The Fat Girl's Guide to Living

Maternity, by {*Sue*}

Bumps. Bellies. Miracles. Bundles of joy. Being pregnant is an open invitation for all of the sweet and adorable baby and belly-related lexicon a girl can handle. Unfortunately it can also bring on panic and negative self-talk when we’re already battling body image. Cute belly descriptives suddenly become caustic as we secretly (or not-so-secretly) replace them with phrases like beached whale. Fear of gaining more weight or getting more stretch marks or needing even bigger clothes ends up ruining what should be a fun, memorable, joyful time in our lives.

I struggled with my own pregnancy-related demons. At my first-ever prenatal visit 18 years ago, I weighed in at a whopping 126. Four months later when I had gained less than 10 lbs my OBGYN blasted me for caring more about my figure than I did about my baby. Because I was young and naive and ashamed from the scolding, I went home and campaigned to gain as much as I could by the time my son was born. When I left the hospital with him five months later, I was 55 lbs heavier. Lather, rinse, repeat with my second child, and, well…you do the math.

So in honor of my son turning 18 this year (hooray!) and since I’ve only lost a measly 25 of those 100 lbs since then (booo) I’ve pulled together a guide on pregnancy for overweight women, with the help of some generous experts in the field, in hopes of helping us all move beyond the fat fears by understanding what we’re really getting ourselves into, and to focus on enjoying the new life we’re giving… and getting.

Understand what is and isn’t healthy weight gain

Like many women, I assumed after that first prenatal visit that “eating for two” was a literal aspiration. I thought that the more weight I gained, the better it was for the baby. Had I known back then that a healthy pregnancy weight gain should really just be the sum of the extra tissue necessary to grow and accommodate a baby, I might not have panicked and piled it on.

“It is important for women to know that if they start their pregnancy over their natural weight, then they only need to gain 15 pounds to have a healthy pregnancy,” says Jessica Setnick, a behavioral nutritionist and recognized authority on eating disorders. “In fact in the first trimester, they may lose weight, and that is not necessarily compromising their baby.”

Setnick also says that it’s important to know specifically where the weight gain comes from: the baby, the placenta, the extra blood flow and other necessary tissue, so that they don’t panic that the weight is all fat. Women who panic about gaining wait often revert to comforting behaviors. “If one of those is eating,” she says, “the fear of gaining too much weight becomes a self-fulfilling prophecy.”

On the flip side, Setnick says pregnancy is not the time to diet. Children who suffered nutritional deficiencies in the womb can have a higher chance of becoming overweight, and the stress on your body associated with dieting can be harmful both physically and psychologically.

Seek out the right allies, especially in the medical community

Others comments may be well-intended or said in jest, but the fact is: we internalize them. Part of us listens and wonders if someone might be right when they say things like, “you’re pregnant, you’re supposed to eat all the time!” or “wow, you’re huge!”

Try to steer clear of people who feel the need to dispense advice or comment on every change in your body. You’re never going to feel good if you’re constantly wondering what you’re doing wrong, so leave it to your physician and dietitian to steer you in the right direction. But even health care professionals can have biases again people who are overweight, and if you feel yours does and won’t stop focusing on it – don’t be afraid to go elsewhere. Your experience should be positive, based in reality, and mutually respectful.

A tip from Setnick: If you obsess about numbers, tell your doctor’s office that you don’t want to know your weight each visit. They can include it on your chart, weigh you with your back to the display, and skip mentioning it unless it’s a valid concern.

Know what the risks are

Keeping an eye on health is important for any woman during pregnancy, but for those of us who are substantially overweight, risk factors go up and we need to be aware of them. The two major risks we want to draw attention to here are preeclampsia and gestational diabetes, but if you’re overweight and pregnant, talk to your doctor about other potential complications to watch for.

Preeclampsia, or toxemia, is a serious condition that can occur during pregnancy, usually after the first trimester, resulting in hypertension, fluid retention, and the presence of protein in urine, also known as albuminuria. Preeclampsia can be life-threatening for both mother and child, and obese women are at higher risk of developing it. Symptoms include frequent headaches, swelling of the hands and face, and sudden and unusual weight gain (even for pregnancy). If you’re pregnant or plan to try to become pregnant, take a look at Google Health’s run-down of preeclampsia to familiarize yourself with it.

“Statistics show that women who gain 22 pounds or more after age 18 have five times the risk for preeclampsia and other hypertensive disorders of pregnancy, while women with a BMI over 29 have three times the risk,” says Laney Poye of the Preeclampsia Foundation. “Women are also having babies later, and with more fertility interventions, which also increase the risk of preeclampsia.”

Poye says women with a BMI of over 25 may want to see an a maternal-fetal medicine physician specializing in high-risk pregnancies.

Gestational diabetes, while rarely life-threatening, can nonetheless pose a threat to both mother and baby. If unchecked, it can result in frequent bladder infections, vomiting and other symptoms in the mother, and jaundice, low blood sugar and even birth trauma in the baby. See Google Health’s section on gestational diabetes for more.

Unsurprising: risks for both preeclampsia and gestational diabetes can be reduced with a healthy diet and exercise, and experts suggest preparing for a healthy pregnancy by getting a head start on those things before becoming pregnant.

New reasons for getting that exercise in

Sometimes it takes just a little bit of an extra reason for us to get up and out there when we’re not feeling like exercising. If you’re pregnant, or planning to be in the near future, let your baby be that reason. Not only will you reduce your risk of serious conditions like those above, feel better, improve your mood and possibly even come out of pregnancy lighter than you were before — studies show that women who exercise during pregnancy, even if just a 20-minute walk each day, overall enjoy smoother, faster, easier births than those who don’t.

Besides, if you’ve been hiding behind frumpy, loose clothing for years because you were ashamed of your belly (who, me?) – now’s your chance to show it off with cute, plus-size maternity clothes like these, and these, and these! Who doesn’t love a pregnant belly?

Focusing on overall health, not size, is healthier for both you and your baby

The Health at Every Size movement (HAES) has been growing, and its philosophies apply across the board to everyone, men and women, pregnant or not, all ages. What it means, in essence, is that the healthiest thing we can do for ourselves is to focus on a holistic definition of health no matter what size or weight we are. Yes, being overweight comes with higher health risks. But studies increasingly find that women who are mildly to moderately overweight but maintain a healthy diet and keep up a steady physical regiment are often systemically healthier than many of their thin counterparts.

That’s not a license to stop caring about it – just the opposite. It means practicing healthy habits like eating whole foods, limiting empty calories, getting out and being active and social and happy and not focusing on the numbers on a scale or the size of your jeans. (Hey, that sounds familiar…)

In pregnancy, it means letting go of the diet cycle and the shame and the worries about acceptance and body image and just being the healthiest version of yourself you can be for you and your baby – and putting everything else aside. It means enjoying your pregnancy and your growing belly without being self-conscious, or beating yourself up over weight gain. And it means bringing your baby into a world, and a home, where health, beauty and self-worth are much broader concepts than anything a scale can measure.

Finally, a post-birth weight tip

Despite old wives tales and fear-mongering among crusty relatives, most women will lose a good percentage of the weight they gained during pregnancy. If you don’t, Setnick says it’s worth seeing an endocrinologist to find out if high hormone levels may be to blame.

. . . . . . . .

One our favorite things about FGG is our community of smart women willing to share their knowledge and experiences. So let’s hear it, ladies: what have I missed? What suggestions would you provide for a happy, healthy pregnancy at any size?