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Navigating Plus Size Pregnancy and Birth: Empowerment, Challenges, and Personal Stories

Pregnancy is a unique and transformative journey for every woman, regardless of her size. However, plus size women often face additional challenges and biases that can impact their experience. With the average British woman being a curvy size 16 with a 36DD bust, it’s essential to address the needs and concerns of plus size women during pregnancy and birth. This blog explores the importance of personalised care, the benefits of water birth, the potential complications associated with instrumental and caesarean births, the use of continuous electronic fetal monitoring (CEFM), and the significant impact on mental health and breastfeeding. We'll also share personal stories to highlight the real experiences of plus size mothers.



The Importance of Personalised Care


Dr. Sara Wickham, a respected advocate for women’s health, emphasises that pregnancy and birth are deeply personal experiences. She states, “Every woman deserves respectful and individualised care, free from bias and assumptions.” Unfortunately, the medical system often focuses too much on a woman’s size instead of her overall health, leading to assumptions based on BMI. This approach can undermine a woman’s confidence and mental health, particularly when she is told her pregnancy is "risky" solely based on her BMI.


The birth of my son Monty, born December 2022 at Frome Birthing Centre


Personal Reflection


As a plus-size woman and a midwife, I faced numerous challenges during my pregnancies. Navigating the NHS system was often daunting, with frequent reminders of risks and potential complications. Despite these obstacles, I was determined to have the births I envisioned. I longed for calm, empowering water births—a choice that felt right for me and my babies.

With unwavering resolve, I educated myself on my options, sought a supportive team of midwives and a knowledgeable and caring obstetrician, and advocated for my preferences at every turn. When the day finally arrived, I was able to achieve water births for both of my children. These experiences were transformative and have undoubtedly influenced my practice today.



The Benefits of Water Birth for Plus Size Women


Water births can be a wonderful option for many women, including those carrying more weight. The buoyancy of the water helps with mobility and pain management, leading to a more comfortable birthing experience. It’s crucial for plus size women to know that water birth is a viable option and to not be discouraged by healthcare providers who may have outdated views on the matter.


National Statistics on Water Births

According to a study published in the British Journal of Midwifery, water births are associated with a reduction in the need for pain relief, a decrease in the duration of labour, and a lower rate of interventions such as episiotomies and instrumental deliveries. Despite these benefits, water births remain underutilised, especially among plus size women who are often steered towards more medicalised birth options.




Continuous Electronic Fetal Monitoring: Challenges and Concerns

Continuous electronic fetal monitoring (CEFM) is a common practice for plus size women, but it often lacks evidence to support its routine use. CEFM can inhibit the natural progression of labour by limiting mobility and increasing discomfort. This is contrary to its intended purpose of ensuring fetal well-being.


Invasive Practices and Risks

In cases where CEFM is deemed necessary, internal fetal scalp electrodes are sometimes used. This practice is invasive and carries risks for the baby, including infection and scalp injuries. The process can be painful for the baby and distressing for the mother, further complicating the labour experience.


Challenges Associated with Instrumental Births and Caesarean Sections

While instrumental births and caesarean sections can be necessary and life-saving interventions, they also come with risks, particularly for plus size women. These risks include infections, mobility issues, and the potential for a more challenging postpartum recovery. These physical challenges can have a knock-on effect on mental health, breastfeeding, and parenting.


Infections and Mobility

Plus size women are at a higher risk of infections following caesarean sections due to increased wound complications. The additional weight can also make mobility more difficult during recovery, leading to prolonged hospital stays and delayed bonding with the baby.


Impact on Mental Health and Breastfeeding

The physical challenges of recovery can significantly impact a mother’s mental health, leading to conditions such as postnatal depression. This, in turn, can affect breastfeeding, as a mother struggling with pain and mobility may find it difficult to establish a successful breastfeeding routine.



Personal Story: Elective Caesarean and Its Aftermath


I recently spoke with a mother (a plus size woman) who shared her story of an elective caesarean section. After a straightforward, uncomplicated pregnancy, she agreed to a caesarean on the basis that her baby was breech, that vaginal birth would be more challenging for her as a plus size woman and that her baby was potentially large for dates.


The baby was born unsurprisingly at an average birthweight, weighing approximately 8 1/2 pounds. While she claimed to not regret her decision to go ahead with caesarean birth, she adamantly felt she was not informed of the implications for breastfeeding, associated with caesarean birth.


Had she been counselled on the potential challenges, she would have prepared herself better for the journey. Perhaps, expressing colostrum antenatally and encouraging immediate skin to skin in theatre.


Sadly, she suffered from postnatal depression, engorged breasts, and difficulties with latch. She felt unsupported by her NHS midwifery team, who encouraged her to combine feed. She reluctantly followed their advice, feeling it was her only option. This story underscores the need for comprehensive counselling and support for all birth choices.


Tips for a Positive Pregnancy and Birth Experience


1. Find the Right Provider: Look for a supportive, non-judgemental healthcare provider who focuses on your health and your baby’s health, not just numbers on a scale.

2. Ask Questions: Don’t be afraid to ask about their experience with plus size pregnancies and how they tailor care to individual needs.

3. Advocate for Yourself: Speak up about your preferences and concerns. Your comfort and confidence in your care plan are essential.

4. Connect with Others: Join communities of plus size mamas who share their stories, tips, and support. You are not alone on this journey!



Health Considerations for All Women


It’s crucial to remember that all women have some risk of developing pregnancy-related conditions. What’s important is to have a proactive and positive approach to health and wellbeing.


- Gestational Diabetes: Regular monitoring and a balanced diet can help manage this condition effectively.


- Pre-eclampsia & Pregnancy-Induced Hypertension: Close monitoring of blood pressure and overall health is essential.


- Thrombosis: Staying active, hydrated, and discussing preventative measures with your healthcare provider is important.


- Breastfeeding Success: With the right support and education, all women can have a positive breastfeeding journey. Lactation consultants, midwives, and breastfeeding peers can provide invaluable help.




Conclusion


The way we talk about and to plus size women during pregnancy has a significant impact on their mental health and confidence. Women need to feel empowered and positive about their pregnancy, birth, breastfeeding, and journey into parenthood. Being told their pregnancy is "risky" based solely on BMI can undermine this confidence.


Remember, mamas, your body is strong and capable of incredible things. Embrace your journey with confidence and surround yourself with a supportive team.


At The Country Midwife, we offer support to women facing any challenges to their care, helping them navigate their journey armed with evidence-based knowledge to empower their decision-making. Please get in touch if you find yourself looking for answers and struggling to advocate for yourself. We provide one-to-one antenatal programs and guided support to help you enjoy your pregnancy and get it right the first time.


Our memories of birth will live with us forever and greatly impact the way that we parent. While we can pick up the pieces and make amends when things don’t go to plan, it’s always better to get things right the first time for us and our babies.


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