Honoring your plus-sized pregnancy

Can you have a healthy plus-size pregnancy?
Of course you CAN and should!

Have you heard providers say obesity or elevated BMI increases certain perinatal risks by one and half or two-three times? Sure, when they look at relative risk, because that risk is “increased” based in comparison. Reporting of comparison has to be balanced with absolute risk for a fair and honest representation. [These are epidemiology terms with the purpose of studying and reporting health and disease conditions in populations.]

The odds are in favor of good outcomes! Let’s explore an example:

Credit: AAFP, Obesity in Pregnancy: Risks and Management, May 2018

First, it must be acknowledged that BMI isn’t without contention, and rightfully so. BMI, or body mass index, is fraught with challenges from racism to inaccuracy. See this link for a bit of history.

Obesity is defined as a BMI of 30 and over. This chart shows a person with a BMI of 25, overweight, has an absolute risk of 1.9 for macrosomia, also called large for gestational age (LGA), or baby weighing more than 8 lb. 13 oz. (4,000 grams) at birth. The absolute risk for a person with a BMI of 35 is 3.5. In comparison of pregnancies with BMI 25 to BMI 35, also called relative risk, the increased risk for macrosomia for a person with BMI 35 is around 84% higher. That is a shocking figure! However, absolute risk shows that 3.5 out of 100 pregnancies for people with a BMI of 35 will result in macrosomia. That means 96.5 pregnancies to people with a BMI of 35 will not have macrosomia.
See the difference in approach?

Relative risk, while a fair statistic to report, brings with it the pains of comparison. “Why can’t you be like your sister?”.

Absolute risk shows the incidence per number of pregnancies categorized by criteria, in this case, BMI.

Overall health, lifestyle, stress, moving your body, meditation and mindfulness practices, and nutrition are crucial for ALL pregnancies. Feeling comfortable in one’s skin, moving freely with agility, and being confident with ability are necessary for all who birth at home. What all this means is that:

Plus-size people can birth at home

Check out Plus Size Birth for supportive information. Be sure your provider is supportive and knows the absolute risks, is not into fat-shaming, and has examined their own weight biases.