What is it like to be pregnant while fat?
I have been working on this post for a long time in my head. Both consciously and subconsciously, I have been making a list of those things that make me different from the “average” pregnant woman just because of my starting size. Given that I’m pregnant with twins after infertility and IVF, my experience may be different from others…but that’s all I intended on expressing is my experience. Yours may differ. In some ways, I hope it does.
More than that, I hope by sharing this, that others find strength in learning that fat is not a death sentence and that you can be healthy—pregnant or not—while fat.
A Quick Note on the Word “Fat”
Before I get started, I think it’s important for those outside of the Health At Every Size (TM) (“HAES”), fat acceptance and size acceptance communities to understand why I choose to use the term “fat” as opposed to “overweight,” “plus size,” or the dreaded “obese.” First, overweight and obese are medical terms and are not very good descriptors outside of medicine. Second, overweight and obese are often stigmatizing concepts for large people. Third, I prefer fat because if it is used properly, it’s not at all stigmatizing to me. I am fat. I have been fat for the bulk of my life. I accept it. So should you.
For other good resources on why you should use fat instead of other descriptors, see here.
For other resources on why fat is not a death sentence or even a one-way ticket to bad health, see here and here. Note that these resources are not exhaustive by any means.
Infertility, IVF and Being Fat
This could be a post and an entire series of posts onto itself. I’ve dealt with it some here before, but I’ve tried to not let myself be defined by my fat or my size. At least not here. But I’d be lying if I didn’t say it was an issue with infertility and IVF in particular. Not because I made it one, because modern medicine has made it one—despite the fact that women much larger than me have been getting pregnant without problems and having babies without problems for centuries. (For great information on this, see The Well-Rounded Mama’s blog.)
When you go through infertility treatments, including IVF, the first thing any doctor will tell you to do is to lose weight. Or to try to. Or some code words for that like “healthy diet” and “increased activity.” Those things in and of themselves aren’t bad, but when thy are being measured by the number on the scale, they are because that number is so deceiving and ultimately irrelevant to one’s health if they remain relatively stable. So, the first battle was finding a doctor who didn’t push this too much I have no problems eating healthier or increasing my activity. I do have problems if the medical professional I am seeing chooses to use the scale as a measurement of my willingness to do these things or my ability to conceive.
Being Pregnant with Twins and Being Fat
Many women who are pregnant with multiples are considered “high risk” off the bat. This is not necessary for many women with twins, as many twin pregnancies are not high risk. But when you add in my size and the fact that I went through IVF to become pregnant, you get labeled high-risk pretty quickly anyhow. I did not fight this descriptor. I went to see the Maternal Fetal Medicine doctor and even he agreed that without any other complications, my regular OB/GYN could handle the pregnancy. I only note the high risk factor here because I was told by my infertility doctor, my OB and the MFM that I was high risk specifically because of my size…something that has not been scientifically proven.
Many women might do one of two things: (1) revolt against the distinction and seek out alternative medical care; or (2) accept size-shaming in the form of a high risk diagnosis simply because of their size. Despite the fact that I saw the MFM, I did not accept the high risk diagnosis based on size alone. If size were my only complicating factor (and it’s not even one based on the research out there), then I’d probably fall into the first category. But I do have other health issues that make me high risk (that are separate from my size) and I would rather take the extra care involved with a high risk pregnancy than regret it later. I do this, though, knowing that my doctors are open to things such as a vaginal birth for twins and limited medical interventions where desired.
First Trimester Weight Loss…or any Weight Loss at All
It is not uncommon for women to lose weight in their first trimester. If you can get food down (which I couldn’t), you often lose it one way or another before it gets absorbed. The growing fetus (or fetuses in my case) get all of the good things first and you get whatever is left over. This makes for a real treat in the energy department.
I lost over 30 pounds in my first trimester. I do not track my weight regularly, but I was losing before I even saw the OB/GYN for the first time. The only reason I know this because they do weigh me at the allergist’s office to adjust my medications as necessary and they noticed a big drop in weight. By time I got to the OB’s office for the first time, I had already lost 15+ lbs.
Now, I know for a fact that as a fat woman I was treated differently from other women who lose weight in the first trimester. It’s not that the doctor didn’t seem to care too much. Many women lose weight regardless of size and are fine. It’s that the doctor didn’t care too much and I was carrying twins and barely able to eat a snack, let alone a meal. If I were a thin pregnant-with-multiples woman saying to my doctor that I was losing weight at that pace, there might not have been an alarm rung, but it would have been taken more seriously.
Outside of the medical realm, the biggest thing that irritated me was the people that thought that it was “good” that I was losing weight, including my own parents. Listen, if losing weight is good, why did I feel like hell? Probably because I was only losing it by failing to eat properly, if at all. That’s not healthy on any scale of health. It was highly bothersome that people didn’t seem to get this.
The only upside was that because of this lost weight, I got to put off buying maternity clothes for longer than most women, especially women pregnant with twins. There are still some of my regular clothes that fit fine. In fact, in the legs and arms of things, I’m swimming in my clothes. The downside to this is that I have no clue what size I will be when this is all said and done, so I might be in need of a new wardrobe.
Take these facts: I started out fat. I lost weight at the beginning.
You get this result: Barely anyone can tell that I’m pregnant.
Now, in some ways this helped. I didn’t have to tell certain people in my life until I was ready to do so. Having gone through pregnancy loss before, this is a huge thing. I was free to live on both sides of the fence until I felt ready. I also had the bonus clothes situation.
But there are also some drawbacks to this, especially when you’ve waited to be pregnant for as long as I have. Whereas other pregnant women are asked about their pregnancy, given much needed seats on busy city buses and so on, a fat woman is not given these things while pregnant because no one knows she is pregnant. Or at least they’re not sure. I didn’t know this would affect me so much until the lady in front of me at the grocery store check out line fawned all over the pregnant cashier and here I was, 25 weeks pregnant with twins and no attention was paid to me. It’s childish, but it’s something that comes with a bigger twinge of disdain when you’ve gone through infertility. I get to get away with people not asking to touch my belly, but I also don’t get the joyful attention that others do. Double edged sword to say the least.
Plus, I always have this fear that people are judging me when I tell them that I am pregnant and they look at me and can’t tell. I swear I’m not lying!
The “Inevitable” Gestational Diabetes and High Blood Pressure
As a fat person that has been to my fair share of doctors, almost all of them will fill you with doom and gloom about your future and current health. According to general wisdom in the medical system, you cannot be fat and healthy. That is despite a plethora of research that shows that you can be healthy regardless of size. But not a doctor’s appointment goes by when you aren’t quizzed about your eating habits and exercise routine and then told you will eventually get diabetes and high blood pressure and high cholesterol.
I have never had diabetes, high blood pressure or high cholesterol. (I have insulin resistance, but while that affects the same organs as diabetes, is actually the opposite of it and I may never get diabetes from it, though I very well may.) Ever. In fact, my blood pressure and cholesterol levels are stellar. Freaking textbook perfect. And when the doctors see that, they almost always look puzzled.
This goes double when you are pregnant.
Now, when I was early in my pregnancy I did have a bit of high blood pressure. But that was because every time I went to the doctor I was in fear that a miscarriage was on the horizon. Once I got through the first trimester, my blood pressure was perfect. In fact, when I went to another doctor’s office (the allergist, for example) my blood pressure was fine even in the first trimester. It was the idea that at any point the OB could tell me it was all over that sent my blood pressure to the low end of the high range.
Despite this, I have been told several times that I will get gestational diabetes. I have also been told that my blood pressure needs to be monitored more closely than the average pregnant woman. So far, I’ve had two gestational diabetes tests and several blood pressure tests and all is well.
I will never experience pregnancy as a slim, skinny or thin woman. I will never experience it as an average woman. I may never experience it again. But I know that being pregnant while fat is very different. Some things are looked at more skeptically, some more seriously and some not seriously enough. It’s a failing on the part of our medical care system that we do not know better about treating fat pregnant women with more dignity during their pregnancies—especially when information and resources are available to do better. But despite it not being my failing, I am the one who has to deal with it.
I do know that my next big challenge is finding a pediatrician who does not fat shame my children who, having two large parents, are likely to be fat themselves. I am hoping that, unlike my childhood, theirs is not filled with the kind of body shame that mine was.