Plus-size pregnancy

A plus-size pregnancy is typically defined as a pregnancy in which the mother has a Body Mass Index (BMI) of 30 or higher. While the vast majority of plus-size women go on to have healthy pregnancies, it's essential to recognise that this group of women experience a whole layer of barriers and resistance from healthcare professionals that people with a lower BMI do not. 

The National Institute for Health and Care Excellence (NICE) provides guidelines on the care and management of women with obesity during pregnancy. These guidelines highlight the importance of personalised care, emphasising the need for tailored advice and support for plus-size pregnant women. Sounds good right? If only that was the experience of plus-size pregnant people.

Plus-size pregnant women often face unique challenges during their journey to motherhood. These challenges can include discriminatory issues that can affect their overall pregnancy experience and health outcomes. Some of these issues include:

1. Limited healthcare provider options: Some plus-size women report difficulties in finding healthcare providers who are knowledgeable and sensitive to their specific needs. Discrimination can manifest as healthcare providers making negative assumptions about their health and subsequently providing substandard care.

2. Stigmatisation and body shaming: Plus-size pregnant women may experience stigma and body shaming from healthcare providers, family members, and the public. Negative attitudes and comments can lead to emotional distress, low self-esteem, and reluctance to seek necessary medical care.

3. Negative birth experiences: Discriminatory attitudes can impact the birthing experience. Some plus-size women may feel judged or dismissed during labour and delivery, which can lead to increased stress and anxiety and in some cases long-lasting birth trauma.

4. Challenges in breastfeeding support: Discrimination and bias can affect the support and advice plus-size women receive regarding breastfeeding, which then negatively affects infant nutrition and bonding.

5. Weight-focused care: Some healthcare providers may focus excessively on weight management during pregnancy at the expense of other important aspects of prenatal care, often leading to interventions being recommended that are not rooted in evidence.

6. Access to fertility treatment: Many plus-size women face discrimination when seeking fertility treatments, as healthcare providers may assume that their weight is the sole cause of their fertility challenges, leading to delayed or denied treatment options.

7. Limited representation in healthcare materials: Plus-size pregnant women may encounter a lack of representation in pregnancy-related literature, websites, and educational materials, which can leave them feeling excluded and uninformed.

Addressing discriminatory issues faced by plus-size pregnant women requires a combination of increased awareness, education, and advocacy efforts. This is where hiring a doula can be useful; they can support you to ensure that your healthcare professionals are providing compassionate and evidence-based care. 

Doulas are non-medical professionals who provide emotional, physical, and informational support to expectant mothers before, during, and after childbirth. When it comes to plus-size pregnancy, the role of a doula is particularly important. Here are some ways in which a doula can make a significant difference:

1. Emotional Support: Plus-size pregnant women may experience body image concerns and heightened anxiety. Doulas provide a safe space for women to express their fears, anxieties, and uncertainties, helping to reduce stress and promote mental well-being.

2. Advocacy: Doulas can serve as advocates for their clients, ensuring that their concerns and needs are communicated to healthcare providers. This is especially crucial when navigating a healthcare system that may not always be inclusive or sensitive to the unique needs of plus-size women.

3. Information and Education: Doulas can offer evidence-based information and education to their clients. This includes helping clients to consider the benefits and risks to support their decision-making. 

4. Birth Planning: A doula can assist a plus-size woman in developing a birth plan that takes into account her unique needs and preferences. This can include discussing positions that may be more comfortable during labour as well as how to navigate healthcare restrictions before and during birth. 

5. Physical Support During Labor: Doulas are skilled in providing physical support during labour, which can be especially valuable for plus-size women. They can offer massage, position changes, and comfort measures that can ease the birthing process.

The NICE guidelines acknowledge the potential benefits of doula support during labour and birth. Doulas can be instrumental in providing continuous support throughout labour, which is associated with positive birth outcomes. Continuous support can include comfort measures, emotional support, and the encouragement of informed decision-making.

Cochrane reviews have also explored the impact of continuous support during labour. The reviews suggest that women who receive continuous support are more likely to have spontaneous vaginal births and are less likely to request pain relief or have a cesarean birth.

For plus-size pregnant women, the benefits of continuous support are particularly significant. The emotional and physical support offered by a doula can help mitigate the challenges that may arise during labour and birth.

Doula Near Me members have access to our Resource Library, where they can access a range of evidence to support plus-size clients. In addition, we recommend the book, Plus Size Pregnancy by Dr Sara Wickham for both doulas who are supporting plus-size clients and pregnant people themselves.

Plus-size pregnancy comes with its unique set of challenges and considerations. The evidence-based guidelines from organisations like NICE and the insights from Cochrane reviews underscore the importance of personalised care and support for plus-size pregnant women. Doulas play a crucial role in this equation, providing emotional, physical, and informational support to ensure these women have a positive pregnancy and birth experience.

It's important to recognise that every pregnancy is different, and the needs of each expectant mother are unique. Plus-size pregnant women should be empowered to make informed decisions about their care, with the support of their healthcare providers and the invaluable assistance of doulas.

By understanding the challenges and embracing the supportive role of doulas, we can work together to promote healthier outcomes and empower plus-size women as they embark on the journey to motherhood.