Am I too fat to have a baby?
November 22, 2015 6:44 AM   Subscribe

Ladies who've done this successfully, and ones who've had complications, please tell me all about it.

We've arrived at now-or-never time, and have been having Serious Talks about the pros and cons. One of my big concerns is my weight, which is in the obese range; my BMI is 34. Related features: blood pressure is in the high-normal range, and I take a low dose of omeprazole daily for reflux. While I believe in health at any size for others, I am not healthy at any size, and I am well aware that I should lose weight. I've tried lots of ways to do so, and this question is not about weight loss - please don't answer this question with "low carb" etc.

Ladies who have had this issue - what was it like? How often do they weigh you? Did you get fat-shamed? What do they recommend about weight gain during the pregnancy? What are my options for managing reflux? What else haven't I thought of?

Other info that might be relevant - I'm in my late 30s. My periods have always been like clockwork. I am aware that weight can affect fertility. Also, I have enough ambivalence about pregnancy that the idea of a baby isn't enough to motivate weight loss (so saying "think of what's best for your baby" isn't going to help).

Thank you. It's scary to put this in writing, so please be gentle.
posted by anonymous to Health & Fitness (32 answers total) 7 users marked this as a favorite
 
My BMI was in the high 30s when I conceived (easily) at age 40. I had an uncomplicated and healthy pregnancy and delivery, and my weight was not an issue at all. I found that I lost some weight during the first half of my pregnancy (increased metabolism & mild food aversions), and gained 10-15 lbs in the 2nd half. Two days after my 8.5 lb baby was born, I was back at my pre-pregnancy weight - basically, my body already had all the extra fat it needed to sustain a pregnancy, so I didn't gain anything beyond the weight of the baby & placenta. My midwife said this is common for larger women. I did not have any issues with fat-shaming or suggestions that I was endangering my baby by being fat. Yes, there are some statistically higher risks when you have extra weight, but it's very possible to have a happy healthy pregnancy at your size.
posted by judith at 7:08 AM on November 22, 2015 [7 favorites]


The website Plus Size Birth would be a great resource to start with.

I can talk a lot about pregnancy and reflux, though not from the perspective of someone overweight. If you've got bad reflux, your doctor will generally just have you try different meds until you find one that works. My reflux got so bad I ended up in the ER with chest pains, but eventually we found a combo of pills that worked.

The American Congress of Obstetricians and Gynecologists has recommended guidelines for weight gain:

25-35 lbs if you're at a normal weight (BMI 18.5–24.9)
15-25 lbs if you're overweight (BMI 25–29.9)
11-20 lbs if your obese (BMI 30+)

I hope you find some good answers here and best of luck.
posted by whitewall at 7:15 AM on November 22, 2015


Also, even if you don't think of yourself as a Redditor, they have some great groups for expecting parents, including r/plussizedpregnancy.
posted by whitewall at 7:17 AM on November 22, 2015 [1 favorite]


You are not too heavy. Not at all. A friend of mine just had a normal baby and healthy pregnancy and her bmi is in the mid 40s, if I had to guess. And when I was pregnant, bmi 31, no one even commented on starting weight at the dr's office, just whether my gaining was in the normal range. One thing, I think pregnancy can be more uncomfortable if you're starting heavier. But seriously, bigger ladies have babies every day. Go for it! Good luck!
posted by mirabelle at 7:22 AM on November 22, 2015


My BMI was similar for my pregnancies. In both cases, I conceived quickly & with no issues at 33 and 36.

They weigh you at every appointment, but they do that for everybody. My doctors/midwives didn't really comment ( beyond saying it looked like things were on track) and definitely didn't fat-shame me. With my second child I actually lost a lot of weight the first half of the pregnancy because I was puking constantly and could not eat anything but Eggo waffles. I definitely gained more than the 11-20 pounds mentioned above with my first pregnancy and probably about 20 with the second, but my babies were both 9+ lbs.

Your doctors will probably be more concerned about the possibility of Gestational Diabetes. They might insist that you do both the glucose challenge and glucose tolerance tests even if the first one comes back in the normal range.
posted by belladonna at 7:30 AM on November 22, 2015


How often do they weigh you? Did you get fat-shamed? What do they recommend about weight gain during the pregnancy?

I had completely normal pregnancies and weight gains and I ate healthily and all that, but I got very hung up on what the scale said, which was really stupid because you're going to gain weight when you're pregnant. I did have excellent midwives in a group practice and they were used to that.

They'll weigh you every time you go in, and it is completely possible and okay to tell your medical team that you can get hung up on this number, so for them to weigh you with your back against the scale, please not tell you what your weight is or how much you've gained, to please write the number somewhere on the chart where you won't see it, and to only discuss your weight with you IF AND ONLY IF THERE IS A PROBLEM.

You won't be fat shamed in a good practice! Weight gain is normal and expected. I put on 50 pounds with my first kid (and lost 23 pounds, mostly fluid, within 2 days of having her), 12 for my second and about 20 for my third. All of these were completely normal for ME.
posted by kinetic at 7:33 AM on November 22, 2015 [1 favorite]


Your family history with pregnancy has a greater impact on your gestational health than your weight. How have other women in your family fared? If you have a family history of gestational diabetes, if you get GD it will not be because of your weight.

One thing to consider, rather than trying to lose weight, is trying to gain muscle. Pregnancy is hard on the body, on the joints especially. Gaining some muscle would help you handle the hard work of labor. Weight training helps prevent osteoporosis, of particular concern for mothers. Simple body-movement exercises that only require floor space are all you need.

People can be awful, but the important thing is your health, not what the scale says.
posted by domo at 7:42 AM on November 22, 2015


You need to find an OB/GYN you really trust. Find one now, because regardless of your child-bearing decisions, it's a good thing to have a doctor you really love, especially for a part of your body this personal. But also, if you decide you want to get pregnant, it'll be so much better if you already have a great doctor. Your OB will be able to talk to you about what, if any, effect your weight and health issues may have on your pregnancy. Your OB will be able to monitor any areas of concern. Your OB will be able to give you specific, personalized advice about any issues with your health. And, you can be certain you won't be fat-shamed by your doctor if you already have a great doctor (and any doctor who fat-shames, but especially a doctor who fat-shames a nervous pregnant woman, can go F themselves, and you should file a complaint with the board that licenses them so that it's on file).

Also, it sounds as though you'd like to make improvements to your health regardless of pregnancy. If that's true (and if it's not true, I apologize for reading something into your post that wasn't there), you can do that without worrying about what effect it has on your weight. That's what Health at Every Size is about: making your body as happy as it can be without regard for what size it is. Eating delicious, nutritious food and doing activities you love and taking care of things that hurt or bother you are all good things. If you need a great doctor to help you, find one, even if you ultimately decide you're not going to try to get pregnant.
posted by decathecting at 7:52 AM on November 22, 2015


Oh, sweetie. This is so not the problem your brain is trying to convince you it is.

Anectdotally:
30 years old, 5'6" and 195 lbs: Totally uneventful pregnancy and perfect delivery and no health care professional associated with that pregnancy ever had a probelm with my weight.

35 years old, 5'6" and 220lbs (Bmi of 36!): another pregnancy free of fat-shaming. I has severe hyperemesis and lost 60 pounds while pregnant and even then at no point was anyone commenting about my being too fat. Everyone WANTED me to gain weight.

I have family members and friends who have BMI of 37 and 38 who have had perfectly normal pregnancies free of any fat shaming. My Facebook feed is filled with big round lovely pregnant fat women having happy, joyful healthy pregnancies. You can, too.

You go for yours, friend. Good luck!
posted by waterisfinite at 7:57 AM on November 22, 2015 [1 favorite]


Yeah I came here to tell you to make sure your current OB/GYN is not a fat shaming jerk before you get pregnant. My OB is amazing and has never once mentioned my weight gain during my pregnancy (although I am overweight BMI and not obese) BUT a friend of mine who is larger than I am had to change doctors because even though we have gained approximately the same amount of weight was fat shaming her left and right and lecturing about eating cheese burgers when she was being very strict about a healthy diet for baby. Your experience after conceiving is really going to depend on the Doctor you have.

If you're in the Philly area, I can give you the name of the OB I go to (and really and truly love). Memail me if you're local!

One of the tips for conceiving I have heard when overweight is losing even a smudge off weight will help. apparently the chemicals released from even tiny weight loss boosts fertility (anecdata - my older sister was about 50lbs overweight and was struggling with fertility for over a year and decided to start training for a 5k to keep her mind off of it - two weeks into regular training was when she conceived her first). Her midwife confirmed it was the training that boosted it (I think she lost like 3lbs before conceiving - so not a significant amount at all).

Good luck with your journey!
posted by Suffocating Kitty at 8:28 AM on November 22, 2015


Yeah, this isn't that big a deal and you won't be the heaviest woman at the ob/gyn by a long shot. They weigh you every appointment but a good ob/Gyn won't fat shame or really even mention it unless there's an actual problem. You have LOTS of options for managing reflux because it's so common in pregnancy. They suggest overweight women gain slightly less weight during pregnancy but they recognize a lot of women don't have much control over how much they gain so, again, unless there's a problem they won't talk a lot about it.

The one actual issue that came up for me during my second pregnancy was that because of the baby's positioning and my overweightness and a retorverted uterus, they had trouble with the heartbeat Doppler during the first trimester a couple times when the baby was snuggled way, way back behind all my fat and muffled by it. By the second trimester that was fine, my uterus had flipped forward and he was a lot closer to the surface.
posted by Eyebrows McGee at 8:44 AM on November 22, 2015


You are not too fat to have a baby but you do have risk factors that women with lower BMIs do not. The attitude in this thread is pretty cavalier to be honest. I AM NO EXPERT (not even close) but I am studying for a nursing exam tomorrow on fetal and maternal implications of obesity during pregnancy. Feel free to email me and I will send you my notes.
posted by pintapicasso at 9:09 AM on November 22, 2015 [4 favorites]


I agree that a good doctor should not fat-shame you, but there are certainly are doctors who do. (I've been working with a client on how to tell off her doctor, because his harping is causing her major body-image issues, which is making her depressed and anxious, which is keeping her from exercising, which is making her body-image issues worse, etc.) So I definitely echo the advice to find a good non-fat-shaming physician/midwife/NP now, but it might help you feel more prepared if you think of what you'd like to do if it does happen, whether that's telling off the doctor or switching practices. Because I absolutely agree that it shouldn't happen, and that it's your right to have a pregnancy free of that nonsense.
posted by jaguar at 9:11 AM on November 22, 2015


pintapicasso: "You are not too fat to have a baby but you do have risk factors that women with lower BMIs do not. The attitude in this thread is pretty cavalier to be honest"

This is true but a) a LOT of very overweight and obese women get pregnant and it is pretty normal these days and b) the doctor monitors for these risk factors and addresses them as they arise. You're at higher risk for gestational diabetes, for example ... so you pee in a cup every time you go to the doctor's office and if you get gestational diabetes, they can monitor and treat it.

The cavalier attitude may be because women commenting in this thread mostly have babies, and as anyone who's had a baby or two can tell you, there are ALL KINDS of risk factors, both within and outside your control, and all kinds of bizarre things that happen during every normal pregnancy, and you can spent your whole pregnancy going "OMG I HAD COUGH SYRUP BEFORE I KNEW I WAS PREGNANT AND OPIOIDS CAN CAUSE SERIOUS BIRTH DEFECTS" or you can accept that there's no such thing as a prefect pregnancy and that you control what you can control, treat what you can treat, and (attempt to) relax about the rest of it.

(My actual risk factors have never come to anything during my pregnancies, but I have gotten far more than my fair share of "well that's just darn bad luck" including a case of pneumonia that had me hospitalized and a bizarrely mal-positioned baby who had to be C-sectioned and the rare and exciting hyperemesis gravardium that goes on for nine solid months. My ob/gyn teased me about being "the 1%" because I kept getting every. single. random thing that happens to "less than 1% of women" in pregnancy. But none of the things I was actually at risk for!)
posted by Eyebrows McGee at 9:25 AM on November 22, 2015 [13 favorites]


You are at a similar BMI to where I was when I got pregnant!

I had no fat-shaming issues at all. There were a few things that you might want to be aware of:

1. I didn't "show" for a long, long time. Strangers didn't realize I was pregnant until my last checkup (so about 9 months!) This was due to many things besides weight, but weight was a lot of it. It kinda sucked because I wanted people to treat me like a pregnant person! Oh well.

2. Already being obese can make decisions about gaining weight harder. I gained 80 (!!!) pounds while pregnant, eventually tipping the scale at 295+. My doctor "counseled" me about it once. You will have to proactively decide what to do about weight gain while pregnant, and it's not an easy decision. It's made more difficult by hormones and other factors, like food aversions. There is little to no information out there about weight gain during pregnancy. What information is out there is contradictory. I decided to eat whatever I felt like, largely on the theory that we don't know much about how weight gain affects fetuses, but we do know how much maternal stress affects fetuses. I also have vague intuitions about the effect of maternal hunger/deprivation on fetuses leading to obesity or other issues later in life. Consequently, I decided not to worry about my weight. The downside of that is that I was stuck with 20-30 extra pounds that were really difficult to lose and that made my life notably worse. Joint pain is worse, my energy level is lower, and my reflux is much worse when I'm 20-30 pounds heavier. I have lost those pounds but that's not something you can count on happening.

3. Lots of things I worried about didn't happen: no one gave me crap for being bigger, and I lived in the land of skinny skinny moms (Manhattan/UMC Brooklyn). It was literally never an issue. My doctor did not care, nurses did not care, no one cared. If you tell people you are pregnant they just try to feed you. It's kinda awesome, actually.
posted by internet fraud detective squad, station number 9 at 10:09 AM on November 22, 2015 [3 favorites]


Although, I should also note that you do need all the screenings and all the tests (I know, I know). Don't buy into the idea that you don't really need the diabetes screen or don't really need all the quick checkups where they take your blood pressure. They also do need to monitor your weight for all sorts of non-fat-shaming reasons, so expect that. They do it to everybody, though. :)

Good luck!
posted by internet fraud detective squad, station number 9 at 10:13 AM on November 22, 2015 [1 favorite]


As a woman with an above normal BMI who is not your doctor, I would suggest that you start asking around for recommendations for OB's and/or Certified Nurse Midwives (depending on your preference) and ask them about their approach to mothers with your exact issues. Of these, get an appointment with your favorite one to come up with a strategy for your pregnancy before you conceive. I wish I had been more on top of my pre-natal health while I was trying to conceive at an above-normal BMI. But conceive I did, and had a healthy pregnancy, a healthy vaginal delivery and a healthy baby.

My OB was very kind and down to earth and did not size-shame me at all.
posted by Pearl928 at 10:15 AM on November 22, 2015


Feel free to email me and I will send you my notes.
Pregnancy is risky. It's easy to scare people. Professionals have to be aware of scenarios that will affect only a small proportion of people. It's hard for lay people to assess risk.

Nobody sends newly pregnant women off to read midwifery teaching texts for the very good reason it would scare them half to death. Reducing stress in the pregnant is a key midwifery skill. Eyebrows' answer flagged as fantastic.
posted by glasseyes at 10:33 AM on November 22, 2015 [4 favorites]


I'm a former OB nurse, have had 4 successful and healthy pregnancies (the last at age 36) with a BMI slightly higher than yours. I've had patients much larger than me have healthy babies. None of my personal OBs or any that I've worked with have ever said anything about any patient's weight unless it was due to fluid retention (happens regardless of initial weight) or if we had to alter how to monitor someone during labor (which only happened twice on my shift over several years of working).

Eyebrows McGee, per usual, has fantastic advice!
posted by hollygoheavy at 10:41 AM on November 22, 2015 [2 favorites]


I had a BMI of 33 when pregnant and the only time anyone raised the issue of my weight was when I asked how much weight I should gain and the OB said 15-20 lbs (I gained 15 total). I was weighed at every appointment, but from talking to friends, that's normal, and the nurse never even said my weight out loud, she just put it in my chart. I actually switched OB practices at 22 weeks when we moved, and had the same experience at both practices. No fat shaming whatsoever. The only time I felt awkward was when a doctor I hadn't seen before walked into the room carrying a measuring tape, then set it on the counter when she realized she couldn't use it on me. It was only awkward because I had heard from other friends that their bellies had been measured at every appointment and knew that they couldn't measure mine since I was so fat and already had a large belly.

I had a healthy pregnancy (no gestational diabetes, for example) and a healthy baby - now preschooler - who is tall and thin. I think the only time that my weight was an issue was towards the end when I was feeling really uncomfortable and had tons of back and pelvic pain. I also had some knee pain, which I think was the impact of all the additional weight on my joints.

Two months after giving birth, I weighed 25 pounds less than when I started and bought my first pair of skinny jeans ever. Then of course a year later, after I weaned my daughter, I gained it all back plus 15. Oops.

Oh, also, I had heard that being overweight/obese meant it would be harder for me to get pregnant. It wasn't. Of course that is very dependent on the person, but wasn't a problem in my case.

Good luck with everything!
posted by echo0720 at 11:47 AM on November 22, 2015


I began both my pregnancies with a MUCH higher BMI than yours -- one 49, one 47, at ages 31 and 35 respectively. In both pregnancies I had borderline sugars in my gestational diabetes test and had to be moderately careful about what I ate for the rest of the pregnancy, and my first pregnancy was additionally complicated by SPD (symphysis pubis dysfunction) that required physical therapy weekly and some pregnancy-induced hypertension at the very end of the pregnancy. I ended up losing about forty pounds in each pregnancy, which resulted in a lot of monitoring and ultrasounds and watchfulness, and in both pregnancies I had more-or-less spontaneous onset of labor (needed an amniotomy in my second pregnancy to re-start stalled labor) and rapid, uncomplicated* vaginal deliveries of healthy babies.

My doctors did not fat-shame me, although I can't guarantee that they wouldn't have if I had been gaining weight rather than losing it. There were some occasional realities involved in caring for my fat and pregnant body, like me having to wiggle around and tilt my pelvis and stuff in order to get good ultrasound or doppler results early on because of the amount of fat on my abdomen, but they were handled pragmatically and kindly.

*my first pregnancy actually did have a labor complication (occult cord prolapse) that could have been a crisis, but it had nothing to do with my weight and ended up being fine.
posted by KathrynT at 12:12 PM on November 22, 2015


I had 2 children when I was very overweight. I don't know what my BMI was, but for my first pregnancy I think I probably weighed about 210 lbs, and I'm 5'2". I was 35 for my first kid, 37 for my second. I gained only a little weight with each pregnancy, about 12 lbs. for the 1st and about 10 for the 2nd.

The only problem I really encountered with my care providers was during my 2nd pregnancy. I had used an OB/Gyn for the 1st, but a midwife for the 2nd. I started to notice a pretty alarmist attitude from them about my blood sugar levels. I had never had any problems with blood glucose and my levels were in a normal, healthy range. But when I foolishly ate a donut the morning before a routine blood glucose test, my numbers were slightly elevated. I felt my midwife overreacted when she told me I now had a high-risk pregnancy due to possible gestational diabetes. I had to really puch back, requesting a re-testing a few days later after eating a normal, healthy breakfast. I test normal, and it was still a push to have them stop thinking of me as being at elevated risk of gestational diabetes. Everything proceded normally, and I had a healthy pregnancy, normal birth, and healthy, normal baby. But it took some pretty firm self-advocacy on my part.

My biggest fear about pregnancy and overweight was my stamina during labor. I was not fit and didn't exercise regularly, so I was afraid I would not be able to sustain the physical effort needed. My first pregnancy ended in an unexpected c-section (unrelated to my weight) after a "trial by labor" which was, of course, really hard, but no more than for anyone else. And for my 2nd my midwife assured me I'd be fine, and I was. Labor is super hard and exhausting, but I guess not much harder for me than for anyone.

One other downside--and it may sound a little silly--was that I didn't really look very pregnant, even at the end, just fatter. That made me sad. Also, I rode the bus to work every day, and I was shocked that I was never offered a seat like the other largely pregnant women. I have to assume it's because people didn't realize I was pregnant, just thought I was a regular fat lady.

Mostly, though, my weight wasn't really too big a problem. Overall, I really enjoyed being pregnant, and labor and birth are pretty bad, but going through that has made me stronger and more confident.
posted by primate moon at 12:36 PM on November 22, 2015


I'm sorry OP, I was truly not trying to scare you! You are getting lots of great, reassuring anecdotes from ladies who have been in your situation; I was offering to give you information on what specifically health care providers do to monitor obese pregnant women. (Please leave my comment up because three people have memailed me for this info so far!)
posted by pintapicasso at 12:41 PM on November 22, 2015 [3 favorites]


It's completely inappropriate and unprofessional for a student nurse to offer anyone their study notes by way of medical advice!

Please make sure to get your advice from a doctor (and/or midwife) you trust and best of luck with your hopes for pregnancy!
posted by JeanDupont at 12:44 PM on November 22, 2015 [6 favorites]


You won't know until you try. Plenty of obese women get pregnant and carry babies uneventfully. If you have trouble, they will call your weight (and your age) risk factors. In my experience they just shrug and don't tell you that X causes Y.

I am over 40 and had a baby recently after years of losses/problems. After surgery to remove a fibroid, I conceived naturally, had an easy pregnancy and then a sudden placental abruption at 36 weeks. I had pregnancy related hypertension but not pre-eclampsia, then a healthy small baby and post-partum pre-eclampsia, which subsided after 4 weeks. I am moderately overweight, so it's not the same, but here are a few things I can tell you from my experiences that may be relevant or helpful.

Have your thyroid levels checked. I was put on a synthroid to bring my low-normal thyroid to a more optimal level. This doesn't promote fertility but it helps to prevent early losses and promote fetal development. My GYN did this before referring me to a reproductive endocrinologist.

Everyone and every pregnancy has a different experience with weight gain. I gained a total of 13 lbs, lost 20 lbs in the first couple weeks after delivery. I didn't have bad morning sickness, I just never had much appetite. But everyone is different, for sure.

I saw an acupuncture and nutrition specialist who specializes in fertility issues. She put me on some supplements and we discussed an improved eating strategy (mostly about controlling blood sugars, nothing about weight loss). This might be helpful for you (for example if you have messed up blood sugar control, you may want to eat as though you have GD even if you don't). It was informative for me (if you're in the Bay Area, I am happy to refer you) and she had a better bedside manner than my RE or GYN.

Good luck!
posted by vunder at 1:47 PM on November 22, 2015


If you have a family history of gestational diabetes, if you get GD it will not be because of your weight.

This. My best friend had gestational diabetes in both pregnancies and she is a perfectly healthy weight (BMI 23 I think). But she has the family history.
posted by kitten magic at 3:37 PM on November 22, 2015


Your blood pressure will probably be much more monitored than your weight! They do take high blood pressure very seriously during pregnancy, but the good news is there are a lot of ways to manage it.(You can see my history for my experience), but even then everything turned out fine. Also, I would just sort of close my eyes or step on the scale backwards during my OB appointments, and no one really brought up weight at all.
posted by Rocket26 at 4:23 PM on November 22, 2015


Your question is specifically how your weight plays into your pregnancy. Different practices will vary in their management, but you are, in fact, at higher risk for gestational diabetes, and are also at risk for other complications - you might get an early 1-hour glucose tolerance test, and may receive closer monitoring in the last few weeks of pregnancy. This would be a point of note during your labor (you're at slightly higher risk for shoulder dystocia and cesarean section). And you would, too, be more likely to receive anticoagulation postpartum to prevent clot formation (again, dependent on the practices of the place you delivery).

That being said, higher risk doesn't mean inevitability, and of course the probability is that you, individually, will have a beautiful pregnancy, and being obese doesn't mean you shouldn't have children, but it would be a lie to say that it doesn't totally matter, because your weight does mean more vigilance to your providers. Since you're pre-conception, it's worth exploring ways to be healthy - for example, losing weight would very likely help with your blood pressure to normalize.

It sounds like you've been making an effort and have awareness of this - and I laud you for this and from afar, encourage you to keep it up!

For the high blood pressure: if you truly have high blood pressure this will be something that will warrant close monitoring, including earlier labs, more monitoring. For the GERD - if it gets worse: the usual progression is Tums (at the usual dose), some lifestyle changes (avoid foods that exacerbate, no food 2 hrs before bed, prop yourself up to sleep), omeprazole or ranitidine. To some degree you might have to accept that GERD is just part of the deal of pregnancy, and that's ok, but uncomfortable!

Just as a little soapbox: The medical profession probably does a bit of disservice in not addressing the issue head-on. For a summary, you can turn to the American College of Obstetricians and Gynecologists suggests as much: "Obstetricians should provide education about the possible complications and should encourage obese patients to undertake a weight- reduction program, including diet, exercise, and behavior modification, before attempting pregnancy."

I think, too, that perhaps the medical profession hasn't quite figured out how to support pregnant women in optimizing weight gain. Evidence suggests that half of pregnant women gain more than the recommended weight during pregnancy.

We can always do better.
posted by noonday at 4:43 PM on November 22, 2015 [3 favorites]


In terms of getting pregnant and fertility, weight is much less important than a regular cycle and other hormonal factors.

My BMI is 40-ish and I've had two distinct experiences with prenatal care. My first pregnancy was with a low/mid risk OB practice and their first two measurements of my weight alarmed them and caused a long lecture about risking out of their practice if my weight increased at the same rate. I felt hormonal and upset by the conversation but it was more of a fact than judgement - their hospital wasn't equipped to deal with people with a BMI greater than 45. After losing that pregnancy (due to cervical insufficiency, not related to my weight) I was seen as a high risk OB practice. At that time I knew the routine well enough to avoid appearing to be gaining weight too fast - no big meals before visits and wear light clothing when possible. They told me to gain no more than 10lbs but didn't comment on my weight afterwards (except to say they were pleased with my weight throughout the pregnancy).

I did have to deal with assumptions that the doctors/nurse practitioners would make when they only glanced at my chart before a visit. Many asked about diabetes (which I don't have) and assumed I had blood pressure issues as well. I did the gestational diabetes screen twice but mostly because I was worried.

Other aspects of my care were impacted by weight but in a matter of fact way. Ultrasounds were less precise because of my size (and the doppler/fetal monitoring were difficult for some nurses). No one made me feel these monitoring difficulties were an issue, just a part of pregnancy.

Delivery was interesting with my weight. Our baby was breech so they tried to turn him (something that might have worked if my stomach were smaller). The cesarean had its own fun issues due to my size (but nothing a good OB couldn't handle). Mainly the surgery took longer, they had to some complications with the amount of extra tissue they needed to go through, and my incision became infected (which they attributed to my weight). My experience is more of a cautionary tale than what I'd expect for any given overweight person.

tl;dr - weight may be a factor with your practice but I expect they'll approach it clinically rather than as an issue about you.

You could also do a preconception visit to feel out doctors and their practice.
posted by toomanycurls at 5:52 PM on November 22, 2015 [2 favorites]


Hey OP, I have no answers for you, but I wanted to reach out and thank you for posting this question. It has been great and educational for me, an overweight woman with no babies (yet), who has always thought her weight precludes her from ever having a healthy pregnancy, to read all these answers and get a clearer picture. Sorry, feel free to flag and delete this comment, but as OP is anonymous, I could not MeMail. Good luck!
posted by Ziggy500 at 2:20 AM on November 23, 2015 [2 favorites]


I'd like to have been a little earlier to this party, but thought I might have a bit to add in the way of reassurance as I'm currently 21 weeks pregnant with a BMI of (gasp!!!) 52.4.

The way my much loved OB/GYN explained it was that it's not just weight in and of itself that's a problem, but rather the conditions that are (for some) associated with weight, like elevated blood pressure and gestational diabetes. I come from a very overweight family and no one who wasn't an alcoholic or a heavy smoker ever had these problems no matter how fat or pregnant they got. So, in my possibly non-scientific opinion, the statisitcs about the risks of being overweight and pregnant do not take into account genetic variations in an individual's overall ability to systemically tolerate the extra pounds without significant catastrophe.

I will say that being as fat as I am makes me an object of scorn in general and being pregnant intensifies that, particularly in the eyes of medical professionals. In the group practice I attend, I no longer rotate doctors/NPs as many women there do because I am sick of the commentary about how difficult that "extra fluff" makes things for them --- my doctor is the only one there who seems to be capable of behaving as a mature adult regarding my weight. In my first pregnancy, the anesthesiologist initially refused to do the epidural, because, as he so kindly put it, "it's not like you're 115 pounds!" (After I burst into tears, he relented and performed probably the most technically perfect epidural of his life.) I also dread certain ultrasound techs who seem convinced that it is necessary for them to apply the painful force of 10,000 men on my belly in order to get an image. (I know this is not true because other techs are gentle as lambs and get better images --- one told me it's a matter of skill and experience in positioning the wand or whatever that thing is.)

I also think weird things I've had happen like pregnancy-induced asthma, SPD, and ultra severe tendonitis might not be concerns if I was less fat. And I fantasize about how much more I would feel the "kittens and rainbows" of emotion if I only looked pregnant even a little, if I only felt pretty even a little.

But you know what, I'm about to be 31 in less than a week and I'm currently 0/2 on pregnancy success (previous losses not due to my weight, according to doctors.) I want my kids to not be 5-10 years older than their cousins and I want to not play the yo-yo weight loss game for so long that I no longer have a real chance for kids. I may be wrong, but I feel like I can focus on losing the weight once the incessant ticking of my biological clock is behind me.
posted by dissolvedgirl22 at 9:48 AM on November 23, 2015 [2 favorites]


I was 250lbs when I delivered my son, who is now 4. I had a really difficult pregnancy with a lot of issues that were made worse by my size. He was almost 10lbs, which definitely didn't help. I had difficulty getting pregnant and had lost almost 100lbs before becoming pregnant. I dealt with high blood pressure, severe pregnancy induced carpal tunnel and sciatic pain so bad that I couldn't sleep the entire last half of my pregnancy. I also had to have a c-section, which was more difficult and recovery was longer because of my size and how much tissue was cut.

These are all things that could happen with someone of smaller size as well, but I was told several times during my pregnancy that the risk factors were much more because I was so overweight.
posted by Sara_NOT_Sarah at 10:26 AM on December 1, 2015


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