Doctors and Fat Pregnancy
I am overweight. I have small bones, little muscle, and am overweight according to every chart I have seen.
In the past year I have seen four doctors. Three of them directly addressed the subject of pregnancy. Two of them urged me to do everything reasonable to achieve pregnancy ASAP. None of them mentioned the fact that I am overweight or provided suggestions for a plan for losing weight and becoming more fit prior to seeking pregnancy.
If my only knowledge came from my doctors, I would think that weight and fitness were inconsequential in achieving a healthy pregnancy, carrying a healthy baby to term, and delivering that same healthy baby without complications. If that is what I thought, I could not be more radically incorrect. Is this reasonable?
What do you think about medical professionals who counsel overweight women regarding pregnancy without ever mentioning the numerous risks to the woman which could be reduced if the woman would lose weight prior to becoming pregnant?
What do you think about doctors actively providing fertility treatments to overweight women without first addressing their weight?
Does it make a difference to you that getting to the root of the weight issue might actually resolve the fertility issue?
What about the fact that the more first-time mothers weigh, the more likely the baby is to die?1
Or is it insane to imagine that a woman could be overweight in the U.S. without being fully aware of the issue? Do you think that it would just cause more pain for doctors to insist on confronting the health issue of fitness and weight prior to either suggesting or facilitating pregnancy?
What is reasonable?
1. “Among nulliparous women, the odds ratio for late fetal death were increased among women with higher body-mass indexes as compared with lean women, as follows: normal women, 2.2 (95 percent confidence interval, 1.2 to 4.1); overweight women, 3.2 (95 percent confidence interval, 1.6 to 6.2); and obese women, 4.3 (95 percent confidence interval, 2.0 to 9.3).” [Source]
I saw a OB when we were living in Indiana and she never said one thing about diet or exercise. The first the midwife did when we started at a birth center after moving was discuss healthy weight gain, getting exercise, had me chart my meals for several days to review, etc. The doctor only cared about the “medical” aspect of pregnancy, which I took it to mean things she could control, and since she couldn’t control my weight, eating or exercise, she didn’t care to even mention it (in her defense, she’d probably seen a ton of pregnant women who didn’t care to follow recommendations and therefore gave up). I feel like weight is no longer a “medical” issue to doctors. I recently saw a segment on 60 minutes or a show like it that said only 30 percent of doctors say anything about weight to the parents of children with obesity. Seriously?
That makes a lot of sense.
The lack of discussion of obesity depresses me since this is a life or death issue, and what on earth is the point of having doctors if they can’t even address these things?
I was what is considered “obese” when I conceived my first. the primary care physician I had at the time (and she referred me to the OB/GYN clinic I used for my first pregnancy) simply said, “Have your babies and then worry about losing the weight.” She said this to me as I lamented that I wished I weighed less when I got pregnant.
Obviously, she was coming from the mindset that I would have one or two babies, be “done” and then could worry about getting in shape, etc.
I am so glad I lost all that weight after I had my first. I weighed 250 pounds before delivering my first baby. I was not miserable, but I think it was because I was still so young. I dropped to a healthy 152 about a year after her birth. Usually I weigh in around 155-165 at the beginning of pregnancy and top out around 220. No matter what I do, I cannot seem to keep weight gain to the minimum 25-35 pounds during pregnancy and my doctor has finally said, “your body does pregnancy this way…as long as you drop the weight afterwards, you are fine.”
I am very glad I have been able to drop the weight between pregnancies, because as I get older, the discomfort throughout pregnancy increases. I can’t imagine what obesity would add to that experience.
Now I am in the throes of trying to lose weight again. Back at Weight Watchers, working out, running…I’m healthier because of it, and recommend that anyone desiring to get pregnant maintain a healthy weight and active lifestyle. But at the same time, your body can probably handle a bit more than you think it can. But you surely don’t want to test the limits too far or too often.
That is an awesome story. My mother apparently always gained a lot during pregnancy and hasn’t been overweight since my youngest sister was a baby so it seems normal to me that some women simply gain more during pregnancy without being unhealthy.
I think healthy weight is a medical issue, but most physicians are trained to focus on the other “more serious” ones–gestational diabetes, preclampsia, etc. Once in awhile you’ll run into a doc who takes it seriously (I have heard of some nazis out there who monitor every bite a woman takes while pregnant, though I have to admit I haven’t heard stories of docs doing this BEforehand).
Your strong feelings on this issue mirror my own when it comes to pediatricians and sleep: VERY few of ours have ever inquired or charted how much sleep my babies or older children get. Personally, this seems to me to be just as much an indicator of health and proper caregiving at home as the standard question of how many smokers there are in our household, argh. Also, parents could use all the help and encouragement they can get when it comes to sleep training and making a schedule that ALLOWS adequate rest for young children.
Oh great, now you’ve gotten me thinking about children and sleep issues. I’ve been trying to ignore this since I heard a teacher in one of the worst schools in Boston talk about how he could tell how late his 2nd grade students had stayed up the night before based upon their inability to focus/think in class on any given day. How is this not recognized as a basic sign of proper care?
I guess I have a very good doctor now. (I just switched primary care physicians.)
I told her I wanted to get pregnant but was struggling with infertility symptoms (no ovulation, no period, thyroid issues) and she recommended I wait a year and lose at least 40 lbs first (I weigh 208 currently). She’s going to track my thyroid at the same time. Hopefully weight-loss helps bring it all to a healthy pregnant me!
I think this definitely depends on your doctor. Our first doctor did not say a lick about my weight, but of course then we switched out of her because her c-section rate was so high. Our next doctor, who we switched to because we wanted to have as natural a childbirth as possible, was all over my weight gain like white on rice. Our midwife pretty much seconded her concern. I think it comes down to if they have a philosophy that you can do something to help make pregnancy and delivery easier/healthier or if they don’t. Our first doctor routinely said things that indicated that she didn’t think there was ANYTHING you could do to avoid a c-section whereas both our second doctor and midwife strongly believe that the patient has more control over things that increase your risk, i.e. weight gain. To the extent that they recommend completely cutting sweets/refined sugars/etc. and not just ‘cutting back’.
All that aside, I am seriously doubting that you are overweight and would love to know your BMI, although even that metric isn’t the greatest way to measure it.
Given that I am given to stereotypes, I think that CA doctors need to take a few chillpills and maybe think about the role that stress plays in pregnancy.
It just drives me crazy that so many won’t address the role of weight and fertility outside of pregnancy. One of my borderline obese friends was handed a prescription for clomid without any discussion of either what weight-loss could do for increasing ovulation naturally, or of the extra risks of seeking pregnancy while overweight.
And I thought my BMI was right above 25 when writing this post, but just for you I went and weighed myself again and I’m above 26.
My doctor has recently been on me about making sure i lose weight before i have any children, so that’s a good thing. But he also uses this an excuse to put me back on the pill. So i don’t have to worry about getting pregnant before i’m at optimal health.