Finding out you are pregnant can fill you with joy and excitement, with dreams of meeting your little one, hosting a baby shower, or maybe gathering with friends and family to celebrate. You think about the milestones to come, your growing belly, and what kind of a parent you may one day be.

You think about cute tiny overpriced baby clothes and where your child might grow up and go to school. And of course you think about medical appointments, labor and delivery, and finding a doctor or midwife. For many this task is as simple as googling a doctor, showing up, and receiving care.

However, if you are a fat person, these happy imagingings can quickly be halted by folks who you expect to educate, care for, and support you. While many folks have the privilege of just finding a doctor and checking care off their list, safety, compassionate treatment, and receiving appropriate medical advice quickly becomes the overwhelming focus for folks living in larger bodies as they move through pregnancy.

The same is true for folks that hold one or more marginalized identities; for example, being Black, gay, and/or disabled, often means inferior or harmful care that can lead to deadly outcomes. Combine being fat with any of these identities and your chances of safe, compassionate, or inclusive care plummet even more.

This is not to say that amazing providers don’t exist, but our systems currently are not set up to prioritize or educate about the whole person, trauma informed, or inclusive care. There are flaws in the medical system that means providers have a harder time learning and providing appropriate care. This leaves many without a trusted primary care provider, let alone an obstetrician or midwife during pregnancy.

The story of how a country where almost half of our population who live in larger bodies can’t access safe care is a blog post, or book in and of itself. This post is aimed at providing tips to secure the most size inclusive care team you can given the systemic and location barriers you may be facing. While it’s unlikely that you can find an inclusive provider that is well educated about all aspects of each of your identities, my hope is that this is a place to start and a way to weed out more harmful providers.

So how do you create a team that cares for the body you have right now, pregnancy included? Here are my top three tips for building a size inclusive pregnancy care team:

One – Be honest with yourself about what you need to care for and center the identities you hold and what systemic challenges may arise.

Questions to ask yourself:

1. Is receiving size inclusive care my number one goal?
2. What would respect for the body I currently have, look like from a provider? What questions would I like to be asked by my provider
3. What terms would I like to be used related to my body and pregnancy?
   • TIP: Reflect on how you have been treated by healthcare professionals in the past, do you have specific memories or examples of negative treatment because of the size of your body? Is it likely this will keep happening in pregnancy? What could a pregnancy look like where you were fully supported in your current body?
4. Are their other identities that you hold that need to be prioritized even more?
   • Trans Black folks have high rates of bias, harm, and death due to our current medical system and may need to focus on finding an anti-racist/oppressive provider or one educated about medical care for trans and Black people first, and then think about size inclusivity. We do know that anti-fatness is also rooted in anti-Blackness and there is a connection between these two. Sabrina String’s Fearing the Black Body and De’Shaun Harrison’s Belly of the Beast are two amazing resources on further understanding these connections.
5. Are there other factors like location and the availability of providers a factor in your decision making?
   • TIP: You may have to look outside of your current location and travel further to a provider. Considering home birth and birth centers may increase options.
6. If you need to consider cost or coverage? i.e. how much a provider costs without insurance or which providers are covered under your current plan.
   • TIP: Call your insurance to see ahead of time to assess who may be in-network versus out-of-network, what is the price difference, do they cover non-OB services and providers like a midwife or doulas? What is the cost of a routine ultrasound? Blood work? Hospitals are now required to list prices for routine procedures, so you can also check your hospital’s website to get estimates.

Two – Do as much homework as you can BEFORE entering the office of a provider.

OB clinics and hospitals do not make this easy and COVID has made this even more complex.

TIP: Start by researching the provider, reading reviews, asking trusted friends and family members who have had babies or are currently pregnant, seek recommendations from fat positive pregnancy facebook or instagram groups (like Big Fat Pregnancy!), interview doulas before OB or midwife providers to see if they have recommendations.

You’ll likely only get a few minutes with the front desk person and maybe 15 minutes with a provider (if they accommodate an early pregnancy call or interview) so make sure you come in with your MOST important questions.

For fat folks, I suggest starting with these:

Call ahead and start anonymously: “I’m looking for an obstetrician/midwife/doula who is willing to provide weight-neutral care. That means treating me without diets or weight loss advice of any kind, is there a doctor in this office who can do that? If they say yes, feel free to ask a few specific questions, ask to set up a consult or early pregnancy appointment with the provider, or ask a few questions from the next page.Start with a few basic questions to get a feel for level of inclusiveness:

• Do you believe in Health at Every Size® (HAES)®?

• Do you have a BMI limit? (as clinic, center, or individual provider)

• Do you automatically consider a BMI (over 30, 35, etc.) a high-risk pregnancy?

• Do you require being weighed at prenatal appointments?

For more on interviewing providers, sign up for our monthly newsletter to receive a free copy of our Big Fat Pregnancy Interview Provider Packet.

Three – Build a care team that includes more than one provider and be empowered to kick people out!

TIP: Find a doula, a therapist, a nutritionist, a chiropractor, a mentor – people who can physically and mentally support your fat body and believe you can birth in the body you have now.

If this is not financially or physically possible, focus on finding a support person who can help you process, hold space, provide suggestions, or be with you as you navigate your pregnancy. Ideally someone who is also fat and working on body/fat liberation, has had similar life experiences, like pregnancy, or works with fat folks during pregnancy, like me!

Four – Make sure your loved ones that will be supporting you during your pregnancy and birth are knowledgeable on your birth plan and feel comfortable advocating for you.

TIP: This may mean that you will want to provide some resources to them and practice role-playing particular scenarios and how you’d like to be supported or have conversations around how you expect to be treated by your care provider team and when they can step into a conversation on your behalf.

If available, change providers if your safety or mental health is compromised or if you just do not like someone! This is your pregnancy, your body, your journey. You get to be the decision maker.

~Christina

I hope these tips help you as you start your journey to becoming a parent! If you have follow up questions, need to consult on your specific situation, or would like to work with me during your pregnancy, please book a FREE consultation.