Here are some things that plus size women have been told they cannot do: wear a bikini, drive a car, be confident, be healthy, find a partner, have a baby.
Hmm, plus size women can’t have babies? I’m no mathematician (as anyone who knows me will confirm) but since six in ten UK women are currently classified as overweight, this doesn’t seem to add up.
Yet trolls, doctors and supposedly well-meaning friends and family perpetuate this misconception, and plus size women continue to prove them wrong. One of them is Tess Holliday.
The model mother of two was inundated with disapproving comments when she announced her second pregnancy in January 2016, and despite claims that she couldn’t possibly carry baby safely to term, she gave birth to a healthy boy last June.
Since then she’s done her best to squash the notion that plus size women are less capable of having healthy pregnancies and children.
She said: “Don't believe what everyone tells you. All bodies and pregnancies are different; you can't generalise them. Listen to your body and trust it, do what you feel is best. Enjoy it as much as possible too, because it goes by so fast and you will miss it. I know I do!"
And she’s not the only one. When Babycenter.com surveyed its plus size readers about their experiences, 70% described their pregnancies as ‘pretty good’ or ‘fantastic’.
But a quick Google search will throw up an abundance of medical evidence and outright scare-mongering about overweight women being more at risk of everything from gestational diabetes to miscarriage.
So what are the facts?
According to the NHS, if you are overweight and planning to start a family, the best thing you can do is lose weight before you get pregnant. BUT! The NHS also says that if you are already pregnant and overweight, to try not to worry because: “most women who are overweight have a straightforward pregnancy and birth, and healthy babies.”
Just as well, since losing weight is often easier said than done.
The advice goes on to say that women shouldn’t try to lose weight during pregnancy as it may be unsafe, and there is no evidence that it will actually reduce the risks.
Let’s take a closer look at what the risks actually are.
- Neural tube defects are when a baby's brain and spinal cord don’t develop properly. While overweight and obese women are twice as likely to have a baby with NTDs as women with a ‘normal’ BMI, the overall risk is very small (around 1 in 1,000).
- Overweight women are twice as likely to develop gestational diabetes.
- Preeclampsia: a condition that's diagnosed after 20 weeks of pregnancy if you have high blood pressure along with at least one other symptom.
- If you develop high blood pressure 20 weeks of pregnancy but don't have any symptoms of preeclampsia, you could be diagnosed with gestational hypertension.
- Obesity is considered a risk factor for macrosomia, or having a baby that weights over 9 pounds, 15 ounces.
- Several studies have found that higher BMI is linked to a longer active labour.
- Some studies show that overweight women are more likely to be induced or have a Caesarean delivery.
So those are the risks, but the situation may not be quite as dire as we’re led to believe.
Firstly, all of the risks associated with weight are determined by your BMI. If you have a BMI of more than 25 you’re considered overweight, and over 30 is classed as obese. But BMI is increasingly being seen as an unreliable way of determining health.
It provides a rough estimate of body fat based on height and weight but doesn't take factors such as genetics or age into consideration, and certainly isn’t a measurement of overall fitness.
Take preeclampsia. While weight is one of the risk factors, age is considered more significant. For example, a woman under 35 and overweight is at less risk than a woman with a lower BMI who's over 35.
Secondly, all of these problems can occur in pregnancy for women of any size, with underweight women at just as much risk as those who are overweight.
Thirdly, the term ‘increased risk’ is incredibly vague. A study in British Columbia found that the rate of still births among obese women only increased by 0.1%, and though obesity may be a factor in macrosomia, only about 1% of babies are macrosomic.
Yet this doesn’t stop plus size women facing discrimination from the public and even medical professionals because of their weight.
Research shows that healthcare workers spend less time with overweight patients and are less likely to engage in discussion with them.
There are also countless incidents of women being turned away from fertility clinics and denied fertility treatment because of their size. This is despite research (published in the journal ‘Fertility and Sterility’) that looked at 239,000 IVF cycles and found that 34% of obese women became pregnant versus 38% of women with a ‘normal’ BMI.
The takeaway from all this is that while all women face the possibility of complications during pregnancy and childbirth, plus size women may be slightly more likely to encounter them.
Nevertheless, it’s important to remember that the vast majority of plus size women have perfectly healthy pregnancies and children.
That said, pregnancy is the perfect time for all women to make healthy choices to support our bodies while they do this amazing thing. With that in mind, the following advice is not size-specific. It applies to all women...
Eat a healthy, balanced diet. Know what foods to avoid. Do some physical exercise every day, but don’t over-do it. Make time for yourself. Listen to your body and do what you think is best for it. Relax. Have a bubble bath. If you have anxieties, voice them to your midwife. If your midwife makes you feel in any way uncomfortable or guilty about your weight, find another one.
Most of all, enjoy what is an amazing time in your life.