Finding a Size Friendly Provider
As you navigate your plus size pregnancy, one element worth considering to help create a positive pregnancy and birth is finding yourself a size-friendly provider. The last thing you and anyone else needs while seeking maternity care is fat-shaming or being mistreated because of your body size. Sadly, we know many medical providers have medical bias towards people of size. This, of course, has negative physical, mental and emotional consequences for those who are on the receiving end of stigmatizing care (Research here). Fortunately, there are wonderful doctors, nurses and midwives who are providing truly compassionate support to people of all sizes and you can often find them if you know where to look!
A size-friendly (also sometimes referred to as size inclusive) provider is someone who provides evidence based, compassionate care which is individualized to your unique situation. They view you as a whole person and not just a BMI or number on a scale. You are not treated as a set of potential risks, but rather someone who has autonomy over their body and their experience.
A size inclusive provider has the following qualities:
Awareness of their own biases
Provides compassionate support for people of all sizes and abilities
Does not class you as high risk solely based on your BMI and doesn’t treat you as such
Doesn't make assumptions about your eating habits and level of physical activity
Has equipment suitable for use with people of size
Treats you with dignity and respect
Understands the importance of informed choice
Respects any boundaries you create with them
Acknowledges that you are the only expert of your body
Encourages health promotion without prescribing weight maintenance or loss
Certify as a size inclusive birth professional!
How Do You Find the Right Practitioner for You?
There are multiple approaches to finding a provider who is size friendly. One of the most valuable may be asking other plus size parents, friends and family members for referrals. You may also be a member of a fat positive pregnancy and/or parenting group where you can ask for referrals for your area. If you're looking for a community to join, click over to the Fat and Pregnant private Facebook group. Here at Fat & Pregnant, you can search the size inclusive birth professional directory! These birth workers specializing in fertility, pregnancy and postpartum care have gone through our certification process so you can be confident that they have the knowledge and tools to provide services free of weight stigma.
There are also a series of online size friendly provider lists, namely the Health at Every Size Community and the Fat Friendly Health Professionals List.
Ask birth workers in your community. As a plus size birth and postpartum doula, I have experience supporting countless families and hearing a wide range of experiences, both positive and negative in my community. Chances are the birth workers in your area may also have some insight into who may be more size friendly.
Once you have created a list of providers, now it is time to contact them.
What Do You Ask?
First off, always inquire about their fees and if they are covered by your insurance, if that is needed. Some providers you may be able to interview in person, while others you may only be able to practically contact via email or phone.
Unfortunately some birth centers, midwives and facilities with pools for water birth may have BMI limitations. This is certainly a question to ask, but also be mindful that it is oftentimes facility policies and not providers directly who make the call on this. There may also be an opportunity for you to advocate to have access to a birth pool, for instance. Other questions you may ask include:
What experience do they have in supporting people who are plus size?
Do they believe having a high BMI (with no underlying medical conditions) means someone's pregnancy is "high risk"?
What is their induction rate and under what circumstances might they suggest one?
Under what circumstances may they suggest augmenting (speeding up) the labor process?
What is their cesarean rate?
What is their philosophy regarding birth? (Tip: this is important because some providers see birth as more of a natural process which rarely needs intervention while others are more likely to see birth as something that needs to be managed).
How do they feel about birth preferences?
What are their thoughts on fetal monitoring and which type do they suggest for plus size folks?
Are they the person who will be supporting you during labor? If not, who else may attend?
What are their thoughts on doula support?
Do they support active labor and being upright?
What are their thoughts about you pushing in an upright position, off your back?
Do they have any policies specifically for those with a higher BMI?
There are loads of other questions you could ask which may help you select the right provider! Explore what is important to you and begin there with your questions.
Download a free hospital bag checklist for plus size folks!
Always remember that you are the only person who knows which provider feels right for you.
If something doesn't sit well, in most cases you have options and you can switch your care to someone else. There are also many situations in which this may not be possible due to finances, geographical limitations and insurance issues. In the event that you cannot switch providers or you are under a public health system in which you cannot choose your primary maternity care provider, it is important that you set boundaries and become familiar with ways you may need to advocate for yourself both during pregnancy and birth. You may wish to enroll in childbirth education that is specifically tailored for plus size expecting families. Hiring a birth doula may be another wonderful option for you and they can assist you in identifying common challenges and instances when you may need to set boundaries. They also provide continuity of care and will spend several prenatal visits getting to know you, learning what is important to you and how they can best support you during labor.
You deserve respectful, high quality care as a plus size person. After you have chosen your provider, you are one step closer in preparing for your positive birth!