Fat Vaginas

I’m sorry. There’s no point beating around the bush. This happened yesterday, and now fat vaginas are on the agenda:

Milli Hill, author of Give Birth Like A Feminist, spoke on BBC Radio Scotland for a discussion about induction rates. With her was Dr Marco Gaudoin, brought in for the ‘expert’ perspective. However, it turns out that Dr Gaudoin’s expertise is in fertility, not obstetrics or gynaecology… which may explain why he said this:

‘With obesity you’ve got increased fat tissue in the birth canal, which makes the birth canal that much narrower, which makes it harder for the baby to squeeze through the birth canal. So you are more likely to end up with what is called an “obstructed labour”‘

Dr Marco Gaudoin, speaking on BBC Radio Scotland 12th November 2019

What’s worse was that this happened at the end of the interview! Milli had no opportunity to challenge the doctor on his statement, or ask for evidence.

Fat Vaginas – Fact or Myth?

It’s no surprise that Milli had never heard this before, because there is NO EVIDENCE for Dr Gaudolin’s words whatsoever. They echo a theory suggested in a research paper back in 1997, and no-one has provided any evidence for it since.

It’s just more fat shaming.

Fat Vaginas: a display of inside-out purses looking remarkably like a selection of vaginas.
Vaginas come in a plethora of different shapes and sizes… image courtesy of The Vagina Museum

Ugh. Makes me want to beat some people over the head repeatedly with a copy of Give Birth Like A Feminist. Shame it didn’t come out in hardback.

You’d really hope that a qualified doctor would stick to established, evidence-based information. Sadly (too often, in my experience) when some doctors feel under pressure, they dredge some half-truth they heard somewhere from the back of their mind and present it as fact, rather than admit they don’t know.

It’s why I recommend anyone embarking on a high BMI pregnancy journey do their research and ensure they’re informed.

I have spoken to countless midwives (who have extensive experience of actual vaginas giving birth) and most agree that with the right support, there is no reason why a high BMI pregnancy shouldn’t proceed as with any other. Indeed, most of them do.

What Happened Next?

On Twitter, plenty came forward to challenge the “expert’s” ill-informed and misogynistic statements.

Then to my surprise, for once, the print media responded positively to the story! This may be thanks to Milli Hill knowing the right people to approach, but it was a refreshing change! The resulting article was comprehensive and well written.

Screenshot of Grazia online article on fat vagina comments.

Then other media outlets picked up on the story, including the Sun, who got an actual expert in obstetrics and gynaecology to comment!

Dr Virginia Beckett, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists clarified that having an “obstructed labour” has nothing to do with “fat vaginas”. Which we knew, but it is nice that someone well qualified to address the issue has done so.

Screenshot of the Sun online article about fat vaginas

Next Up to fight our corner was the Daily Mail!?

Yes, really! Asking lots of people with much more experience and expertise… and me. So, yeah. That happened. I was tempted to be indecent and suggest that if our vaginas are so ‘restricted’, how lucky must our husbands and partners be? But I behaved myself. And contrary to my expectations, the journalist didn’t twist or change what I wrote at all, bar removing a paragraph that had already been covered by a previous interviewee. You can read what I wrote here:

https://www.dailymail.co.uk/femail/article-7680527/Doctor-claims-obese-women-fatter-vaginas-likely-experience-obstructed-births.html

Jaw on floor.

The article came with the usual stock headless belly image, naturally! But as soon as I realised and offered an actual picture to replace it, it was quickly swapped.

Of course, the article goes on to report the bloody relative risk stats rather than the true percentages, as always. So there’s still a way to go, but feeling strangely positive at how this story has turned out, for once!

As I have said before and seem to need to keep saying; having a higher BMI while pregnant is associated with a slightly increased risk of some less desirable outcomes. But there is also evidence that the precautionary way high BMI labours are managed may contribute to this.

There is no evidence that fatter people have fatter vaginas. There is no evidence that having a fat vagina (if such a thing exists) is a cause of birth obstruction.

If you want to read more about how micromanaging our births can cause a spiral of negativity and interventions – see article I wrote on The Impact of Negativity on Labour and Birth.

‘Encouraged’ to delay contraceptive removal

Are you thinking about removing your long-acting contraceptive method (coil/implant) because you’d like to try for a baby? Did you make an appointment to have it removed, only to find instead you were ‘encouraged’ to delay contraceptive removal and lose weight? I’ve been hearing murmurs lately that this has started happening in the UK, and it’s taking people by surprise.

Researchers at Cardiff University and Cardiff and Vale NHS University Health Board are conducting a study and are really interested to find out from anyone who is or has been overweight and has used a contraceptive implant/coil/rod their thoughts about this.

If you complete their online survey you could also be in with a chance to win £100 worth of high street vouchers.

3 larger women smiling - ad for Plan-it study about being encouraged to delay contraceptive removal

The study has ethical approval and has the support of the National Institute for Health Research. It’s not very long, so isn’t too arduous to complete. There are lots of free text fields for you to voice your opinions!

The survey portal will be open until December. So if you have an opinon on the appropriateness of being encouraged to delay contraceptive removal, please act quickly! It’s important we don’t miss the opportunity to make our voices heard!

Click here to go to the survey (opens in a new window):

https://cardiff.onlinesurveys.ac.uk/plan-it

How To Submit an FOI Request for Maternity BMI Policies

If you’re pregnant or trying to conceive, you might want to know how to submit an FOI request (Freedom of Information) to your local maternity providers. It’s worth finding out as much as possible about your likely treatment beforehand, and it’s pretty simple to do.

How to Submit an FOI Request

  1. Find out which NHS Trusts cover your local area

    Quickest way to do this is to use the postcode location service on the NHS website. This will list all the local services, sorted by distance. https://www.nhs.uk/service-search/Maternity-services/LocationSearch/1802

  2. Check out the Trust websites you’re interested in.

    Mostly clicking through to the individual pages will display the website at the top under the name, if not, just Google it.

  3. Find the page on Freedom of Information requests.

    There always is one. Easiest way is to type “FOI” into the search box, usually found somewhere near the top. Somewhere on that page will list the email address you need to send queries to.

  4. Send your questions/request for relevant policies to the FOI email address.

    If you don’t want to write your own, feel free to use/adapt mine:

    “I would like to know with regard to your fertility, maternity, childbirth and post-natal services:
    1. Do you have a policy for the management of larger women? If so, what is the BMI cut off (or other criteria) where this policy comes into use?
    2. Please attach a copy of the above policy.
    3. Please could you attach any other policies/guidelines/protocols relating to fertility, maternity, childbirth and post-natal which address the management of higher BMI women. This could include (but not be limited to):

    Inclusion/exclusion criteria for use of midwife led unit, hospital birthing pool, home birth, IVF etc.
    Glucose Tolerance Testing and Gestational Diabetes,
    Clexane prophylaxis
    Pre-Birth Anaesthetist referral
    Additional growth scans

    Digital copies/pdfs preferred.

    Kind regards”

  5. Wait for a response

    The authority must reply to you within 20 working days.

    Anyone has a right to request information from a public authority. For your request to be dealt with according to the Freedom of Information Act, you must:

    Contact the relevant authority directly
    Make the request in writing, for example in a letter or an email
    Give your real name; and
    Give an address to which the authority can reply (postal or email)

    You do not have to:
    Mention the Freedom of Information Act
    Say why you want the information

    They can charge you for the costs of sending the information, such as photocopying and postage if you request a copy by mail, but not if you request copies by email. They must let you know any cost beforehand.

    By law they must provide the information unless there is good reason not to; e.g. if in the interests of public safety or security to withhold the information or they do not record that information. See the Information Commissioner’s Office page for more info.

  6. Send the documents to Big Birthas for inclusion on the website!

    If you do get copies of your local policies, please contact me via the form on http://bigbirthas.co.uk/about-big-birtha/contact-big-birtha/ to let me know, and I’ll email back (stops me being inundated with spam!). Then you can send me the documents so I can add them/update them here for the benefit of all.

Negativity in Pregnancy

Really interesting interview with Tracey Neville, former coach of England’s gold-winning netball team, about negativity in pregnancy. I’m not normally a follower of BBC Sport, but she makes some good points:

Tracey Neville speaking to BBC Sport about negativity in pregnancy

https://www.bbc.co.uk/sport/netball/49751520

Tracey, at 42, comes under the realm of a ‘geriatric’ pregnancy, i.e. ‘older than we’d like you to be’. While she’s not got a high BMI, she’s still subject to the same alarmist ‘high risk’ labelling. From her perspective as a coach, she points out how this negativity is unhelpful:

The thing that I’ve really found around this is the negativity that comes around older women having children… It creates a real fearful environment; they [the doctors] go down the route of “Well, we’re preparing you for the fail.”

I don’t prepare my team for the fail – I prepare them for the win! And if they’re not successful, we then look at other avenues, or other steps we can put in place…

Tracey Neville, former England Netball Team coach

She knows the pain of miscarriage, having suffered two, including one the day after leading England to Commonwealth gold. But, as she is pregnant again, due in March 2020, she highlights the difference she sees in approach:

I’d come out of a miscarriage and another consultant was giving me these stats again.

No, tell me what can I do…

We don’t sit down [with athletes] and quote stats at them, and quote how many times we’ve lost. We sit down and look at how we can win.

If only there was just a bit more positivity around health and wellbeing.

Why is pregnancy not targeted like that, why is it not given that positivity?

Tracey Neville

I probably should mention here that if the surname sounds familiar, it’s because Tracey is part of the Neville sporting family. You may have heard of her brothers Gary and Phil, who were reportedly quite good at kicking a ball around.

But she’s absolutely right – why is it in pregnancy, far more than with anything else, we have to look at the doom and gloom angle? Does negativity in pregnancy serve any useful purpose at all?