Can A Plus Sized Woman Have A Natural Birth?- Guest Post By Janie Oyakawa

I met Janie a few months ago when she was going through training to become a natural birth teacher.  All women who go to the work involved in teaching natural birth are passionate about it- but Janie had a particular passion about a particular subject:  Plus sized natural birth.  

Who cares about plus sized women and how they give birth?  Why should anybody care?

You know what- we should all care about this subject.  Of all the women blamed for bad obstetrics, plus sized women suffer more than most from scare tactics and limited choices because of provider fear.  And then, if things go wrong- ACOG is quick to blame plus sized women for a c-section or any other intervention.

In fact, they (like many others) are in between a rock and a hard place-

They are told they MUST birth in the hospital because they are high risk (no home birth for you!) and then very often they are treated so high risk that a natural birth in a hospital is next to impossible.  

I support the right of women everywhere to make an educated choice about where they birth and with whom they birth- and I hate to see it limited simply because of size.     

But never mind what I think- I am proud to introduce a woman of passion and drive and an experienced mother with many different birth experiences- Her words are more powerful than mine.  

   

The straps didn't fit right. The nurse struggled back and forth over my ample belly to track the baby and then get the too tight strap to stay in the correct position. I angled myself sideways a bit, not quite on my back and not quite on my side. "Eureka!!!" she said. "That's it, don't move" and she turned and left the room. I knew a contraction was nigh at hand, I looked at my husband: "What does she mean don't move?... Is she coming back?"  Did she mean don't move as in don't get up and go to the bathroom or don't move as in freeze when you were a kid and even itching your nose meant you were a rotten egg?  So I picked the latter.  

I decided I wouldn't move. There was a strange comfort in hearing the swoosh, swoosh, swoosh of my baby's heartbeat. I didn't move an inch lest that dang strap got messed up. A contraction came hard and fast and I grimaced - the only technique I had left for dealing with them. I couldn't move, I couldn't get up, I couldn't sway, my husband couldn't even rub my back - we may disturb the straps. I laid there longing to be sitting up in the rocker, or standing behind it. I fantasized about that rocker and all the crazy positions I could labor in that wouldn't involve straps or me being told "Don't Move"

Next contraction hit, I writhed a bit and the strap cut into my side, like a deep paper cut. That was it. I was out. I'm tapping on the mat. I fell onto my back and sunk into the bed, and the nurse came in visibly frustrated with me. I just couldn't do it anymore.  I said it: Those words again. The words I desperately didn't want to say:

I'm ready for the epidural.

The epidural brought with it a catheter, a blood pressure cuff, then an internal fetal monitor. Even though I wasn't bothered by the straps as much anymore they needed to track the baby constantly so she got an electrode inserted into her scalp. The next day I could see the scratches on her head - they kind of looked like the cuts on my side from the straps.

I decided that if there was ever another baby to join our family the birth would be different.

Before my period came back I called a few midwives. If none would take me I'd call a urologist for my husband's vasectomy. I was that committed. I wanted a natural birth out of the hospital.  It felt like a strange dating game where I wanted to be completely honest for integrity sake but also sell myself too:

"Fat woman desperately seeking understanding midwife for heartfelt prenatal appointments and a fantastic homebirth"

It took four phone calls.

I found her! Appointments were thorough but conversations about my size were brief. I found confidence in my body. We took a childbirth class even though this would be my fifth birth. I bought birth supplies and daydreamed about sitting in the rocking chair for every contraction if I wanted, sans straps.

And late one night in September I texted her.

"In labor, keep your phone close by"

I got in the pool lovingly prepared by my husband. I varied my positions frequently, with a deep frogger being my favorite. My midwife spoke softly and laid a cool washcloth on my head. My husband said the colors of the rainbow in ten second intervals and after each contraction said how amazing I was.  Pretty much heaven - if heaven involves hardcore uterine contractions every three minutes (I hope not)

A little after 3 am a baby boy was in my arms. I had done it! My body had worked just like it should. "I did it" were the first words out of my mouth. I did do it. Without drugs, without straps and even without the rocking chair!

Here are my tips on how to have a happy plus sized birth:

1. Make peace with yourself. As a plus size woman you have probably spent a lot of time frustrated and possibly even angry at yourself. Forgive yourself. Like right now. Pregnancy is not the time to belittle yourself or be angry at your body. There is a whole 'nother person growing inside of you and your body is doing that! Be grateful - nourish your body, mind, and soul; by doing so, you and that little baby will grow together.

2. Be very mindful of the interaction you have with your healthcare provider. You may choose to address your size directly with them or just be aware of their attitude toward you. Let your instinct be your guide. If you can tell they are uneasy about your size or start making claims about what complications you will "most likely" have, you have reason to be concerned.  They can be realistic about issues but blanket statements like "you will probably need a c-section" or "you will most likely have gestational diabetes / high blood pressure, etc." are red flags.

This brings up the issue: Is obesity a complication? Are obese pregnant women deserving of the "high-risk" label? It is accurate that obesity increases rates of complication, but as with most topics in modern medicine some perspective is needed. Take for example gestational diabetes: rates in women of average size are 2-5% and in the super obese 10-15%.  But you know what that means? 85-90% of plus size pregnant women will NOT have gestational diabetes. Do not let your provider bully you in the name of concern.

If complications arise in your pregnancy, ask your provider what they would do in the situation if you were average sized. In other words are they reacting more aggressively because of your size? Factor their answer in when you go forward with treatment.

3. Dieting... now is not the time. You might be told to gain very little weight, or possibly even no weight. This is a concern. You should be eating well. Eat whole, unprocessed foods, increase your protein, drink enough each day... All common sense advice that applies to any pregnant mother applies to you. Restricting calories though is not appropriate for you or the baby. Even the mere thought process of dieting triggers a metabolic response from your body.  Dieting during pregnancy also triggers changes in your baby. Studies have shown a link between mothers who diet during pregnancy and obesity in their children.

Eat healthy. Eat intuitively. Don't diet.

4. Do what you need to feel comfortable during your care. Bring your own robe. Ask politely that they have an extra large blood pressure cuff on hand for you, buy your own birth ball, ask your doula how long her rebozo is. Schedule your ultrasound later in the pregnancy if you are worried about clarity during the procedure.

5. You can (and should) plan for a natural birth. Natural birth has benefits for any woman but it is almost essential for the plus sized woman. If you think maternity care is in crisis for women in general - it is in shambles for plus size women. In the typical hospital birth, you are more likely to undergo a cesarean and more likely to experience complications from your cesarean. A natural birth reduces your exposure to common interventions. Moving in labor, access to waterbirth, and a prepared support team are essentials for the plus size laboring woman.

Get prepared! Find a provider who is in sync with your birth plan, take a quality childbirth class, find a doula, and find exercise that you enjoy.  Watch videos and read stories of other plus size moms birthing. The natural birth community is here with open arms for you! I didn't get my homebirth sooner because I thought no midwife would take me. Not so!

Visualization can also help increase your confidence in your ability to birth. Picture your body doing its job, imagine the perfect birth in your body.

6. Find a support group - there is a great online community developing for plus size mothers. I highly recommend that all women of size or any woman that has ever uttered the words "I have always struggled with my weight" read the book Health at Every Size by Linda Bacon. Read the depth of research done by Pamela Vireday at the blog Well-Rounded Mama.
(Additional work by Well-Rounded Mama found here.  Plus Size Birth is another fantastic resource.)

Janie Oyakawa is the mother of six children, her last two babies were born at home in the water when she weighed over 300 lbs. Other than Hyperemesis Gravidarum she has had healthy pregnancies and deliveries.  She is a Birth Boot Camp instructor in Prosper, TX excited to start teaching moms of all personalities and sizes. She also blogs as the Mom of Oz about her life, her kids, HAES, birth, frugality, and sometimes photography.