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.

Why hospitals need to grant pool access to bigger women

Anyone who has followed this blog for a while will know that I strongly believe hospitals need to grant pool access to women with higher BMIs.

My being denied access with my first-born is one of the reasons this blog even exists! I’d discussed it at every appointment, was promised a pool birth in the hospital (so long as the pool in the delivery suite wasn’t occupied when I needed it), taken on a tour of the pool room, but then repeatedly denied access to the pool while I was in labour until someone finally told me at 8cm dilated that I would not be allowed to use it after all. It’s also the reason I chose to have my second baby at home!

Hospitals need to grant pool access to bigger women - Big Birtha's Home Water Birth

My second labour and birth, where I did have access to a pool, confirmed everything I had suspected. The warm water was incredible at helping me manage the pain of contractions! Coupled with that, the buoyancy provided by the water meant that I could move around with ease. I was so much more comfortable and relaxed – even during contractions!

The frustrating thing is there’s no evidence to support restricting access!!

To be honest, there’s not a lot of good-quality evidence about the use of birth pools full stop. But because so few women get access to water birth there’s no data to show it’s safe for larger mums. But because there’s no data to show it’s safe, we’re denied access! Anyone see a problem here?

I’m not alone in thinking this!

It turns out that Health Care Professionals are beginning to notice this. So I’m delighted to report that the Association for Improvements in the Maternity Services asked me to write an article for their journal, complete with oodles of references for you to wave in the faces of healthcare naysayers you may meet. Enjoy!

AIMS Journal Article featuring Big Birtha

https://www.aims.org.uk/journal/item/waterbirth-high-bmi

Intended/Intending To Breastfeed?

Researchers from the universities of Manchester, Stirling, and Leeds Trinity are doing some research on the topic of breastfeeding.

There is a fair amount of data that suggests bigger women have lower breastfeeding rates. There are many hypotheses about why this could be, but as yet there are only questions, no answers. The researchers here have designed a workbook intended to support bigger mums to breastfeed, and are looking for your feedback. Does this sound interesting to you and would you be willing to give them your input?

They need participants who:

  • Are 24 or more weeks pregnant, with a Body Mass Index (BMI) of 30 or more and planning to breastfeed, or
  • Had a 30+ BMI at the start of pregnancy, gave birth within the last 1months and began and/or are breastfeeding.
  • Can read and understand English.

If you take part, they will ask you to use the workbook and participate in an interview/focus group. (Interviews can be by phone or in person)

The researchers are planning for the interviews/groups to last approximately 1hr, and you’ll be given a high street voucher as a thank you.

If you have any questions or comments or would like to take part in the study, please contact Stephanie Lyons (stephanie.lyons@manchester.ac.uk or 07706123929). See the attached PDF for more information about this important research on the topic of breastfeeding.

At last! Good news! A study on LOW RISK obese mums!

I’ve said it for quite some time. I know high BMI means a greater risk of developing complications in pregnancy, but what if those complications don’t develop? I’ve never understood why my pregnancies can’t then be considered ‘normal’? Is there such a thing as a low risk obese pregnancy?

At last a large study, from Oxford University no less, has asked this question:

The researchers discovered that obese mums pregnant with their second or subsequent baby, who haven’t previously had caesarian sections, and haven’t developed complications like high blood pressure, diabetes etc. are actually at lower risk of interventions or complications than ‘normal weight’ mums having their first baby!

The figure for intervention or complication was 21% for ‘very obese’ but healthy women having a second or subsequent baby. For ‘normal’ weight women having their first baby it was 53% – about 2 and a half times more!! What’s reassuring too, is that this was a large study, looking at 17,230 pregnancies.

Low risk obese pregnancy - Happy pregnant mum in a park - image courtesy of Obesity Canada

Isn’t it time for more equality of access?

This begs the question, how is it fair that first-time mums with low-risk pregnancies can plan to have their child in hospital, at home, or in a midwife-led unit, while women with a BMI over 35 are generally restricted to birthing only in an obstetric unit, even if they’ve had previously uncomplicated births?

This finding does highlight a possible anomaly in the guidance given to women on where to give birth

Dr Jennifer Hollowell, lead author of the study

As expected, the researchers found that the risks of complications during childbirth increase with increasing BMI even among otherwise healthy women. But the increase was surprisingly modest; only 6–12% compared with women with a ‘normal’ BMI.

My experience of low risk obese pregnancy

When I was planning the home birth of my second baby (after an easy hospital birth of my first) I met with a consultant obstetrician at 36 weeks. She wasn’t impressed and tried to convince me to birth in hospital; even when I pointed out that it was the hospital’s policy forbidding high BMI women from using the birth pool that was forcing me into a home birth.

The consultation was a waste of time for us both. She misquoted NICE and RCOG guidance (and I corrected her). She couldn’t explain why I was still deemed ‘high risk’ when no complications had arisen. My previous birth had gone without a hint of the complications you can’t predict beforehand (shoulder dystocia, post partum haemorrhage), but she would not consider my pregnancy low enough risk to permit me to use the birth pool in the hospital. So we agreed to disagree and she signed me off to the care of my lovely, supportive midwifery team.

I then met the Supervisor of Midwives, who was far more amenable. The SoM said that she thought current policies are non-sensical and discriminatory, and that as far as she was concerned, she was more interested in my previous birth history as an indicator of how this birth would go. I’m so pleased this study validates her lived experience! (I still had to sign a document saying that I was undertaking home birth against medical advice, though).

However, without the discriminatory policies, I would never have had the inclination or determination to birth at home. Which was wonderful, and I’d do it again in a heartbeat. Every cloud, eh?