourished and dehydrated – something that wasn’t picked up on until I was so weak I could barely walk and was admitted to hospital. People were so focussed on how much I weighed that they overlooked how seriously unwell I was for several weeks. I actually ended up being induced early as my baby was measuring so small due to the severity of my HG. Had I not been overweight when I fell pregnant, I am sure I would have actually been taken care of. I’m still angry at the extent my safety was put at risk because they were so bothered about the number on the scales.

Thankfully, Jenny’s baby was born with no complications and at a healthy weight, and they both left the hospital the day after birth.

A common theme between these two women is the lack of appropriate medical care due to their weight. With BMI largely hailed as a very outdated way of judging whether someone’s weight is healthy or not, is it time for medical professionals to find a new system?

With the BMI system dating back to the 1800s, it simply uses your weight and height to decide if you are healthy or not. Of course, this cannot account for muscle mass, body fat percentage, or where the fat is being carried on your body.

It is certainly time for healthcare professionals to look at a pregnant woman in terms of more than their weight; a more holistic approach will pave the way to eliminating the biases experienced by women like Christina and Jenny.

Next time we’ll be talking about age, so keep an eye out for the next post!

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