Plus-sized pregnancies need more respectful care and less stigma, advocates say: 'I was waiting for my body to fail me'

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When she first realized she was pregnant, Jen McLellan felt anxious and ashamed. Even though she wanted to be a mother, she weighed almost 300 lbs. — and all the information she gathered online and from healthcare practitioners made her feel certain her pregnancy would have complications because of her weight.

“I was waiting for my body to fail me,” McLellan told Yahoo Canada, adding that she was expecting to get gestational diabetes and have a cesarean birth. “It just didn’t seem like there’d be a healthy outcome.”

A recent article published in the Canadian Medical Association Journal (CMAJ) called for more “respectful care for pregnant people living with obesity.” The article, written by dietitian and nutrition researcher Naomi Cahill, highlights concerns and recommendations on weight bias in maternity care. Many pregnant Canadians share experiences like McLellan's, highlighting a need for a change in the way healthcare professionals provide care to people with larger bodies.

How does weight stigma affect pregnancy?

According to a 2020 study in the BMC Public Health journal, nearly one in five women surveyed reported experiencing weight stigma in healthcare settings, specifically from doctors and nurses.

Some subjects said they experienced stigma and judgment "a few times a month" and that aside from fielding rude or unnecessary comments about their bodies, providers focused on their high-risk status and potential consequences on their baby's health even when the birth outcomes were ultimately healthy.

"Doctors may be concerned about potential consequences of maternal weight, but increasing pregnancy-related anxiety can itself be deleterious as well," the study said, adding that anxiety during pregnancy can have negative effects on fetal neuro developments, preterm birth and child cognitive and motor deficits.

What does 'respectful care' for plus-sized pregnancies look like?

In her CMAJ piece, Cahill urged healthcare professionals must confront negative weight-related attitudes and assumptions, such as “misconceptions surrounding lifestyle behaviours, including [the] assumption of laziness,” or tying weight to a person's ability to parent. She added that weight-inclusive or weight-neutral care aims to shift the focus from weight control to encouraging sustainable, healthy behaviours in all pregnant people regardless of their BMI.

“The few…studies that have evaluated weight stigma during pregnancy suggest health care providers feel they have insufficient training and lack the skills to confidently counsel pregnant people about weight-related risks,” Cahill said. Weight-related risks in pregnancy include gestational diabetes, hypertension and a cesarean delivery.

One suggestion she made was to ensure that providers have suitable and weight-inclusive equipment. This includes beds, wheelchairs, gowns and medical items, among other things.

“And positioning scales to weigh patients in private,” Cahill said, adding that healthcare providers should ask permission before discussing and evaluating weight. “Centre conversations around metabolic indicators, reported symptoms, and the patients’ overall health and well-being.”

Cahill also noted the importance of language and each individual’s preferred ways of referring to their body. “Neutral terminology such as ‘higher weight’ or ‘larger body’ are considered more suitable than other terms such as ‘excessive weight’ and ‘morbid obesity.’”

Empowering plus-sized pregnancies

About five months into her pregnancy, McLellan began working with a midwife who was less concerned about McLellan’s weight than the health of her pregnancy. They followed a “health-at-every-size” approach focused on McLellan's lab results and regular blood pressure rather than her body max index (BMI) exclusively. According to McLellan, the change in perspective from her healthcare provider allowed her to believe that she could have a healthy pregnancy.

"It's just really important that people in larger bodies learn how to advocate for themselves," she said. "There are so many wonderful care providers out there who will treat you with dignity and respect and you are deserving of that."

Following her healthy pregnancy and the birth of her son, McLellan founded Plus Size Birth in 2011 to provide a space for pregnant people in larger bodies to find community, resources and product recommendations she said she wish she had when she was pregnant. In 2018, she began the Plus Mommy Podcast and collaborated with the National Institute of Health in 2019 on the Pregnancy is For Everybody Initiative and is now a certified birth educator.

She also features many plus-sized pregnancies on her Instagram page, a beautiful mosaic of healthy and happy women and soon-to-be mothers. People have even sent her photos from the hospital after they have given birth–a "thank you" of sorts for feeling validated and seen.

While risks during pregnancies do exist, that doesn’t guarantee complications. McLellan adds that with appropriate medical support and monitoring, many women navigate pregnancy safely and successfully, especially with ongoing support throughout their journey.

McLellan said it's important to approach plus-sized pregnancies with empathy and personalized care.

"I think what we've realized is when we treat people with compassion and we meet them where they're at, we're not just creating a safe and supportive environment for people in larger bodies, we're really supporting everyone," she said. "There is harm being done and there does need to be a shift in care, but I have started to see a change and I'm really hopeful that will continue,"

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