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.

My Top 5 Twitter Feeds Of 2019

Social Media is a funny thing. I’ve been on Twitter for years, but I didn’t really ‘get it’ until recently. Maybe it’s since they upped the character limit; I struggled to compress my thoughts into 140 characters! I still often have difficulty with 280, to be honest. But lately, I’m finding Twitter really useful, so I thought I’d share BigBirthas Top 5 Twitter Feeds of 2019.

#1 of Big Birthas Top 5 Twitter Feeds of 2019 = @justsayinmice

If I had to pick just one Twitter feed to tell you about it would be @justsayinmice.

Tweet from @justsayinmice pointing out (yet again) a news article quoting research as if factually correct for humans is based only on mice.
Big Birthas Top 5 Twitter Feeds of 2019

It’s the Twitter feed I didn’t know I needed, until it existed.

If you’ve ever read a long article about a research project which seemed super important and relevant, only to be irritated when a small paragraph near the end mentions it was a rodent study, this is for you.

It’s brilliantly simple. When a report’s title implies a study is about humans, but is actually on mice @justsayinmice retweets saying “IN MICE”. It’s international too; if it’s a Spanish study they write “EN RATONES” etc. instead. Saves a lot of time and frustration. Now I know which studies to ignore, and it’s having a positive impact by encouraging more responsible reporting too!

If you want to read a bit more about how the Twitter account came into being, it’s here: https://medium.com/@jamesheathers/in-mice-explained-77b61b598218. And yes, before you say it, the profile picture is a rat, because that’s funny.

Recommendation #2 – @justsayrisks

Following on from @justsayinmice, @justsayrisks takes on the reports which love to misrepresent statistics. You know the ones – “being obese TRIPLES your risk of [insert undesirable outcome here]”. Often these risks are very tiny, and so the increase in risk is negligible, but sounds really bad.

The author has written more about this here: https://medium.com/swlh/relative-vs-absolute-risk-e80efd68fa5

Human beings are, by and large, terrible at understanding risk. But that’s mostly because no one has ever explained it properly.

Author of @justsayrisks Gid M-K

I’ve only just found this one, but it’s already saved me wasting my time on some clickbait headlines!

@ObesityUK_org

Obesity UK is a relatively new charity (set up in 2014). It doesn’t even have a functioning website at the moment, just a landing page at https://obesityuk.org.uk/. But it is fighting the good fight against obesity stigma, and tweets and retweets are positive, useful, and relevant.

@millihill

Often I’m reading an article about pregnancy or labour, nodding along, only to discover it was written by Milli Hill. She’s a freelance writer penning articles for The Guardian, Telegraph, Independent etc.

Milli is also the founder of the Positive Birth Movement, whose aim I wholeheartedly agree with:

We aim to challenge the epidemic of negativity and fear that surrounds modern birth, and help change birth for the better. 

Positive Birth Movement

Milli is good to follow as she tweets and retweets about all sorts of pregnancy related issues.

@WRISK_project

Lastly I wanted to mention a project Big Birthas is involved with that I’m really excited about.

The WRISK project is interested in the way that risk messages are communicated in pregnancy, particularly to marginalised groups. It’s a collaboration between the British Pregnancy Advisory Service and Cardiff University. The WRISK Twitter feed is great because they’re very quick to notice any relevant news stories and comment on them.

And of course, don’t forget to follow @BigBirthas on Twitter too!

Who do you follow? Feel free to comment and share below!

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

Plus Size Friendly Care

Plus Size Friendly Care? What do we mean by it? If you’re a healthcare professional, how do you ensure you’re delivering it?

What is Plus Size Friendly Care?

I was lucky enough to attend the Primary Care and Public Health conference (PCPH) in Birmingham recently. (Thank you Parenting Science Gang and Wellcome for making that happen!) There I had the opportunity to speak to many midwives and other health professionals about the issues we face in the maternity system.

I took with me two big banners displaying the quotes we had gathered from our Parenting Science Gang Research. The white banner displayed what women wanted and expected from their care – i.e. plus size friendly care; the blue banner showed their real life experiences… which were less friendly. (Click here to read about our research)

Our stand at Primary Care and Public Health 2019 - talking to Health Care Professionals about Plus Size Friendly Care

Common themes arose in our study. Bigger women, (much like anyone attending maternity services!) are looking for choice being offered and having options available, feeling supported and heard, feeling respected, and for information to be presented clearly and sensitively.

Sounds sensible! Was this not the case?

Sadly not.

And this was reflected in the conversations I had at PCPH. Most Health Care Professionals I met are clearly are doing great work providing holistic, supportive, sensitive care, and continually reflecting on their practice in order to improve. A few think they’re doing a great job, but after a few moments conversation, the terminology and phraseology they use, and particularly the way they feel about maternal choice, betrayed subconscious biases and less than helpful attitudes.

As soon as a see a woman come in with a long birth plan of things she wants, I know she’s going to be a problem. Worse still if it’s laminated! Half the time, birth plans might as well go straight in the bin, I don’t know why people bother with them…

Comments of a midwife attending PCPH Conference

When having those sorts of conversations (while internally wincing!) I will try to subtly encourage reflection on words used and opinons held. Comments like “But don’t you find that women…?” or “Maybe people do X because they feel…?”, or “Perhaps that’s because they want…?” are ways to introduce a conflicting perspective, without outright challenging the position the HCP holds.

Changing people’s atitudes

Woman looking unimpressed at the lack of Plus Size Friendly Care she's receiving

In all honesty, I know that those who are most likely to have problematic attitudes are also likely to be the most convinced that their way is the right way – because that’s part of the problem! But you catch more flies with honey than with vinegar, as the proverb goes; telling someone with strongly held views they are wrong is just likely to make their views more entrenched. Making them consider the possibility of alternatives is the first step to changing their minds and showing them a better way.

Big Birtha’s Tips For Professionals Wanting To Deliver Plus Size Friendly Care

It’s easy to point out examples of bad practice, but how do we turn that around into a helpful guide for good practice?

I’m a big believer in solution-focused working. No point telling me there’s an issue, if you can’t think of a way of doing it better! So, I’ve written a page for professionals to help give some pointers on how to deliver plus size friendly care. Have a read. Share it, please, if you agree. If you don’t, or I’ve missed anything out, feel free to comment – it’s a work in progress!