Without Measure (WOM) 365

August 24, 2007

The Doctor Lecture Series: Morbid Obesity for Morons (Meaning You, the SDSW)

Filed under: health,self esteem,size acceptance — laurelnymph @ 8:29 am

The Continuing Adventures of the Super-Duper-Sized Woman 

By Daphne Yvonne Bradshaw

 

Daphne, the Super-Duper-Sized Woman, has sat through many CME (Continuing Medical Education) courses in the patient rooms of her various doctors through the years and has heard that many other fat people of all varieties of size have also sat through similar lectures. So, since the many doctors think it very important to spend countless minutes each appointment to teach the following lessons for a fat person’s own good and because most of the doctors seem to think that fat people have not paid attention, not realized the seriousness of their issues with us, or maybe are unable to listen (probably due to too much fat clogging our ears,) Daphne, the SDSW, thought it would be helpful to write out a list of lecture notes so that all will know whether or not we have listened, understood, and considered these words of supposed wisdom and truth on the issue of our weight, specifically the issue of our large supply of adipose tissue.

 

The following list will be in no particular order of importance. It will simply list lecture points. No comment on these points will be made at this time. This listing does not mean any agreement with the points or any disagreement with the points. Furthermore, these lecture notes do not mean the method of speaking to the fat patient is respectful or warranted. It is simply making sure the doctors know we have heard them properly… and perhaps have now passed this part of the course finally and can move on to more helpful aspects of our doctor visits. Well, Daphne, the SDSW, can dream, can’t she?!

 

So, without further ado, here are Daphne’s notes from her doctors’ lecture series entitled “Morbid Obesity for Morons, Specifically You (the Super-Duper-Sized Woman:”

 

1)      My weight is killing me, and my death is to be soon… even within the next five years (endlessly renewable as five year allotments pass.)

2)      I am in denial by refusing to go into hospice by thinking I am not near death when it is obvious I am dying soon due to being so very fat.

3)      I lie continuously and consistently about what I do and don’t eat.

4)      I obviously do overeat but refuse to admit it.

5)      Either I am a pathological liar about food and weight issues, or I am delusional or both.

6)      Maybe I am unaware of portion sizes, caloric values, the glycemic index, or other fine points of nutrition.

7)      I am apparently ignorant of the research and proof (and I am instructed to go read up on it if I am unconvinced) of how my weight is killing me and need to read more research on it since I am very determined to stay so huge.

8 )      I have never considered or even thought about the possibility of losing weight.

9)      I am incredibly lazy and either sit around or lie around all day, refusing to move. But, some doctors do add that if they had even an extra 100 pounds on them, they wouldn’t want to do anything either.

10)  I need less self-acceptance and more losing weight.

11)  A 1000 or even less calorie diet is healthy for me because the alternative is death.

12)   I need the gastric bypass surgery to make all my troubles go away. In fact, each doctor knows several people who have lost down to their normal weight and have no need for their former medicines. Some patients have even been cured of diabetes this way.

13)  Obviously I have no self-control or will power, so the only hope is the gastric bypass.

14)  It is my fault that none of the medical equipment, none of the doors, and none of the facilities are accessible or accurate for me because of my size, but I am to struggle through the agonizing pain physically and emotionally as well as paying the many fees for the services that don’t fit me and/or do not help me. After all I need the exercise anyway.

15)  Doctors hate seeing their patients, specifically me, killing themselves, but this is a part of the job, alas.

16)  Only I can choose what I do or don’t put into my mouth. If I would choose to eat less, I would lose weight.

17)  I need to exercise and move about or die.

18)  Anything I say or do that does not support the theory that my weight is killing me and is caused by my deliberate and willful choices is either fabricated or an obvious misinterpretation of whatever happened.

19)  I am too stubborn about medicines and the side effects. All medicines have side effects. But if I choose not to take a medicine, a cholesterol lowering medicine for example because it caused jaundice in me, then that is my choice. However, I should be aware that my choice is killing me. And, what is the point of taking a fasting lipids blood test if I am not going to be taking any medicines anyway?

20)  Since I am in a lot of pain, I need pain medicine not a firm diagnosis of what exactly is going wrong to cause the pain since I have already been told that my pains are caused by my huge amount of adipose tissue crushing and killing me.

21)  My too tight control of my diabetes is hindering my losing weight.

22)  Every condition is caused by and exacerbated by my fatness.

23)  I need psychiatric help because I am so huge and determined to stay that way.

24)  No professional medical person – nurse, OT, PT, practical nurse, nutritionist, dietician, or social worker who comes to my home and sees my conditions here has a true picture of how I eat or not eat and, hence, have all been brainwashed by me to lie for me concerning these matters.

 

Other entries in the continuing adventures of the Super-Duper-Sized Woman can be found here:

Adventures of the Super-Duper-Sized Woman
Pushing Jack Back Down the Beanstalk: So, I’m Fat; Must I Be Made Constantly Afraid?

July 27, 2007

Your Friends Make You Fat…Not!

Filed under: fitness,health,self esteem,size acceptance — directisaa @ 4:14 pm

The newest tidbits of expertise on obesity from one segment of the medical world published in the New England Journal of Medicine (NEJM) (vol 357, 370-379, 2007) are, not surprisingly, painfully flawed and guilty of the same underlying prejudice against fat people that plagues the medical community in general. If you break down their findings, two dangerous messages come across loud and clear:

1. Being around fat people will increase your chances of getting fat, so you better not hang out with fat people; and
2. If you’re fat, you’re going to lose all your friends if you don’t lose weight, so you better get thin as soon as possible!

Even the Chicago Sun-Times had a problem with the new research in this article. They concluded that the NEJM research “may also contribute to prejudice against overweight people.” I agree.

The new research hangs on that blemish of science, the Body Mass Index (BMI), which has never been an indicator of health and the research also makes sweeping generalizations about social networking influencing eating habits.

Common sense always provides answers where research fails, because research can be influenced by the researchers’ assumptions and prejudices.

Common sense says your friends don’t make choices for you. You decide what what you want to do with your life, even if you decide to agree to what your friends suggest you do. The assumption the medical community wants you to make is that all fat people make poor food choices and overeat with abandon, so you’d better get away from their social influence or by gum, they’ll make you lazy, ugly and stupid, too!

It’s a silly assumption but too many doctors and medical professionals make leaps of logic like that every day.

Common sense says everyone is an individual and individuals make individual choices. It may be hard for some people to understand but people of all shapes and sizes can be fit, eat healthy and be productive and active members of society. By the same reasoning, people of ALL shapes and sizes (including thin ones) can also lack fitness, have un-healthy habits and not be productive and active members of society. For some reason, some people don’t like to hear that — but it’s the truth.

Common sense says that you choose your friends based on whether they’re good friends or not.

There’s another term for choosing your friends based on appearance…it’s called “discrimination.”

June 27, 2007

Filed under: fitness,health,self esteem,size acceptance — laurelnymph @ 11:45 pm

Pushing Jack Back Down the Beanstalk: So, I’m Fat; Must I Be Made Constantly Afraid?

by Daphne Yvonne Bradshaw  After my adventures with my now ex-doctor, I started thinking of all the fear mongering put on me and on others like me. I am constantly warned of a shortened lifespan with a terribly painful death awaiting me from cardiovascular (or insert another major disease or, if the fear monger is particularly rude, “your lifestyle choices!”) disease. This is even more a certainty because of diabetes, of course. The diabetes alone adds more terror — the potential loss of limbs, sight, and other ghoulish complications. This death is expected at any time because of my morbid obesity and other risk factors. Just an aside here–I am WELL beyond being morbidly obese, thank you! So, I will die eventually in a larger than life manner? So? I live larger than most life around me already. Now what?


 

Well, I am told that this demise will be extremely painful over a long period of time, but my death will come unexpectedly at anytime. Yes, the fear mongers do use a lot of redundancy and contradiction, I repeat … and I am still trying to figure out how to reconcile that. Excruciating but unexpected demise? Long period of time but suddenly? Hmmm….oh well…onward with my rant… When I am doing all I know to do and all that I am convinced can be safely done, is it still reasonable to beat me up over these risk factors? Have I really deserved what I get because of these factors? Do only people of large size with my risk factors get this treatment? Is this fear mongering normal for the wider population? or even the narrower population? Do skinnier people with the same disease(s), minus the morbid obesity (but note that fat is not a disease!), get the same whipped frenzy of terrorization? Has any of the “mob squad” ever studied genetics, body chemistry, endocrinology, or even basic high school science? Yes, I do include our medical professionals here, alas. Maybe the skinny, maybe the whole population, maybe we all get these scare tactics, but do people like me get it more than the “norm?”  What is the acceptable harassment and terrorism of fat people index for today anyway? Do any of these terrorists realize that fear is itself a major risk factor? Hmmm…maybe that is their angle? They DO want rid of my hulking hugeness by any means necessary. I hear it replayed now–“Kill the giants!”


Oh, and it starts young, too. We have to save those fat kids before they grow any bigger and have more risk factors! Why, don’t you know that even KIDS die of cardiovascular disease now-a-days? Uh, perhaps, but so do some major league pitchers, Olympic ice skaters, wild/health food nuts, avid joggers, … Oh, oops, I wasn’t supposed to look there. Foolish footnote freak that I am! Geesh. Sorry about that. Personally, I see scare tactics used to sell almost everything this society wants us all to buy. It is right up there next to the woman’s boobs which are used to sell everything else. But, I can’t help but feel that the supersized and the still-fat-but-less-than-supersized do get more of the terrorization. Terror keeps all too many of us in line…docile…not rebelling and disabling the farts who are pulling all the strings and stealing all the fear hostages’ money.


I do resent being targeted so often for things I either cannot control or for things I am doing the best I know how to do. I know these diseases are nothing to take lightly, but do I have to be beaten into terror in addition? Can’t I enjoy whatever life I have nevertheless? Can I opt out of being afraid or being made afraid?

My next trick is learning how to stop being afraid and just smile. I will button up my overcoat, put on my hat, silently smile for now, and wheel myself right past all my detractors. Want to come along with me? Yes, there will be obstacles in my path and yours, too, no doubt. Does anyone have suggestions for the huge hurdles?  Oh, I forgot that I am too large for jumping hurdles. Drats! Ok, so I will have to settle for mowing them down with my wheelchair! Onward ho!

February 10, 2007

More Recommended Reading – Sue Widemark On WLS

Filed under: health — directisaa @ 11:16 pm

WLS – Weight Loss Surgery – the real question is quality of life

(Click the above link to read the entire article)

January 20, 2007

Recommended Reading From Sandy Szwarc, RN, BSN, CCP

Filed under: health — directisaa @ 3:30 am

Junkfood Science Weekend Special: Bariatric surgery – the most life-altering decision you’ll ever make

(Click the above link to read the entire article)

January 9, 2007

Adventures of the Super-Duper-Sized Woman

Filed under: health,self esteem,size acceptance — laurelnymph @ 7:46 am

by Daphne Yvonne Bradshaw

 

Finding and receiving even adequate respect when you are a fat person is both tricky and vital. All too often, a fat person does not get something even closely similar to minimal afforded dignity much less a good standard of treatment. This is true in a wide variety of fields, too, from inadequate space to move to clothing that truly fits to medical care. Even in the most personal of relationships, respect is all too often lacking because the use of a person’s fat is too easily used as a weapon to punish the “transgressor.” And, boy, can I tell you some tales!

 

As almost every fat person can tell you, everything bad or even the merely not good tends to get blamed on the fat. Good things that happen to and for a fat person are usually looked at as suspect or as consolation prizes of some kind. The message is loud and clear: You’re fat, so how could you have received that good thing (compliment, award, promotion, lover, etc.)—wasn’t there a more normal-sized person around at the time? Oh no! A fat person cannot have keen intelligence nor wit, beauty in and of themselves, good skills and talents, or any of the other things normal to humankind, right? It is as if respectable traits are in a negative ratio to body poundage: the more pounds the less good traits. Of course, when a fat person is berated for something that is automatically blamed on the fat, the fact that humans of all sizes and shapes tend to have these very same traits is not mentioned and is certainly not mentioned to the fat person in question. Why, that might just empower the fat person and destroy the power of the berating! We cannot have that, now can we?!

 

And so, let me introduce you to Daphne, the Super-Duper-Sized Woman who also sometimes likes to call herself the Quarter Ton Woman. She is loosely based on me, of course, but she does tend to have a lot more adventures than the real Daphne does, which is ok by me since she also gets into a lot more trouble than I tend to do on my own. Some of what Daphne, the SDSW (Super-Duper-Sized Woman,) gets into is based on situations either the real Daphne or my friends have experienced, but the stories are changed enough to protect the privacy of the participants, including or maybe especially including me. Daphne’s story will usually be told in third person so as to differentiate her tales from my own true tales which will be in first person. The Daphne used in first person is the one who tends to write documented articles and more serious stories; whereas, Daphne, the SDSW, likes to have fun and tends to be quite mischievous.

Give Me My Death Certificate, dag nabbit!

Daphne, the SDSW, was long overdue for a doctor’s appointment. Months had passed, and she had been unable to get out to see one of those she thought of as extremely overpaid and overly respected professionals. It wasn’t like she was deliberately trying to skip appointments…. Well, it was exactly like she was deliberately skipping appointments, truth be told—doctors tended to have hard to get into and around offices, tended to have very bad attitudes toward fat people in general and toward super-duper-sized people especially, and never seemed to give any remotely decent standard of care to a super-duper-sized person beyond “lose weight and all your troubles will be miles away.” In other words, if passing out awards for being truly unhelpful and even tending toward abusiveness, doctors ranked high up there in Daphne’s mind.

 

But, that wasn’t the primary reason she hadn’t been to see a doctor in months. The real reason was she had been in much more pain and extremely decreased mobility because of that pain for months. Flared up joints all over a body tends to do that even to the best of people and intentions. However, being practical about needing medications like a depended upon one known as insulin gave an added incentive not to put off seeing those doctors too long.

 

So, the day came when Daphne, the SDSW, made a valiant effort to get out to see her doctors all in one day so as to get it over and done with at one time. Even the weather decided to help her efforts… It was one of the strongest torrential downpours of the decade type of day. Ah, such joy.

 

Anyway, dripping onto the tiled floor, Daphne awaited her verdict. Surprisingly, she was not kept waiting too long this time to be disappointed much. The Doctor came in, shook her hand lightly, and proceeded to tell her she was dead already; therefore, she must go get the miracle performing and resurrecting “chop you up and serve you for sausage” surgery because, well, super-duper-size was a grave condition after all, and this procedure will get rid of all the many things going wrong in that super-duper-sized body. Never mind if the patient may die from the procedure because all know that such an enormous person did not have a life anyway. Besides, no one really knows when another will indeed die, and it would be much better to die after paying an enormous price to a very lucrative medical experimental business before expiration dates on a particular body than to die without adequate assisting of a payroll, now would it?

 

What was worse, Daphne wondered: being bullied into a quasi-submission or being declared dead but not given your death certificate that you’d already paid for? (Doctors’ office staffs have become very clever at requiring payment before allowing a person to see the MDieties anymore.)

 

Yes, both she and the doctor are still at this time breathing. And, she is still waiting to receive the paid for Death Certificate so she can approach her insurance for possible death benefits. Meanwhile, the saga will definitely continue, have no fear!

January 2, 2007

New Year, New Diet Mania

Filed under: fitness,health,ISAA,self esteem,size acceptance — directisaa @ 8:26 pm

Dilber from 01-01-07

We all know the scenario: the end-of-year holidays have come and gone and now the diet marketing goes into effect. People are guilt-tripped because they supposedly ate too much during the holidays, make New Years’ resolutions to lose weight this year and will try just about anything to accomplish this goal. Ah, but this year, we also have weight loss surgery being pushed by bariatric corporations, whether gastric banding or the full shebang, gastric bypass.

I’m pretty passionate in my disapproval of weight loss surgery (See ISAA’s Position on Weight Loss Surgery). I’ve had friends die from it, I’ve seen numerous lives ruined by it and I learn more not to like about it almost daily.

My outlook is not all gloom and doom, however. Actually, I have seen a lot of positive changes in recent years. Modern teens and young adults do not make weight loss as high a priority as their parents. Some do not make it a priority at all. In the United States, at least, this is the first generation of people to be raised with some awareness of size acceptance and the scientific proof that diets do not work. I believe this will eventually happen in other countries where word about size acceptance and healthy body esteem is beginning to spread, slowly but surely.

As we continue to work to get information about size acceptance, Respect Fitness Health and the pitfalls of the junk science being used to promote weight loss is dispensed in person and over the internet, the more information people will have to make informed choices concerning their health.

Even new studies are clearly showing that weight loss is not necessary to be healthy while making improved food choices and being active is. I believe we will see more research in this area and more conclusive proof but of course, time will tell.

Best Wishes,

Allen

December 2, 2006

Powering the sports car

Filed under: health,ISAA,self esteem,size acceptance — lyndafinn @ 9:44 pm

Many years ago, a friend recommended that I try the Hip and Thigh Diet.

I asked her how the diet plan knew to take weight only off my hips and thighs. What if it got it wrong and just took fat off one bosom and I ended up with one voluptuous breast and one saggy, skinny one. Or suppose it targeted my legs, I didn’t wants to walk around with one thin leg and one strong, shapely one.

She told me seriously that this was a, “scientifically designed diet to improve health and wellbeing”. Up to then, I hadn’t really thought of her as terminally stupid.

No diet, whether it is aimed at reducing body fat or designed for improving nutrition, can possibly target specific areas of the body. The Heart Diet doesn’t zoom in on that muscle and immediately repair any damage and cause it to beat happily for the next fifty years. The Liver Diet does not sweep through only that organ, cleansing like some nutritional hoover.

Of course you can eat foods which are kinder to the liver but they also reach every tiny particle of the whole body.

A certain food may upset your stomach and give you headache but it is also reaching every blood cell, every vein and muscle – because that’s what food is designed to do.

That’s why we have well nourished feet!

There are sensors throughout every particle of our wonderful bodies and when the glucose level falls they leap into action. First our senses become more acute so we can see and smell food and respond positively to it.

If you doubt this, try looking at your favourite food when you have a full tummy – doesn’t have the same appeal at all!

Then the awareness of food, or the need for it increases and our brain is unable to concentrate fully on whatever we are doing.

It begins small, the odd thought, ‘Gee, I’m about ready for a cup of coffee’, and continues, if we don’t respond, to a more intrusive imagining, the smell and feel of Java.

Eventually we just can’t get on with the job in hand because the body is crying out for sustenance.

Our need for food is no different to our need for water – the longer you deny that need, the more the body shuts down other faculties so it can concentrate on making you reach for something liquid, or edible.

I call that pretty wonderful.

Every tiny atom of you has been built and is sustained by one thing – food and this is why everything in the body is geared towards finding and consuming it.

From the pupils of the eyes, which dilate when we see food, to the saliva glands, taste buds and stomach juices which ra-ra in anticipation.

If we consume a diet full of low-nutrition foods, we will be malnourished, every part of us, and that means the organs will deteriorate.

This is why the diets aimed at certain organs are just plans to get better nutrition into the body so it can heal itself.

Eat fruits, vegetables, quality meats and fish, nuts, seeds and grains and (unless we are allergic to something) we will be filling every particle of our body with the elements it needs to repair and remain healthy.

That we should now be firmly trapped in a culture which seeks to feed the body on something which offers no nutritional value, or deprive it of the essentials it needs, is sad beyond belief.

It’s like buying a top-of-the-range sports car, expecting it to run on mower fuel and never maintaining it.

YOU are that sports car and you deserve the very best to power and keep you going, every part of you, hips, thighs and all.

November 16, 2006

Avoiding Surgery: Lowering the Cesarean Rate in Big Moms

Filed under: health,Pregnancy,size acceptance — directisaa @ 7:44 pm

This is a WOM article submitted by Kmom.

Most articles about pregnancy in obese women emphasize an increased risk for cesarean section. But is this really true? Can the cesarean rate be lowered among women of size? And what can a big mom do to lower her personal chances for a cesarean?

Why Not A Cesarean?

Some people today see a cesarean as just another way to give birth. Unfortunately, they don’t fully understand the risks of cesareans. 1

Certainly no one opposes truly necessary cesareans. But nowadays, more and more women are being convinced into a cesarean that’s not really necessary. Unfortunately, this has many health implications, many of which are not explained fully when deciding about a cesarean.

A cesarean is major abdominal surgery. It carries twice the risk for maternal death as a vaginal birth. It can cause severe bleeding, injuries to the bladder and bowels, life-threatening blood clots, painful internal scar tissue, long-term pelvic pain, and infections. Many women experience pain and problems for years after their cesarean.

Cesareans are also risky for babies. Some babies are cut during the surgery, risking infection and causing scarring. Babies born after cesareans are more likely to experience severe breathing problems, have low Apgar scores, and to be admitted to intensive care units. Breastfeeding is also less likely to succeed after a cesarean, which can have long-term health consequences for the baby.

A prior cesarean puts a woman at more risk for future birth complications like tubal pregnancies, placental abruption, premature birth, uterine rupture, and severe placental implantation disorders. Each successive cesarean raises these risks even higher.

Cesareans are even more risky for obese women. 2 There are increased risks for blood clots, anesthesia problems, severe bleeding, wound problems, and infection. Doctors should be doing everything in their power to lower the cesarean rate in obese women, but instead are doing far more cesareans in this group than ever before, risking the health of both big moms and their babies.

Skyrocketing Cesarean Rates in Women of Size

Just how high is the cesarean rate in big moms? Numbers vary greatly between studies, but several recent studies found that one-third to nearly one-half of obese mothers ended up having a cesarean. 3, 4 The rate in supersized women is even higher. 5 But it doesn’t have to be that way.

Doctors today assume that being fat interferes with the ability to give birth vaginally, and that a high cesarean rate is the logical outcome of obesity. However, in the past, the cesarean rate among women of size was significantly lower and many studies did not find a higher cesarean rate among obese women. 6, 7 If the cesarean rate was low in the past for obese women, it means that most fat women CAN give birth vaginally under the right conditions, and that a high cesarean rate is not an inevitable outcome of obesity.

While the overall cesarean rate has increased over time, the cesarean rate in women of size has increased proportionately far more than for women of average size. This suggests that attitudes and management protocols have changed the cesarean rate in women of size far more than obesity itself.

In fact, many of the cesareans in women of size today are “iatrogenic” — that is, caused by the attitudes and management protocols of the doctors, rather than by the woman’s size. This echoes the anecdotal experience of many big moms, who have found that when they shift to a less-interventive care model and become more empowered, they experience better outcomes and fewer cesareans.

The good news is that there are many things that a big mom can do to lower her risk for a cesarean. These include:

  • Be proactive in health habits
  • Choose a less-interventive care model
  • Educate yourself about childbirth issues
  • Choose a size-friendly care provider
  • Choose natural birth whenever possible

Be Proactive In Health Habits

Get regular exerciseWomen of size are at higher risk for high blood sugar and high blood pressure during pregnancy, thereby inviting more interventions and cesareans. Regular exercise can cut the risk for blood sugar and blood pressure problems significantly.

Practice excellent nutritionGreat nutrition is vital to a healthy pregnancy. Moderation is the key. Quantity of food is less important than quality of food, and overall nutrition should be emphasized over rigid weight gain goals.

  • Pay careful attention to the baby’s position If the baby is not in a good position, it does not fit through the pelvis as easily and can cause long hard births. Some research shows that obese women have a higher rate of malpositioned babies, 8 so preventing a malposition is especially important for them. Women can encourage a well-positioned baby by not slouching back when sitting, by keeping their hips higher than their knees, and by adopting forward-leaning positions as much as possible. 9
  • Get regular chiropractic care Because obesity is a strong mechanical stressor on the body, it can throw the back and pelvis out of alignment, and this may be another cause of fetal malpositions. Chiropractic care can help correct breech 10 and other malpositions, so regular chiropractic care may be another important way to help lower the risk for cesarean.

Choose a Less-Interventive Care Model

  • Hire a midwife Hiring a midwife to attend your birth lowers your risk for a cesarean significantly. This is especially true for women of size. 11 Some women assume that an OB offers better care, but research shows that outcomes are actually better with a midwife. 12 Some midwives practice in the hospital and can prescribe medications and labor drugs. Others attend births at home or in birth centers. Most are covered by insurance and work in consultation with area doctors if labor complications make a cesarean necessary. 13
  • Consider non-traditional birthplacesMost people think that hospital births are safer than non-hospital births. In fact, many studies have shown that birthing center and home births are just as safe as hospital births, yet much less likely to end in a cesarean. 14 Birth at home or in a birth center, attended by a midwife, is a reasonable choice. 15 Obese women can have out-of-hospital births too, and many big moms find that they have excellent outcomes and much more satisfying birth experiences in these settings.
  • Hire professional labor support – Professional labor support (a “doula”) can lower cesarean risk by up to 50%. 16 Doulas can be an amazing resource during the process of pregnancy and birth. They are especially helpful if you are birthing in the hospital.

Educate Yourself About Childbirth Issues

  • Be an informed health-care consumerThere are many controversies about the best way to manage pregnancy and birth. Understand the pros and cons of important issues so that you can make informed decisions about them. Read The Thinking Woman’s Guide To A Better Birth, by Henci Goer.
  • Take an out-of-hospital childbirth education class – Hospital childbirth classes are cheap, but you get what you pay for. Taking a good non-hospital class will help educate you about childbirth issues and becoming an empowered healthcare consumer.
  • Understand the pros and cons of prenatal testsPrenatal testing can be a double-edged sword. Its benefits often come at a price of further invasive testing and interventions. Understand exactly what is being tested and its benefits/risks. Remember that you always have the right to decline testing too.

Choose a Size-Friendly Care Provider

  • Choose a truly size-friendly provider – Being truly “size-friendly” means using size-appropriate equipment (like large blood pressure cuffs), not using extra interventions because of size, and not restricting nutrition or weight gain. A truly size-friendly provider believes in your ability to give birth vaginally and knows that spontaneous natural labor is the best way to achieve this. \When interviewing caregivers, ask open-ended questions, like “What extra tests or interventions might I need as a large woman?” and then just listen for the provider’s underlying attitudes to reveal themselves as they talk.

Date the pregnancy accuratelyMany women of size have longer menstrual cycles, 17 but doctors rarely account for this. This can make your due date artificially early, increasing the chances of induction or cesarean for an “overdue” pregnancy. If your cycles are longer than about 32 days, your due date should be adjusted accordingly.

  • Choose a provider comfortable with the possibility of a big baby Although most big moms do not have big babies, statistically they do have more, and this scares doctors. They are convinced that all fat women have huge babies who will get stuck on the way out. 18 Sadly, the fear of big babies is one of the strongest factors driving the high rate of cesareans in women of size. Your best bet is to find a provider who is comfortable with the possibility of a big baby and who will not try to rush the baby out too soon.
  • Don’t agree to estimate fetal weightMany care providers order an ultrasounds to estimate the baby’s weight. Research shows this is very inaccurate for predicting big babies, and greatly increases the risk for cesareans. 19 Choose a caregiver that does not do fetal weight estimates.
  • Don’t intervene for a big babyIf a big baby is suspected, many providers induce labor early. Research clearly shows that this strongly increases the risk for cesareans. 20 Other doctors insist on elective cesareans for big babies; research has also found this harmful. 21 Big babies are more likely to be born safely if labor is spontaneous, natural, and if the mother has full mobility during labor and pushing. Ask your provider if he/she would induce early or do a cesarean for a big baby, and if so, find another provider.
  • If you have had a prior cesarean, consider a vaginal birth for future pregnanciesMany doctors strongly discourage women of size from Vaginal Birth After Cesarean (VBAC), and this plays a very significant role in the high cesarean rate in obese women. Yet many women of size DO have VBACs, 22 given proper laboring conditions. The cesarean rate could be reduced significantly if more obese women were given a fair chance at giving birth naturally in future pregnancies.

Choose Natural Birth Whenever Possible

  • Avoid induction of laborInduction of labor is one of the strongest risk factors for cesareans, especially in first-time mothers, and carries significant risks. 23 Yet obese women are induced at far higher rates than other women, and this is one of the strongest factors driving their high rate of cesareans. For example, one study 24 found a cesarean rate of 19% in obese women in spontaneous labor, versus 41% in those who were induced. Let your baby choose its own birthday and you are much more likely to have an easy birth.
  • Labor spontaneously Let your labor progress on its own timetable. Many hospitals rush labor by augmenting with artificial drugs or by breaking the bag of waters. This carries risks to the baby. Let your labor progress naturally, at its own pace.
  • Don’t go to the hospital too early The cesarean rate is lowest in women who labor at home until labor is well-established and intense. 25 A doula can help you decide when it is time to go to the hospital if you are unsure, or you can give birth at home and not have to worry about when to leave at all.
  • Choose intermittent monitoring – Many hospitals insist on constant monitoring of the baby’s heartbeat. However, constant monitoring does not improve outcomes, and “false positive” readings cause many unnecessary cesareans. Intermittent monitoring helps track the baby’s condition just fine and lessens the chance of a “false positive” reading.
  • Avoid routine hospital protocols for women of size – Some hospitals require that all obese women have their waters broken on arrival to insert an internal monitor, or require all big moms to get an early epidural, “just in case.” These set up a self-fulfilling prophecy for a cesarean. Choose a less interventive birthplace.
  • Labor naturally – Although pain relief sounds alluring, remember that it comes at a price. Baby is exposed to drugs, labor slows, and the risk for cesarean increases. 26 Laboring naturally is very doable, especially with the help of a doula or warm water. Epidurals come with a high price; use them only when truly needed.
  • Labor with full mobility and change positions oftenMoving around freely during labor is very helpful and can lessen labor pain. Upright positions use gravity to help move the baby down, increase pelvic space, and help position babies better for birth. Immersion in water can especially help increase mobility in women of size during labor, and many women of size report absolutely loving laboring or giving birth in water.
Conclusion

Websites that offer only scare tactics about pregnancy at larger sizes emphasize how high the cesarean rate is in women of size. And it is true that the rate is high—–far too high. But it doesn’t have to be that way.

Research from the past proves that the cesarean rate was not always so high in women of size, and that in many studies, it was no higher for larger women than for average-sized women. That means the cesarean rate does NOT have to be so high in women of size, and we can all help normalize that rate.

The first step belongs to consumers. Women of size must take responsibility for their health; they must be sure they are healthy before pregnancy, they must be proactive about nutrition and exercise during pregnancy, and they must learn to research childbirth issues so they understand the benefits and risks of all proposed interventions. They can benefit from using a less-interventive model of care and from choosing their care provider and birthplace more wisely.

The second step belongs to healthcare providers. They must recognize that modern practice patterns and biases have raised the cesarean rates much more than obesity itself. They must stop inducing labor at such high rates, they must stop intervening for “big babies,” they must stop forcing women of size into unnecessary and debatable procedures, and they must become more vigorous in their promotion of spontaneous natural labor for women of size.

When allowed to labor naturally and with excellent support, women of even very large sizes have given birth vaginally, and with very good outcomes. But until women take responsibility for their own health and childbirth decisions, and until healthcare providers recognize the harm they cause with routine interventions for women of size, the cesarean rate in this group will only continue to climb.

Research References

1http://www.motherfriendly.org/Downloads/csec-fact-sheet.pdf – Evidence-based summary of the risks of cesarean to mother and baby, published by the Coalition for Maternity Services (CIMS)

2 ACOG Committee Opinion. Obesity in pregnancy. Obstetrics and Gynecology 2005 Sep;106(3):671-5.

3 Weiss JL et al. Obesity, obstetric complications and cesarean delivery rate—A population-based screening study. American Journal of Obstetrics and Gynecology. April 2004. 190(4):1091-7.

4 Crane SS et al. Association between pre-pregnancy obesity and the risk of cesarean section. Obstetrics and Gynecology 1997 Feb;89(2):213-6.

5 Hood DD, Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology 1993 Dec;79(6):1210-8.

6 Edwards LE et al. Pregnancy in the massively obese: Course, outcome, and obesity prognosis of the infant. American Journal of Obstetrics and Gynecology. 1978. 131(5):479-83.

7 Sicuranza BJ and Tisdall LH. Cesarean section in the massively obese. Journal of Reproductive Medicine. January 1975. 14(1):10-1.

8 Jensen H et al. The influence of prepregnancy body mass index on labor complications. Acta Obstet Gynecol Scand 1999. 78:799-802.

9 See http://www.spinningbabies.com for information on how maternal posture can influence fetal position

10 http://www.chiro.org/pediatrics/ABSTRACTS/The_Webster_Technique.shtml – abstract of a study about the effectiveness of chiropractic care for helping resolve breech malpresentations

11 http://www.cdc.gov/nchs/pressroom/98news/midwife.htm – Center for Disease Control website press release showing that the risk of infant death is lower with a midwife than with a doctor

12 Kaiser PS and Kirby RS. Obesity as a risk factor for cesarean in a low-risk population. Obstetrics and Gynecology 2001 Jan;97(1):39-43.

13 http://www.cfmidwifery.org/midwifery/faq.aspx – Description of different types of midwives available, with a summary of their training and certification requirements

14 Johnson KC and Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ (18 June) 2005;330:1416 (abstract available for free online at http://bmj.bmjjournals.com/cgi/content/abstract/330/7505/1416)

15 http://www.maternityservices.com/is_homebirth_with_a_midwife_safe1.htm – Webpage on the safety of homebirth with a midwife

16 http://www.maternitywise.org/mw/topics/laborsupport/index.html – Summary of the benefits of labor support (especially professional “doula” labor support) in improving the quality of the birth experience and the interventions used. See also www.dona.com for information on finding a doula in your area.

17 Symons JP et al. Relationship of body composition measures and menstrual cycle length. Ann Hum Biol 1997 Mar-Apr;24(2):107-16.

18 Robinson H. Is maternal obesity a predictor of shoulder dystocia? Obstetrics and Gynecology 2003 Jan;101(1):24-7.

19 Parry S Ultrasonographic prediction of fetal macrosomia. Association with cesarean delivery. Journal of Reproductive Medicine 2000 Jan;45(1):17-22.

20 Combs CA et al. Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia. Obstetrics and Gynecology 1993 Apr;81(4):492-6.

21 Zamorski MA and Biggs WS. Management of suspected fetal macrosomia. American Family Physician 2001;63:302-6. Free full-text article available at http://www.aafp.org/afp/20010115/302.html

22 Goodall PT et al. Obesity as risk factor for a failed trial of labor in patients with previous cesarean delivery. American Journal of Obstetrics and Gynecology 2005 May;192(5):1423-6.

23 http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf – Summary of the risks of induction to mother and baby, published by the Coalition for Maternity Services (CIMS)

24 Usha Kiran TS et al. Outcome of pregnancy in a woman with increased body mass index. BJOG 2005 Jun;112(6):768-72.

25 http://www.ahrq.gov/research/aug03/0803RA13.htm#head3 – Summary of a study that found lower cesarean rates in women who saw nurse-midwives and also in women who waited until active labor was well-established before being admitted to the hospital. Jackson DJ et al, Impact of collaborative management and early admission in labor on method of delivery. Journal of Obstetric, Gynecologic & Neonatal Nursing 2003 Mar;32(2):147-157.

26 http://parenting.ivillage.com/pregnancy/plabor/0,,8jzw-p,00.html – Article on the benefits and risks of epidurals in labor

Other Miscellaneous Resources

Non-Hospital Childbirth Education Organizations:

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