Break out the Shloer - supermodel Ashley Graham has announced that she’s expecting a baby. And although we’re so different we could be cast as Danny DeVito and Arnie Schwarzenegger in a remake of Twins, I’ll soon be able to say that I have something in common with Ashley Graham: namely, in about six months time we will both have gone through a pregnancy with a high BMI.
Higher, at least, than the narrow band that the NHS consider to be 'healthy'.
I don’t know Graham’s weight, but she’s a plus-sized model and anyone above a size 10 seems to be classed as having a high BMI nowadays, so it’s fairly safe to say that Graham is also in that camp and will have all the crap that goes with it.
Yes, it’s impossible to get good maternity clothes in a size 16+ and yes, it’s weird to have a pregnant body that isn’t like any pregnant body you’ve seen on screen before, but the real fun begins when you hit the hospital.
It started with blood tests. There’s a lot of blood tests when you’re pregnant, but I had to have extra - and then, because doctors were so convinced my BMI meant I’d get gestational diabetes, even more because they didn’t believe the results.
I’ve had so much blood taken from me I’m starting to worry they’re selling it on the black market, but every test has come back negative. Gestational diabetes is a serious condition, but I do wish they’d actually believe the results when they come back rather than focusing on those of my most recent weigh-in.
Then there were the extra appointments. At first, it was with a nutritionist who wanted to make sure that the baby wouldn’t come out looking more like Colonel Sanders than my husband.
She sent me and my food diary away with a stamp of approval and I was left wondering why every mother wasn’t having these appointments - unless, of course, the NHS believes that overweight mothers all eat badly and that thin mothers universally eat well...?
Second was my first appointment with an obstetrician. I was told very bluntly that because my BMI was high my baby was at risk of all these different things and I wouldn’t be able to use either the birth centre OR a birthing pool during labour, before being sent on my way feeling like I’d failed as a mother before the baby was even born.
Although I’m lucky - at least I knew why I was having these tests and appointments.
Hannah said 'throughout my pregnancy I had a lot of tests and talk of being high risk, but no one said directly that it was because of my weight. I felt confused and belittled, and only put it together afterwards that all of this monitoring, and being denied use of the midwife-led birth centre, could have been down to weight. I'd rather they were upfront with me - feeling uninformed at such an intense time was so much unnecessary stress.'
And it is stressful. Pregnancy in general is stressful, but all the extra tests and dire warnings make it worsen I started wondering how much was down to a reasonable concern for my baby, and how much was down to weight prejudice.
For example, the blood tests. The stat is that women with a BMI of 30+ are three times more likely to get gestational diabetes. It’s scary, until you realise that risk is 2.3% compared to 9.5%, so over 90% of women with a high BMI won’t get gestational diabetes
Was it really worth putting me through repeated blood tests which came back negative, for a chance of less than 10%?
And then there’s that Hannah and I couldn’t use the birth centre, which is designed to make the birth experience more relaxing. We weren’t allowed because of the risk of shoulder dystocia - where a baby's shoulders gets stuck coming out - is four times higher in women with a BMI over 35. Four times higher! That’s terrifying...until you realise that it goes from 0.1% to 0.4% and that 90% of shoulder dystocia cases are solved by pushing the mother’s legs up towards her shoulders.
That’s a lot less scary, but it’s being used as justification to stop women with a high BMI having a birth that could be more relaxing and pleasant, despite the fact that the Birth Trauma Association estimated 30,000 women a year in the UK experience some form ofbirth trauma.
In many cases it’s the processes that are the problem, not the staff. Robyn was told by her GP that losing weight during pregnancy should be a priority, but told by the midwives that 'half the women in that waiting room are larger than you. I wouldn’t worry about it.'
After my obstetrician appointment I bumped into my midwife who told me that the amount of tests I’d had to have and the weight-warnings were unhelpful, but it’s what she was forced to do because it was procedure. I heard something similar from my nutritionist and from multiple perinatal mental health practitioners - they know the system is broken, but they don’t have the power to fix it.
Claire, who lives in Scotland, experienced the benefit of a more understanding system: the first time she met her midwife she pre-empted shame by saying she’d lost three stone before conceiving and the midwife 'congratulated me on my weight loss, but also made it clear that as far as she was concerned, it was completely irrelevant.'
As a result, Claire went into labour feeling supported and confident, whereas I’m going into mine fearful of a cascade of intervention that will leave me with mental scars that will take far longer to heal than torn ladybits.
I’m not saying that there aren’t risks to having a higher BMI in pregnancy and I’m not saying that these risks shouldn’t be managed. What I am saying is that processes seem to be solving problems even when the tests have shown that there aren’t any, and this is causing stress and shame that pregnant people just don’t need. I’m more than happy to do anything the doctors want when there’s actually an issue, but until that point it’d be nice to be left to get on with it.
But hey. At least the last eight months of stress and fuss will give me and Ashley Graham something to talk about at NCT in six months time, right? Right