Sunday, May 28, 2023

The Motherhood Diaries: BMI & Babies, Pt2 – Weight Bias In Pregnancy: ‘Every Step Of My Pregnancy, They Took The Joy Away.’

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In part two of our BMI & Babies series, we chat to four women who experienced a range of weight bias in pregnancy. They share their experiences, as well as advice for those embarking on the same battle – and for too many pregnancies, it is a battle.

Welcome to our series, The Motherhood Diaries – a safe space for you to share your experiences, advice, hopes and heartbreaks. We’ll be hearing from industry experts giving practical advice alongside Capsule readers (You!) sharing your firsthand experiences. We’re looking at everything from fertilitytrying to conceivepregnancythe fourth trimester, newborns, toddlers, children’s mental health and teenagers, fertility issues and everything in between! 

(TW: There is discussion of disordered eating in this story)

Qiane: ‘There were mental health issues that come with thinking, “if I eat this, am I going to be able to have a baby?“‘

For Qiane Matata-Sipu, founder of social enterprise NUKU, the focus on her weight started long before her pregnancy journey began. Qiane and her husband, Willie, had been together for 14 years before they had their first child – and six of those years had been spent trying to get pregnant. Along the way, Qiane found out she had Polycystic Ovary Syndrome (PCOS), a hormonal disorder that grows cysts in the ovaries and the side effects of which can include weight gain.

To get a better picture of what this meant for their overall fertility chances, they sought out a fertility specialist. “They basically said to me, your BMI is too high – there’s nothing we can do to help you,” she says. “They didn’t look at the fact that I was very healthy and fit, or had no other medical issues.”

A second fertility expert a few years later said similar things but that they would be willing to try her on intrauterine insemination (IUI). “Again, there was no focus on my healthy lifestyle, or any other medical [indicators], it was all just about my weight.”

The stress of having this myopic focus on her weight pushed Qiane into become fixated about what she was eating. “There were mental health issues that come with constantly thinking, ‘if I eat this, am I going to be able to have a baby?’” she says. “You want to fall pregnant so badly, and the specialists that you trust, because they are medical professionals, have implanted into you the fact that you are too big to have a child.”

After all that, Qiane and her husband then became pregnant naturally after looking into Māori fertility treatments instead – and after she stopped obsessing about her weight. But after becoming pregnant, the reality of being weighed at every appointment pushed her back into that anxious space again. So did constantly being told she was at high risk of things like gestational diabetes, or preeclampsia (neither of which eventuated).

Qiane says, “It felt like, ‘Okay, here I am, a Māori Pacifica woman, who’s overweight, and everyone is just assuming that I’m going to have all these complications in my pregnancy.’”

“Here I am, a Māori Pacifica woman, who’s overweight, and everyone is just assuming that I’m going to have all these complications in my pregnancy.’”

The next BMI-related hurdle came with trying to find somewhere to give birth. Qiane had wanted to go to a birthing unit, rather than a hospital, but was told her BMI was too high. She applied to go to a smaller Auckland hospital and was told that before they would accept her as a patient, she needed to meet with them. The first thing they did was weigh her, with the nurse immediately saying, “There’s no point us carrying on with this meeting – you can’t give birth here, your weight is too high.”

“I’ve never felt more embarrassed and deflated,” Qiane says. “Because I had been having a really beautiful pregnancy; I’d been doing pregnancy yoga, I felt strong, I felt capable, I felt healthy and well.”

In the end, Qiane said it was her pregnancy yoga teacher who gave her the confidence to believe that her body was capable of having a healthy birth, that she could trust it. “She gave me a sense of control that no-one else had, so that by the time I went into labour, I had that shit on lock,” she laughs. “She told me that my body was made to birth children, and I had to start listening to it, and stop listening to everyone else.”

The birth of her daughter, Haeata te Kapua, was the birth she had hoped for – healthy, and fast. Afterwards, Qiane says she can remember getting up to have a shower, wash her hair, and “shooting a whole photoshoot of my child,” she laughs, all the time feeling so proud of her body. “I was like, ‘Hang on, am I not supposed to be the fat person who is not going to cope with labour? Wasn’t I supposed to have all these complications? Wasn’t my baby supposed to be too big?’ That constant negativity flooded my mind.”

For any future pregnancies, Qiane says she will be keeping herself far away from the medical side of things. “To be told for years that the reason that you can’t get pregnant is your weight, and then to get pregnant and constantly think ‘what if I lose this baby because I’m overweight?’ It really f–ks with your mind,” she says. “And actually – yeah, I was overweight. And my child was perfectly fine.’”

Meg: ‘Just 72 hours after giving birth, I got an email telling me to lose weight as fast as possible.’

Due to the public nature of her job, her popular Instagram following and her public role as an advocate for body positivity, The Edge radio presenter Meg Mansell said she was well aware that there were a lot of people who were following her plus-size pregnancy. “I feel like I was almost a test dummy to see ‘how is it going to go for you… because I had a really bad time.’” From her messages with friends and followers, Meg says she knew that the weight focus in pregnancy was inconsistent, at best. “It’s almost like luck of the draw as to who you get, and what they believe.”

Meg says she was very, very nervous about getting pregnant because there were so many unknowns, including the very basic thing of not having any examples in the public eye of plus-size pregnancy. “I was trying to find forums of ‘what was my body going to look like?’ because I was so at a loss as to what to expect.”

She and husband Guy conceived a lot faster than they was expecting, but Meg says she had a lot of apprehension about finding a midwife who was confident in having a plus-size patient, particularly because Meg has past experience with disordered eating. “It’s something that isn’t taken as seriously when you’re big because it’s almost an eye-roll moment of ‘how could you possibly have an eating disorder?’”

But she knew she’d hit the jackpot with her midwife, Katie Hawkey, when on her first appointment, Katie crossed out the section of the booklet that was about weight.

“She said something along the lines of ‘it isn’t important.’ I just sat there and started crying,” Meg recalls. “I hadn’t weighed myself in years and I knew it was something that was going to be a trigger, so having her tell me it didn’t matter was amazing.”

“She obviously was going to make sure I was healthy – I don’t deny that being overweight can cause health issues, I’m not blind to that – but what I don’t understand is why I managed to go through my entire pregnancy without being weighed, and nothing went wrong because of that, whereas other people have to be weighed constantly.”

“I managed to go through my entire pregnancy without being weighed… whereas other people have to be weighed constantly.”

Meg developed gestational diabetes right at the very end of her pregnancy and said she felt a lot of shame – even though gestational diabetes is possible in all body types, and ended after she give birth. But the diagnosis, she says, was rough. “The shame I felt, and the guilt – the feeling that I had done this, that I had put my daughter at risk,” she says. “It was only after finding out that so many smaller people also get gestational diabetes, that the shame lifted.”

That inconsistency about the importance of weight in pregnancy was still an ongoing theme. A nutritionist asked Meg to keep a food diary and at one stage was worried she was under-eating in comparison to what was required for her baby’s health. But then she had the opposite experience from another health professional, at possibly the world’s most insensitive time. “Just 72 hours after I had given birth to Daisy, I got an email from one of the team telling me to focus on losing the weight as fast as possible,” Meg says. “That shocked me quite a bit; I just felt so much shame in that moment.”

When it comes to giving advice to other people who are worried about how much focus will be placed on their weight during pregnancy, Meg says her biggest tip is to do your research when it comes to finding a lead maternity carer. “If you have the ability to do so, try and get a midwife where – before you sign up with them – you find out their thoughts on plus size bodies and pregnancy,” she says. “If you don’t have that ability… then it is rough out there. But just know that you can have a healthy birth at a bigger size. I felt like I didn’t even know that, that it was possible. But I had a very healthy, vaginal birth, at the size I am, and I was never weighed. I only know my own experience, but it is absolutely possible.”

Kristina: ‘I couldn’t find someone who I felt would support me, in the body that I’m in.’

After years of teaching Fat Yoga classes, Kristina Cavit is no stranger to the anecdotal horrors she heard about how fat bodies are treated by some health professionals. That fear, she says, bookended her pregnancy experience – starting with the fact that it took her months to click with a Lead Maternity Carer.

“I couldn’t find someone who I felt would support me, in the body that I’m in,” she says. “And that process was only because of a shit-load of work and advocacy on my behalf, and feeling like I had to be really staunch all the time, protecting myself, as opposed to feeling accepted by the people I was meeting with.”

“We really need to normalise fat bodies – and normalise the word ‘fat’! – doing things, like getting pregnant, moving our bodies for joy, not for punishment.”

Eventually she signed up with Manya Lynch, part of a Māori midwifery team in West Auckland, who Kristina says “never created an environment where there was any weight stigma.” But there were still complications ahead – Kristina started to lose weight in her pregnancy, due to extreme nausea which turned out to be undiagnosed hyperemesis gravidarum – severe, debilitating nausea and vomiting – and she wonders if it took so long to be taken seriously by her GP because of her weight.

“I went to the doctor specifically because I was so sick – all day, all night, I couldn’t sleep, I was vomiting the second I got into a car, eventually I had to stop working,” she says. But she said her doctor’s reaction fitted a similar pattern of having her health concerns “dismissed or minimised, because of my weight.” 

“Now, looking back, I wish I had had the strength to say ‘this is serious, I need to be taken seriously and I need medication.’” If she had come in with a smaller body, Kristina wonders, would this have been taken more seriously?

Kristina says the fear of fat shaming was also the reason she steered clear of signing up for any post-natal help. “I had heard bad anecdotal stuff from other people, so – besides my amazing midwife – I didn’t get any follow-up support, and I f—king needed it,” she says. “I wish I could have had someone come every week, who I knew wasn’t going to judge me, because it’s hard! But I just didn’t feel comfortable enough.”

Carrying a child and giving birth, Kristina says, was a “beautiful experience” and she says it’s one of many achievements we need to see – and celebrate – fat bodies doing. “We really need to normalise fat bodies – and normalise the word ‘fat’! – doing things, like getting pregnant, moving our bodies for joy, not for punishment,” she says.

“I never, ever want my daughter to feel ashamed of her body. I never want her to waste one minute of her life worrying that her body isn’t good enough. So, I’m really making an effort, post-partum, to love my body as much as I can.”

Bronwyn: ‘They took the joy away. Every f—king step of my pregnancy, they took the joy away.’

In her 20s, Bronwyn Jones says her weight was treated as the number one reason why she couldn’t stay pregnant, despite her diagnosis of endometriosis, a condition where uterine tissue grows outside of the uterus, which is proven to create fertility issues. “I had many, many miscarriages,” she says, but was consistently told that the disease had nothing to do with her fertility, it was her weight that was to blame.

When Bronwyn was in her late 20s, she and her husband sought fertility help and was told that even before she could have any of the tests, she had to lose weight. Over a decade later, Bronwyn can still remember how infuriated this response made her. “If I could ‘just lose weight,’ I would have done that by now!”

So, they didn’t move forward with fertility treatment, but ended up getting pregnant on holiday – and this pregnancy ended up being a full-term one, with Bronwyn now the proud mum to her 11-year-old son, Adam. But the weight bias started immediately, she says.

“He told me: ‘You’re quite a lovely, bonny lady – it would be a shame for you if you didn’t get your weight under control.'”

“At my first midwife appointment, the first thing she did was hand me a pamphlet about all the different risk factors in pregnancy and told me, very, very blatantly that my obesity would be a high-risk factor for my baby to die,” Bronwyn recalls. “It was my first interaction with a midwife, and I just sat there, sucker punched; like I was a bad, bad human, who ate too much food, and it was all my fault.”

There was no information given to her about her pregnancy, about the next steps; it was all about her weight. Needless to say, she did not go back. She joined an obstetrics team instead, due to being considered high risk due to her weight.

When Bronwyn started to experience severe back pain in her third trimester – pain so bad it was stopping her from sleeping – she was told at every stage along the way that it was due to her weight. In fact, after a 3D scan to check her baby, the obstetrician said to her, “You’re quite a lovely, bonny lady – it would be a shame for you if you didn’t get your weight under control.”

“I have remembered those words in my head for the last 11 years,” she says now. “I walked away, holding my 3D scan, both super overjoyed to see my baby’s face but also deeply ashamed. They took the joy away. Every f—king step of my pregnancy, they took the joy away.”

From early on in her pregnancy, Bronwyn was made to take the glucose test for gestational diabetes repeatedly – she ended up taking it four times in total, all tests coming back negative. “I started pushing back and was told that ‘because of your size, you will have gestational diabetes at some point in your pregnancy.’”

When she went into labour early, she was told it was because of her weight and, again, that she definitely had gestational diabetes, it just wasn’t showing up. Both she and Adam were monitored for the first three days for diabetes, both eventually testing negative.

But there was finally a reason for that severe pain – Bronwyn had a tilted uterus, so her baby had been in the transverse breech position – Adam’s head pushing against one of the nerves in her back for three straight months. As a result, he was born with a condition called torticollis, where the right side of his neck was all tight and he couldn’t turn his head.

Even at age 11, he still has a flat head on one side. “All of that was blamed on my weight – and it was nothing to do with my weight; it was because I had a funny-shaped uterus and I’ve got endo… none of which is my fault.”

A decade later, Bronwyn says she feels sad that she was robbed of having a joyful pregnancy experience, because her weight was always treated as the be all and end all of her overall health. “I could talk about this all day, to be honest. Because I’m not ashamed, anymore. I’m angry,” she says.

“Why is this not a conversation that more people are having? Why are fat people still demonised? It feels like the last acceptable form of discrimination is fat phobia. It’s the last thing we’re ‘allowed’ to be mean to people about.”

In part three of our Babies & BMI special, we talk to four experts – a nutritionist, an obstetrician, a fertility specialist and a midwife – about where the BMI is important, and where they would like to see the system changed when it comes to a hyper-focus on weight.

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