by Kmom
Copyright © 1996-2001 Kmom@Vireday.Com. All rights reserved.
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
CONTENTS
Am I, as a fat woman, healthy enough for a pregnancy? Will my weight or lack of physical conditioning impede labor and delivery or harm my baby?
Many fat women have wondered this question. Really, there are no easy answers to this. This is something only you and your health provider can decide, using an honest evaluation of your health.
You and your future baby deserve the best start, so don't assume one way or the other---look at your life objectively. Be sure to find a size-friendly provider to help you look honestly but without judgment. Look seriously at your:
It is particularly important to be sure your blood sugar and blood pressure are normal before considering starting a family. If there is a reason for concern, it is EXTREMELY important that the problem is being taken care of through medication or other treatment BEFORE starting to try to conceive.
Inquire into your family history for pregnancy problems that may run in the family. These may tell you more about health problems you may need to watch out for, and in particular which things you may have to be extra proactive about. There are a number of things that you can do to help you be proactive about avoiding problems in pregnancy; it is important to be aware of the information on these and work to incorporate them into your pregnancy plans.
Be sure to start on prenatal vitamins several months before trying to conceive so that you get enough folic acid, which may help prevent neural tube defects. Consult your provider about the best dosage for you. Start charting your periods, cervical mucus, and basal body temperature in order to determine your cycle length, fertile period, and whether you ovulate regularly. This can save a great deal of trouble when it comes to dating the pregnancy and preventing medical mismanagement in your pregnancy! Eat VERY nutritiously, with an emphasis on lots of fruits and vegetables, plenty of protein, and reasonable but not excessive amounts of carbohydrates. Stay away from junk food.
Don't forget to evaluate the mental and emotional aspects of having children---you need to be ready physically AND emotionally for life's greatest challenge---parenting! Are you and your partner in a committed relationship? Are both of you committed to having children? Have you thought about how children will change your life? Have you considered what to do about your job situation, and how are your finances? If you would be a single parent, do you have extra help and support lined up? Considering all of these are important parts of becoming a parent, whether through pregnancy or adoption. Although many people have become parents unexpectedly (without time to fully consider all these questions) and have done just fine, most people do better if they take time to really explore the implications of this life-changing decision ahead of time.
If you feel you are, on the whole, healthy and ready for a child, then do consider pregnancy as an option. You don't have to postpone or forego pregnancy just because you are a large person! What's important is your overall health, your regular nutrition and exercise habits, your family history, and your emotional readiness. If these are poor, then perhaps it is a good decision to postpone pregnancy and address these issues first. But if these are fine, you are perfectly reasonable to pursue a dream of pregnancy! You don't have to postpone your life simply because you are big!
Remember, fat women have been having babies successfully for years, and at an amazing range of weights. On the Big Moms mailing list, we have moms who have had successful, healthy pregnancies and babies at weights up to and well over 400 lbs. There are birth stories on this web site from ALL sizes of large women, from just-barely-big to truly supersized. Although there is a higher rate of complications in pregnancies of bigger women and some fat women do experience them, in actuality MOST fat women do have healthy pregnancies and healthy babies. If fat women absolutely could not have pregnancies or healthy babies, there'd be a lot less fat people in this world!
Size is less important than overall health; fat does not have to equal unhealthy. No matter what your size, if you are not healthy and don't have good nutrition, then you should think twice about becoming pregnant. That's true for fat women, for skinny women, for women of average size---for all women. However, as a large woman, if you are proactive, take excellent care of yourself, actively pursue competent and size-friendly care, know the research about risks for larger women and act accordingly, you have a good chance of having a healthy pregnancy too. There are never 100% guarantees for women of any size, but chances are in your favor, especially if you act proactively and be as healthy as possible. Don't let your size automatically dissuade you from considering pregnancy!
In most cases, it is not wise to diet just before pregnancy. Make sure your weight is stable for quite a while before trying to conceive. If you have dieted during the year before pregnancy, you may be starting out the pregnancy malnourished (particularly in important vitamins and minerals), which some health providers feel can lead to complications. Also, your metabolism may be in 'starvation' mode, slowed down in order to conserve its fat. If you consider the fact that one of the body's jobs during pregnancy is to accumulate extra fat stores for the energy requirements of labor, delivery and breastfeeding, and then add in a body which may already be in metabolic "starvation/store" mode, you can end up with excessive weight gains in pregnancy. Indeed, these are common in women who are chronic dieters or who have recently lost a great deal of weight.
Never diet during pregnancy either. Excellent nutrition is CRITICAL to a healthy pregnancy. If you feel your health is not up to a pregnancy, work on your habits instead of on your weight. If some pounds drop in the process, terrific! If not, your health is still better than when you started. But deliberate dieting through hypocaloric intake, strict restrictions of certain types of food, or excessive exercise do not prepare your body for healthy pregnancy. Even 'sensible' diets that promote weight loss too fast or restrict intake too strongly can be harmful. Forget the dieting and forget what the scale says; look instead at improving your daily nutrition and exercise.
Your regular habits are a more important sign of your health than any number on a scale. Regular physical activity and superb nutrition are what you should concentrate on instead. Many providers feel that a number of common complications can be avoided with proper nutrition and exercise. The importance of terrific eating and activity habits cannot be overemphasized! Don't slack on this in any way.
In the future, a FAQ on Pregnancy Nutrition will be added to this website to discuss different nutrition questions in detail, but in the meantime, here are some issues to consider. Keep in mind that not all nutritionists agree on proper pregnancy nutrition, but these are some basics that some providers believe can help prevent or minimize pregnancy complications in some women:
1. Be sure to get enough protein and calcium/magnesium in pregnancy. Pregnancy-Induced Hypertension (PIH) and its more severe version, Pre-Eclampsia, are potentially serious complications of pregnancy. Larger women in particular may be more prone to PIH. Some providers feel that inadequate nutritional intake is the cause of some cases of PIH/Pre-Eclampsia, and that getting the proper amount of protein can help prevent problems. In addition, some providers believe that adequate calcium/magnesium intake is important in preventing some cases of PIH, although research is mixed on this issue. A bit of extra calcium in pregnancy may be a good idea, and ideally it is taken with magnesium to help increase its absorption. However, be sure to consult your provider for exact guidelines as to dosages, etc. Salt should not be restricted for most women; salt your food to taste.
2. Be sure to get enough calories in pregnancy; do NOT restrict calories to try and limit weight gain. If a pregnant woman does not receive adequate caloric intake, her body diverts some of the protein she eats for basic energy needs instead of for baby-building tasks. Although most pregnant women do not need a great deal of extra calories, it is important that they not be restricted either. Yet fat pregnant women are sometimes told even today to restrict their intake strongly. Doing so may cause problems later. Actually, it is less important to increase the quantity of food than to improve the QUALITY of food you consume. In other words, how much you eat is much less important than the QUALITY of what you eat. Make what you eat really count.
3. Be sure to get enough B vitamins (especially folic acid) both before and during pregnancy. Too little folic acid can increase the incidence of Neural Tube Defects, and may be especially important to large women, who may experience NTDs at a slightly higher rate than average-sized women. Since research seems to show that as a group, large moms consume slightly less dietary folate and have slightly lower rates of prenatal vitamin usage, concentrating on getting enough folic acid and other B vitamins may be especially important in big women before and during pregnancy. Remember, birth defects occur very early in pregnancy, often before women even know they are pregnant. Practice GREAT nutrition (with plenty of fruits and veggies) before you even start trying and especially during the early days of pregnancy. Some research shows that folic acid is less protective in larger women than in average-sized women, so some women have speculated that perhaps big moms need a slightly higher dosage of B vitamins. Consult your provider as to the dosage they would recommend for you, but be sure also to get plenty of dietary folate as well.
4. Don't let pregnancy nausea derail your nutrition. Many larger women have a tendency towards low or uneven blood sugars, and pregnancy hormones can exacerbate this. Many doctors tell women not to worry about eating during early pregnancy if they have a lot of morning sickness, but in fact this can make things much worse. The baby's needs don't stop just because you feel sick, and the most important developmental work and formation is happening in the very early parts of pregnancy. Actually, pregnancy nausea is a sign that you NEED to eat. Although it is not fun at first to eat when you are feeling nauseous, that is exactly the time when you need to do it MOST. Concentrate on eating small amounts every 3 hours or so, and especially when you start to feel nauseous. If you throw up the food, go eat a small amount of protein again. This can help the pregnancy nausea from getting out of control and throwing your blood sugars out of whack. For more information, see the section on Handling Nausea in Pregnancy.
5. Eat smaller but more frequent meals, and be careful of carbohydrate consumption. Gestational Diabetes is another risk for larger women, and may occur because of underlying insulin resistance or a tendency towards uneven blood sugars. Some health providers believe this can be prevented in some women by eating smaller, more frequent meals that combine protein with carbohydrates. This slows down the process of converting carbohydrates to blood glucose and helps prevent large spikes and dips in blood sugar levels. Also important is avoiding simple carbohydrates like sugar in its various forms (fruit juices and sodas etc.), limiting refined carbs (like crackers) to eat more complex carbs instead, and adding in regular daily exercise, which helps increase glucose uptake by the body. (See also the section on GD: Can It Be Prevented on this website.)
Some women may be afraid that eating healthily will be like being on a diet for 9 months or more. You don't have to completely eat like a monk! You can work in reasonable amounts of foods you love, but it is important to be pretty strict---your baby is depending on you! Some midwives use the guideline that you can have a small 'treat' or indulgence as long as you have at least one food from the protein, whole grain, fruit, and vegetable families first. Although research is contradictory on whether more careful nutrition and exercise can lower the rate for pregnancy complications, anecdotal evidence does strongly support that. As long as you are reasonable, extra careful nutrition is unlikely to do any harm, and may actually help. Just apply common sense liberally.
None of these guidelines, of course, can GUARANTEE that you will not get any complications, but some research and anecdotal evidence shows that it may help, plus it is just sensible eating overall. However, eating well is not enough---physical exercise is also an important part of preventing complications.
Research shows that regular exercise can help cut the risk of gestational diabetes in HALF in obese women, probably by helping the body use its own insulin better. Regular exercise decreases some of the discomforts common to pregnancy (like constipation) and helps keep your body moving optimally despite its pregnant load. Good physical conditioning can be a help for an easier labor. Of course is no guarantee of a short easy birth (baby position is probably the most important factor in that!), but it is another factor that you can have in your favor.
Many women think they have to have rock-hard abs in order to push out that baby. Actually, although abdominal strength can help, it is not necessary to push out a baby. There have been cases of women who were paralyzed or in a coma and unable to physically do the usual 'pushing' routine seen on TV, yet still had their babies vaginally. The uterus is a very strong muscle all on its own, and it does not need any other muscle to push out a baby.
However, that is not to say that abdominal tone is a bad thing; sometimes in extremely large women who have a very big and floppy 'apron' (fold of fat in the abdominal area), the lack of abdominal tone can cause the baby to be malpositioned. Midwives know to watch baby position in women with 'pendulous abdomens' (gotta love that terminology!) and will sometimes use a special scarf or shawl tied around the middle to support the abdomen and help the baby get into position in these women. Good pre-pregnancy abdominal tone may also help prevent complications like umbilical hernias which larger women may be prone to developing.
But while good abdominal tone can be helpful and should be encouraged pre-pregnancy, it is not absolutely necessary for having a baby. If you are already pregnant and don't have great abdominal tone, don't worry about it; abdominal tone can't really be developed much in pregnancy. As long as the baby is in the right position, you will still be able to push your baby out. You can concentrate on improving abdominal tone after pregnancy (watching for abdominal muscle separation or umbilical hernias first).
What is more important than abdominal tone is actually simple endurance and strength. Labor is hard work. It is involuntary work; it's not the same as running a marathon where you have to train up ahead of time. Even women that are very out of shape can give birth, but again it's another factor in your favor if you have better endurance and strength before beginning labor. You don't need to become a marathon runner, but do consider doing some regular exercise like walking, prenatal yoga, water aerobics, or swimming. (Swimming is actually a great exercise for pregnancy, as it helps reduce edema and puffiness, and promotes good baby position for birth.)
After getting your doctor's approval, start increasing your physical activity. If you are not already active, try to exercise at least 20-30 minutes every other day, and work up to at least 30 minutes every day. If weather temporarily interferes with your exercise, use the steps in your house, or just walk or dance around your house. Even upper body 'aerobics' (getting two containers of canned food and 'pumping' them) has been shown to be effective in lowering the blood sugar levels of gestational diabetics!
For some women, breaking up the exercise into 2 twenty-minute periods works better, whereas other women prefer to do their exercise all at once. Find whatever pattern works best for you. A short walk after breakfast, for example, is often an important part of handling gestational diabetes, since blood sugar levels often peak after the morning meal; you can then add another short walk later in the day to help later blood sugar levels. The key is to find what works best for you in YOUR situation.
Most doctors advise not overheating while exercising in pregnancy, so keep your core temperature at a reasonable level at all times. Most guidelines suggest that your heart rate should not exceed 140 beats per minute and that this period of maximum heart rate should not exceed 15 minutes, so consider working slowly up to and down from that level or maintaining a lower level for a longer period. You are not trying to 'go for the burn' when exercising in pregnancy, so don't overdo. Just keep a pace that allows for comfortable conversation and that you won't be hesitant to keep up every day. Don't forget to stretch some at the beginning and end of your exercise.
If exercising brings on Braxton-Hicks contractions for you (usually felt as a tightening in the abdominal area), take a pause in your activity until it goes away, then cautiously resume your activity. If exercise causes too many or too frequent BH contractions or other problems, stop the activity and discuss the issue with your health provider, who can guide you further. Of course, if you have special health considerations, your exercise program will have to be designed and monitored by an expert.
Specific exercises for pregnancy such as the Pelvic Rock are important to good back and abdominal health in pregnancy. They also are important in helping the baby to be optimally positioned for birth, which can make for a much easier birth! Although doctors tend to be dismissive of the value of pelvic rocks, many midwives swear by them. In fact, it is often a good idea to spend as much time as possible on all fours in the weeks before birth, as this helps the baby position better and eases back pain. (See the web section on Baby Malpositions for more details about the importance of good posture, especially near the end of pregnancy.)
Don't forget Kegel exercises, which exercise the all-important muscles of the perineum (the area around the vagina). These are vital for toning and strengthening a critical area for childbirth, and should be done religiously. Instructions for these pregnancy exercises can be found in any pregnancy book. Although you can certainly give birth without doing Kegel exercises, they really are important for helping the area avoid tears during birth, and for long-term optimum health of the area. Since heavy women have more tendency towards prolapses and urinary problems, it is probably particularly important for them to keep this area well-toned.
For more information about specific pregnancy exercises and considerations, consult Elizabeth Noble's Essential Exercises for the Childbearing Year. Although it's a bit size-phobic in spots and a little over-hyper about exercising, it mostly has a lot of good common-sense information about exercise during pregnancy. And better yet, it has information about exercise after birth as well, to tone the body back up and recover from the stresses of pregnancy. Although it is not a perfect book, it is quite useful.
Finally, although it is important to exercise regularly, don't make yourself crazy over it. If you need to take a break from it now and then, go ahead. Try not to let a 'break' from exercising go on for too long (since the key to exercise benefits is regular exercise), but don't fixate about it. Although exercise is going to help most women have an easier and healthier pregnancy, women can and do birth normally without being Olympic athletes. Exercise shouldn't be a burden. Find a way to work whatever level of activity you can best deal with into your life, but don't obsess over the issue. Pregnancy is to be enjoyed, not obsessed about. It's not a 'pass/fail' activity, and you don't have to be 100% perfect! Be as healthy as you can, but be self-forgiving too. Find whatever patterns work best for YOU.
Many fat women worry about whether their babies will be healthy; they are often very concerned whether their size will impact their babies' health. There is no simple answer to this question.
The results of years of studies on the babies of obese mothers have been inconsistent. Some studies have found increased rates of problems in the babies of obese mothers, while others have not. Often, when problems are found, they are most concentrated in the pregnancies of women with complications, especially those with severe complications. When the pregnancies of heavy women with complications like gestational diabetes or pre-eclampsia are controlled for, most (but not all) studies found that the babies of obese moms were just as healthy.
Keep in mind that these studies are extremely simplistic in their design; they rarely examine other possible factors that might influence the rate of complications. An adequate control group is often not provided for in many of the early studies, chronic dieting status is almost never controlled for, and often providers do not factor in treatments that they themselves have initiated that may cause problems.
For example, for years fat pregnant women were put on strongly restricted caloric intakes in pregnancy; some researchers still do this even TODAY. So were the problems that were developed in those studies due to obesity, the restricted diets, or a combination of both? One recent study examined the use of a diabetes medication in pregnancy in obese women; there was a higher rate of perinatal mortality in the group on the diabetes medication. The authors questioned whether this was because of the diabetes medication or the obesity common to the group. However, they completely overlooked the fact that they had all the fat women on 1200 calorie diets----in PREGNANCY!----and that this often produces ketones, which is known to be harmful in large amounts. Nowhere do they mention monitoring for ketones, or even questioning whether a 1200 calorie diet might be harmful. So the question remains----was it the diabetes medication that was the problem, was it the obesity, or was it the extreme caloric restriction in pregnancy that they mandated? Almost never are the 'treatments' of obese pregnant women questioned as possibly causing harm. Only obesity is considered as a possible cause.
Nor are possible co-morbidities questioned. Many fat women who experience the most complications in pregnancy actually have PolyCystic Ovarian Syndrome (PCOS). Is it the obesity that causes their complications, is it the abnormal hormonal function of PCOS, or a combination of both? PCOS is almost never controlled for, yet GD studies show that a very high percentage of women with GD actually also have PCOS (which is a disease of insulin resistance). Yet while GD studies often note that more obese women get GD than lean women, they rarely control for PCOS in the study.
This is not to minimize that there probably are increased risks associated with pregnancy at larger sizes, just that these risks have to be kept in perspective. It is possible that you might develop a complication that might impact your baby if you are not careful, and it is possible that even if your pregnancy is normal, your baby might still have problems that could possibly occur more often in larger women. The risk is small, but it is possible.
However, keep in mind that MOST babies of large women do just fine, and the babies of uncomplicated pregnancies tend to be very comparable in perinatal health whether the mother is large or average-sized. While the babies of mothers who developed pregnancy complications like GD and PIH did have more problems in some studies, they generally turned out fine in the long run as well. Pregnancy complications don't have to mean an unhealthy baby! Most are fine if the mother takes care. And don't forget that many health providers feel that with proper nutrition and exercise, many cases of GD and PIH can be prevented, even in larger women, so it's very important to be proactive for both mother and baby's sake.
It is also important to remember that MOST large women do NOT develop complications. Some fat-phobic health providers will assume that if you are large, you will get either PIH or GD for sure. This is not supported by the research. There is some increased risk, which should be watched for by your provider in a reasonable manner, and you should be counseled as to possible ways of decreasing your risk of these complications through the use of superb nutrition and regular exercise, but to assume that the complications are inevitable is not justified statistically. CAUTION and prevention should be the name of the game, not over-reaction!
All women, no matter their size, should be extremely careful of their health before and during pregnancy. Excellent nutrition is especially important in pregnancy, and regular reasonable activity can also be very beneficial. Without becoming obsessed about it, do be as proactive as possible before and during pregnancy----your baby deserves the best!
But in the end, only you can answer whether or not you are healthy enough and ready for parenthood, or if there are some changes that you need to work on first. Take honest and careful stock of your habits and life, and decide what the best course is for YOU.
Remember that while there are some increased risks, most fat women actually do have healthy pregnancies and healthy babies. Even if you do develop a complication like gestational diabetes or pre-eclampsia, this is not the end of the world-----there ARE treatments for these conditions, and most babies of these pregnancies are born healthy with a little extra care and caution. No one can promise a problem-free pregnancy or perfectly healthy baby to women of any size, but the odds are everything would probably be fine even in women of size.
Just because you are fat doesn't mean that you cannot or should not become a parent! Fat people deserve children too. If you are reasonably healthy, loving, and willing to put in the time and sacrifice necessary for a baby, then by all means pursue parenthood in whatever way is most appropriate for you.
Parenthood is a joy not to be missed as long as you are ready to put in the time and effort and love required. Don't let fears, rational or irrational, dissuade you from it or ruin the experience for you. There's nothing more wonderful than being a parent!
Copyright © 1996-2001 KMom@Vireday.Com. All rights reserved. No portion of this work may be reproduced or sold, either by itself or as part of a larger work, without the express written permission of the author; this restriction covers all publication media, electrical, chemical, mechanical or other such as may arise over time.