“I don’t want you to “care” for me any more. Now get out.”

Seriously, this is ridiculous. Even content aside, why would I care what my provider wants? I hire her to tell me what she advises, not to please her.

Also, just to compare to my new midwives who saw me for the first time at 17 weeks: They asked my height and pre pregnancy weight (5’4″ and 154, so overweight but with a body type that makes it not as bad as it sounds) and then said, “Ok, if you want a guideline based on that the standard recommendation is that you gain 15 to 25 pounds. However, we’re a lot more concerned with you’re putting in your body and that you’re eating generally healthy than what the scale says.” See? Recommendation out there, but not focused on, and done professionally.

My OB told me I wasn’t supposed to gain more then 20 lbs and I was only 160 pre pregnancy….

1. Practicing restricted eating during pregnancy is an even worse idea than doing it when you’re not pregnant. Any medical professional who actually advises it is one I would presume incompetent.

Healthy eating and exercise are important during pregnancy. Putting these things secondary to weight is foolish.

2. “I want”, “I like”, or “I prefer” from a medical provider is a strong indication that boundary issues are rearing their heads. In this context, patients do not and should not care what the provider “likes”. This isn’t about the provider’s preferences or wants.

(I know most providers would defend this sort of language by saying it’s some sort of shorthand for “I advise”, but the choice of words gives away a lot about a person’s attitude, and in this case makes the provider’s priorities all too clear.)

none of my OBs ever said anything. In my last pregnancy I was 175lb at 5’7″ and ended up losing 20lbs. With the second baby I was more like 205lbs, and they didn’t say a word about it, I still ended up losing weight(20lbs) as well, but mostly due to the GD diet due to high sugar. But still you get my drift. Also, I have a friend who is a size 2, and her baby was over 8lb’s so what is this obsession with weight gain? My first was 7lb 6oz, the second was 8lb 1oz. The second was bigger because of my GD issue. And when I did ask about gaining, the docs always said what Eileen’s doctor said, its what you eat not what you gain. They expected me to gain 25lbs. Go figure

All too often plus size women are subjected to this type of narrow-mindedness by their medical providers. Plus size does not equal high risk! Rather than placing limitations upon the amount of weight a woman should gain throughout her pregnancy, medical providers should be talking to their patients about their lifestyle. Like all women, if a plus size mom is eating a healthy diet and exercising regularly then odds are she’s going to have a very healthy pregnancy.

If I had said this to a Momma when I was a student midwife, the midwife I was training under would have immediately thumped me in my head! Sheesh, what an idiotic thing to say!

And yet the recommendations are backed by science! As a morbidly obese woman who gained ~35lbs delivered a 9lb 6oz, ~30lbs delivered a 10lbs5oz and gained 8lbs delivered a 7lbs 13oz, (no Gestational diabetes at all) there surely is a link. This pregenancy I have gained 8lbs again, big babies are nice but not good for them or mom, be honest with yourself about your weight and stop being silly about the truth.

For my daughter, my pre-preg weight was 175. I gained 32lbs (just perfect according to my midwife) and had a very healthy 8lb 13oz baby. My pre-preg weight was 223lbs. At 37 weeks I have gained 9lbs. This time, my midwifes are fussing at me that I am not gaining enough and making sure I know how important it is not to diet during pregnancy. I’m not, by the way. The point being that the midwife in the comment would be thrilled, but my amazing midwifes want to check and make sure babe is healthy despite my low weight gain. Two very different perspectives!

I was 195 up until the end of my first trimester, after losing 60 pounds in the year before I got pregnant. I’m now at about 135lbs and no one has said anything to me about my weight gain. I’m glad I’m eating because all of my first and half of my second trimester I had to MAKE myself eat or I’d get sick… whether I wanted to eat or not. Now, if I don’t eat every couple of hours I’m a raging bitch. No one should be restricting your weight gain so intensely during pregnancy, and who cares how much a baby weighs when they are born?

Ethel – your personal experience is not science. Random, blind, double tested-scientific studies do not support the idea that weigh gain is related to baby’s weight. With the exception of unregulated GD babies.

oh, and as babies go I would rather have a big baby than a small one!

Everytime I hear a fat-phobic OB I want to flood the office with old-style fertility figurines. You know, the ones the represented the pinacle of health and maternal beauty for thousands of years with big, fat, heavy breasted, ‘morbidly obese’ women. I bet these doctors would all have collective apololexy at the knowledge of a traditional ‘fattening time’, you know, the time before marriage or attempts at pregnancy where women laid around and were fed as much as they could eat until they were considered sufficiently fat for a desired bride or healthy pregnancy.

Should a student really be saying something like that? Seems a little overstepping to me. Everything I’ve read so far says that overweight moms should gain around 15 lbs.

I was probaly 160lb and was told the exact same thing, to gain no more than 10 pounds. Well of course I gained more than that so they kept telling me she was bound to be a big baby, probaly close if not over 10lbs, and that I would need a c section. I ended up with a beautiful 7lb 3oz baby that I gave birth to vaginally with no tears. Im sorry they said this to you, I know I was very upset most of my pregnancy because I was scolded at every appointment.

5’9″ I have started pregnancy at weights from 145-228. I’ve gained anywhere from 15-40 lbs. All my babies have been 7 lbs give or take a few ounces. I’ve had my weight mentioned to me twice. Once when I gained 6 lbs in my 6th month after losing the previous 5 and was told to go on a diet. Idiot. The other was my current ob who only said ” you don’t need to gain any weight” which was said in a nice manner making sure I understood because I am carrying enough extra weight I don’t *need* anymore and he was right. I’m a solid 60 lbs overweight I’m not deluded. I don’t need any extra but he wasn’t a jerk about it and only mentioned it once.

Let’s discuss what the actual research says, eh?

Current IOM guidelines are 15-25 lbs for “overweight” women (BMI 25-29), and 11-20 lbs for “obese” women (BMI 30+). At some point soon they will start differentiating wt gain recommendations by class of obesity but the research on this is still ongoing and different studies have found different “optimal” gains, so no consensus is out there yet.

Very large weight gains ARE associated with a higher risk for LGA/big babies, in both normal weight and women of size (Crane 2009, Park 2011). However, it’s not a one-to-one correlation; many women of size with large gains have average-sized babies, and many of us who have small gains have big babies.

Limiting wt gain may reduce the number of LGA babies, but it also raises the risk for SGA/underweight babies, prematurity and stillbirth. (Scheive 2000, Potti 2010, Wise 2010, Beyerlein 2011, Bodnar 2010, Dietz 2006 etc.) SGA also increases the risk for health issues later in life like insulin resistance and diabetes (Meas 2008, Veening 2002, Vaag 2006). And SGA babies of obese women tend to be particularly at risk for stillbirth as well (Salihu 2009).

So there’s a tradeoff here. Personally, I’d rather have a slightly bigger baby than risk an SGA baby, given the health issues associated with SGA babies.

I don’t have a problem with care providers emphasizing the importance of sensible nutrition and exercise, letting women of size know that we tend to gain less on average than other women, and that we tolerate that lower gain better.

However, I DO have a major problem with rigid and unrealistic wt gain goals that emphasize the scale over nutrition. It’s not healthy for a woman who would gain 20 lbs with normal nutrition to restrict her nutrition markedly in order to meet some dumb provider’s 10 lb. maximum. Emphasize great nutrition over weight gain goals, and then trust the woman’s body to gain what it needs!

Oh and my personal anecdotal experience? I gain about 5 lbs in each pregnancy (lose and then regain to a slightly positive net). I watch my blood sugar like a hawk, have great nutrition….and still have Godzilla babies. Obviously there’s more to it than JUST weight gain.

I think it’s okay to ask women of size to try and avoid very large weight gains (>35 lbs.); there is good research that poorer outcomes are associated with very large gains. But you also have to remember that there are other factors that may interfere. Women of size with the largest gains tend to be the chronic dieters, those who have edema from pre-eclampsia, or those who lost weight before/between pregnancies (Mumford 2008, Paramsothy 2009, Glazer 2004). They may have limited control over those gains. OTOH, if they can lower their gains by cutting out junk food, that’s something within their control.

So the picture is not so simplistic. A lot has to do with how a provider presents information on prenatal weight gain to women of size (or any woman), how rigid they are about weight gain goals, how they expect women to meet restricted gain goals (no one should be dieting in pregnancy), and whether they punish a woman who does exceed the goal despite her best efforts by inducing them early or making them have a c/s (which some providers are doing now).

I personally only ever use providers who emphasize NUTRITION over what the scale says. Food fascists (those who over-obsess about food types/amounts) and weight gain fascists (those who see wt gain in pregnancy as the outcome of choice rather than nutrition) are on my personal no-fly list.

WOW!! its about 2 kg to a pound right (sorry we dont use lb much in AUS) my son was 3.6kg so about 8 pounds ? born i lost 7kg just from the birth (c section) and another 3 by 2 weeks PP… i cant do the maths exactly but i can say thats a hell of a lot more than 10 pounds right there. if you do have a 10 pound baby (which im sure isnt uncommon) what about the extra blood volume the amniotic fluid, the mass of your growing uterus and breasts, not to mention fluid retention (which im pretty sure was the cause of most of my stretch marks and my HUGE butt last time hahaha) boy oh boy im glad you dropped that one she obviously needs to go back to primary school and learn basic math!

At the risk of resurrecting an old thread, I had to speak up on this one. I was 310 when I first found out I was pregnant (6 weeks.) Went to the doc’s at my 13 week checkup, and was 301 – I just wasn’t hungry. Went BACK at 19 weeks and was 307, and got chided for gaining too much weight. She (my OB) told me I shouldn’t be gaining more than 10-15lbs through the entire pregnancy.

See, ma’am, there’s a problem. I’m actually DOWN 3 pounds from when I was 6 weeks pregnant, and I’m halfway through my pregnancy now (twins, so not AS likely to carry to 40-42 weeks, though my goal is to get them to cook as long as possible!) so…yeah.

Other issue is now that they’re getting bigger…I’m HUNGRY! And just to clarify, I know being pregnant does not give me carte blanche to dive into the Wendy’s fridge and start eating all I can. They’re only a pound each, but you know what? If I’m hungry, I’m going to eat. I’m going to have a sandwich, or a bowl of chili, or soup. I’m not going to starve myself, because I’m also starving MY BABIES when I do that.

Hmph.