Imagine being told that “people like you” have bodies that struggle to go into labor. You’re tagged as high-risk simply because you belong to a certain demographic. You’re pressured into an induction because the nurse midwife on duty has a bias against women like you. Picture her saying, “Someone else who looked like you had an induction last week and did fine,” as if all bodies in your category are the same.
This was the experience of Laura, a mother of two, and it happened because she’s plus-size. Research from the University of Tennessee Medical Center indicates that women with a BMI over 40 face a staggering 56.6% chance of needing a C-section. In fact, C-section rates soar with increased weight. A comprehensive study revealed a 71% C-section rate for women with a BMI exceeding 52. Even more disheartening, one investigation found that 24% of nurses admitted to feeling “repulsed” by obese women, while a broader look into weight bias among healthcare professionals showed that many perpetuated the harmful stereotypes that fat individuals are lazy, unintelligent, and unworthy. It’s no wonder that plus-size women often receive inadequate maternity care.
While I wasn’t bullied into having a C-section, gaining 100 pounds during my last pregnancy—partly due to gestational diabetes and medication—exposed me to a slew of fat-phobic comments. Thankfully, my OBs were understanding and never criticized my weight. However, the anesthesiologist who came to administer my epidural was a different story. After multiple painful attempts to insert the epidural, he complained, “I’m having trouble because of all the fat back here.” I was already in tears from the pain, and his words felt like a slap in the face. He was simply using my size as an excuse for his incompetence.
It shouldn’t come as a surprise. A study from Temple University revealed that over half of doctors labeled obese patients as “ugly” and “noncompliant.” A third even went so far as to deem them “weak-willed” and “lazy.” It’s as if there’s a misconception that larger individuals can’t eat healthily or exercise. In reality, half of women diagnosed with gestational diabetes are not overweight, yet many plus-size women are forced to undergo the glucose challenge test every month during pregnancy, as noted by Midwifery Today.
The indignities don’t stop there. Some women report being pressured into sterilization during labor. Many face verbal abuse during prenatal appointments or humiliation during weigh-ins, with every issue pinned on their size. It’s an all-too-common joke among larger individuals: arrive at the doctor’s office with a sprained ankle, and suddenly it’s because you’re fat. Have metabolic issues? Fat. Ear infection? Fat. Cold? Well, maybe if you weren’t so “Fatty McFattyson,” you’d be able to fend off germs better. In the world of childbirth, weight is often blamed for everything from having larger babies to requiring C-sections to difficulties in breastfeeding due to larger breasts.
The situation has become so dire that a survey published by the Sun Sentinel in 2011 found that 15 out of 105 obstetrical clinics outright refused to accept larger patients, citing weight limits of 200 pounds or other obesity indicators. Some claimed their equipment couldn’t handle larger patients—perhaps it’s time to invest in better equipment! Others admitted their reluctance stemmed from viewing heavier patients as high-risk. “People don’t realize the risk we’re taking by caring for these patients,” said one doctor, exposing his bias for all to see.
In response, Midwifery Today has issued guidelines for size-friendly practitioners. The first recommendation? Don’t assume we’re overweight because we sit around eating bonbons all day! It’s possible to lead a healthy lifestyle and still struggle with weight. Healthcare providers need to treat all plus-size women as individuals, inquire about their medical histories, and customize their care accordingly. Because, as Laura quipped sarcastically, “You know all fat people have the same body.” Moreover, it’s critical for providers to avoid trying to “fix” patients or forcing weight loss during pregnancy, recognizing that most plus-size women experience healthy pregnancies and normal births.
Fat prejudice is increasingly viewed as one of the last socially acceptable forms of discrimination in America. This bias is so pervasive that even children, like Laura’s 7-year-old son, face ridicule for their mother’s weight. The medical community, especially OB-GYNs, should be a safe haven for all women, yet until women gain knowledge and challenge sizeist attitudes in healthcare, individuals like Laura and myself will continue to endure unnecessary suffering.
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In summary, plus-size women face significant discrimination and bias during pregnancy and childbirth, impacting their care and overall experience. It’s vital for the medical community to adopt a more inclusive and understanding approach to ensure that every woman receives the respectful and individualized care she deserves.