Ep 79: Facts and Misconceptions About Plus-Size Pregnancy and Care with Jen McLellan

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I'm really excited for this episode because this time I'm learning right alongside all of you. Back in episode 40 I talked about obesity and pregnancy, but I focused too much on the risks and not enough on how to have a healthy  a plus size pregnancy. Happily, I get to revisit this topic today with an incredibly knowledgeable guest, Jen McLellan!

Jen McLellan is a published author and founder of Plus Size Birth and the Plus Mommy blog. She helps people navigate the world of plus size pregnancy, shares tips for embracing your body, and laughs her way through the adventures of parenthood. She is also a childbirth educator, skilled patient advocate, professional speaker, wife, and mother to a charismatic 10-year-old.

Jen and I first talk a bit about terminology for and common misconceptions about plus size pregnancies. We especially dig into the fact that having a plus size pregnancy does not automatically mean you will have problems or complications, which a lot of websites and providers do not make clear. 

We also chat about what a size friendly provider looks like and the importance of medical providers bringing compassion and an awareness of their own biases to their work. Jen also shares some ideas about relative vs. actual risk and tells us about her work with the National Institutes of Health (NIH).

In this Episode, You’ll Learn About:

  • How and why Jen started working in plus size pregnancy advocacy
  • Terminology to use around plus size pregnancies and why we should listen to how people talk about their own bodies
  • Common misconceptions about plus size pregnancies and ways to reduce risk
  • What you can do to have a good pregnancy and birth experience
  • Why you should take the time to find a size friendly provider to care for you during pregnancy and birth
  • The difference between relative and actual risk and why we need to frame information about risk differently
  • Some of the work Jen is doing with the NIH and her own organizations to help plus size parents have great pregnancies

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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Speaker 1: I am so excited to have Jen McLellan from Plus Mommy and Plus Size Birth on the podcast.

: Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a practicing board certified OB GYN who's had the privilege of helping hundreds of moms bring their babies into this world. I'm here to help you be knowledgeable, prepared, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at www.ncrcoaching.com/disclaimer. Now let's get to it.

Speaker 1: Hello. Welcome to another episode of the podcast. This is episode number 79. I'm so glad you're here spending some of your time with me today. So I am really excited about today's episode. I have Jen McLellan on. Jen is a certified childbirth educator, a wife and mother to a charismatic nine-year-old, almost 10 year old. She's the host of the Plus Mommy podcast, a published author, speaker and founder of Plus Sized Birth, the premier resource for all things plus size pregnancy with over 5 million page views on her blog, 26,000 followers on Instagram and 180,000 followers on Facebook. Jen is passionate about plus size pregnancy, body love and navigating the bumps along the road of parenthood. She has been featured in People, Good Morning America, Glamour, The Bump, Parents, Today, Romper, Pop Sugar. Just to name a few.

: Now I asked Jen to come onto the show because I did an episode of the podcast called the truth about obesity and pregnancy. It was episode number 40, and I feel like I screwed it up a bit. I feel like I focused too much on the risk associated with weight and pregnancy and not enough on how to have a healthy pregnancy, even if you are a person of size. So this episode is just as much about me learning how to be a better provider as it is for you. So in this episode, Jen shares her thoughts on terminology, around having a plus size pregnancy, misconceptions about a plus size pregnancy, tips to have the best pregnancy and birth when you are plus size, what is a size friendly provider, how to know how to find one. She gives me some tips as a provider on things that I should know about caring for plus size women. And then she talks about this really cool initiative that she was involved in with the NIH, the National Institutes of Health, something called Pregnancy For Every Body.

Speaker 1: And let me tell you what, Jen really knows her stuff. And you're going to learn a lot from this episode, whether you are plus size or not. But before we get into the episode, I have a quick question for you. Have you made your birth plan yet? Your birth plan is a great way to communicate your wishes for your birth. You know that your voice in your birth matters and you need to get informed so you can make solid decisions about your birth experience. So check out my free online class, how to make a birth plan that works, in order to do just that. It's one hour, it's on demand. Women love this class and in it you'll learn two factors that have the greatest impact on your hospital birth experience and how you navigate those two important factors. You learn how to approach making a birth plan.

Speaker 1: So even if things don't go exactly as you plan, because birth is an unpredictable process, you are in control, as much as you can be during your birth experience. You get eight questions that you must ask your doctor before you write a single word or your birth plan so that you are knowledgeable and empowered. And then you also learn how to get your doctors and nurses to respect your wishes and pay attention to your birth plan. You can check that class out, again is totally free, at www.ncrcoaching.com/register. All right, let's get into the episode with Jen.

Speaker 2: Nicole: Thank you so much, Jen, for agreeing to come on the podcast. I'm really excited to have you here today.

: Jen: I am so honored. Thank you so much for having me.

: Nicole: So why don't you start off by telling us a bit about yourself and your work and your family.

: Jen: I am a certified childbirth educator and a consumer advocate for people of size during pregnancy. I got into this work because I found myself plus size and pregnant in 2010. And I went on to Google. I think a lot of people nowadays go onto Google when you find out you're pregnant. When you're a person of size and pregnant things look differently. And when I went online, I really struggled to find any positive information. I read that I would have gestational diabetes. I would have a cesarean birth. And because of the comments sections, I read some of hurtful things that I shouldn't even get pregnant because I'm fat and shouldn't be a mother and it was so disheartening, but I had always existed in a larger body. And I worked really hard to have a healthy pregnancy and to connect with a great care provider. And I had a completely healthy pregnancy.

Speaker 3: Jen: I gave birth on my knees in a hospital at nearly 300 pounds. And it changed everything for me. And a few months after my son was born, I just felt called to share my story. I wanted to see images of people plus size and pregnant, celebrating their bodies and have helpful information on how to have a healthy pregnancy as a person of size. Where do you even find maternity clothes that would fit my body? Having no idea at the time, what it was to blog or be a blogger? I mean, I, I had a whole different career and it just exploded in that time. And it has now been my life's work and passion for the past nine years.

Speaker 1: Nicole: And you are very serious about your work. Not that you need me to tell you that, but I've listened to your podcast and you know what you're talking about. It's obvious that you stay up to date on things you are in the know, you know what you're talking about. This isn't like a little side sort of thing. It's clear that you're very serious and passionate about this work.

Speaker 3: Jen: Yes. I mean, I was just a mom with a blog and then realized as it exploded that I had a responsibility that I had started to amplify a conversation and I needed to become educated on the topic. And that's why I became certified as a childbirth educator and attended continuing education courses all the time and have had my work validated by major organizations like National Institutes of Health, and been quoted in the New York Times. And to me, that's been a validation that my work is legitimate. You can be a lay individual whose life is forever changed and then become an expert in something. And it's been years of hard work, but I think it's a really important conversation and I'm not afraid to talk about increased risk and things that I know we're going to talk about because I think it's, I think it's really important that we talk about plus size pregnancy with evidence and compassion and we support people and empower them to have healthy outcomes. And that's what you as a care provider once. And that's what me as someone who's been pregnant once too. So we both want the same thing.

Speaker 1: Nicole: Yes, yes, absolutely. Absolutely. So let's go ahead and get into it. You said you're not afraid to tackle some of the harder topics. Let's just get into what I find to be one of the most difficult topics. What are your thoughts on terminology? And I know obviously you can't speak for every person of size. It would be like me trying to speak for every black person or every, you know, we can't speak for whole populations, but in general, sorta like what are your thoughts of plus size versus fat versus obese or overweight? Like what thoughts on terminology?

Speaker 3: Jen: Sure. I think when we talk about terminology for anything, we really need to listen to the language people use when they talk about their own body. I think that that's first and foremost, really important. I did a survey a couple of years ago of a hundred people asking them about terminology and what they preferred and what they did. And I listed all the things right from plus size to chubby, you know, all the full figured and obese. And of that 100, only two people said that they were comfortable being called obese. And that's something I hear across the board is, you know, obese. It's a medical term that's commonly used, when you went to medical school and is used in today's medical world. But it's not a word that most people of size feel comfortable with. And out of everything on that survey, the majority of people said they were comfortable with plus size. And so that's kind of the language that I've used within my work. I often use people of size people in a larger body, but at the end of the day, even though I've been doing this work forever, I would never walk up to someone that I view as plus size and pregnant at the grocery store and be like, hi, I'm Jen. I have this podcast.

Speaker 3: Jen: I don't know that that person self identifies as plus size. Is that different for you as a care provider with the BMI chart? And we know how people are classified, you know, if your patient is overweight or obese. Absolutely. But, but when we're talking to people on a one to one level, I really think it's important that we meet people where they're at and use the language that they're using to talk about their bodies. And again, when that is between a patient and a care provider, that can be a little different because there are absolutely conversations that you need to have with your patients of size that is directly related to their BMI.

Speaker 1: Nicole: Oh, okay. I love that because, and that's probably like, just in general about how we should approach how we talk about people, like use the language that people use about themselves.

Speaker 3: Jen: Yeah. Like you have a patient that's over 35. You're not going to be like, hello, Susie. So you're geriatric, right? That's medical language. And on Susie's chart, Susie's a geriatric patient. Like you're not going to be like, well, you know, since you're geriatric, you're going to say, you know, because you're over the age of 35 and with a patient of size, you could say, no, because you exist in a larger body. There are certain things that we're going to do together to help you have a healthy outcome or as best outcome we can for you and your baby. And that's just as important to you as it is to me.

Speaker 1: Nicole: And using the word obese doesn't, it's not like I'm saying something, I don't know. It's not like I'm providing some new insight or information. People know their weight. They know their size. It's not like, you know what I'm saying? Like, it's not like I'm divulging something that's a secret, like people know their bodies. So how about we talk about what are some misconceptions about having a plus size pregnancy?

Speaker 3: Jen: There's this clear belief and it's been, you know, open up the internet and Google still to this day, all these years later, my kid is about to turn 10, there's this belief that because you exist in a larger body, you will automatically incur risk. That you will inevitably have gestational diabetes. And yes, there are increased risks and yes, the higher your BMI, the greater the increased risks. And I actually just updated my book, My Plus Size Pregnancy Guide. And I had a researcher go through and look at some new studies. And what is the evidence based information around increased risk, like gestational diabetes. And we're looking at about a 17% increased risk. And so to me, how I encourage people to look at that is, yes, you have an increased risk, but there's a lot you can do with nutrition and physical activity and working with a size friendly care provider to help reduce your risk. And when we look at that 17% increased risk, we can also say that you have about an 83% chance of not developing gestational diabetes. And here's how I can support you even further to reduce your risk. And to me, it's just about how the conversation takes place. Instead of making people feel ashamed, we make people feel empowered to make healthy decision making.

Speaker 1: Nicole: This is so great. Have you ever been accused of, cause I'm wondering if people accuse you of saying like, you're trying to ignore the risks associated with being a person of size and pregnant? And that is like not the case at all.

Speaker 3: Jen: Yeah. I mean, not by professionals, but absolutely by trolls on the internet. I get hate mail and horrible things said all the time. And to me, it's just like, I've never been afraid of the evidence. My career before this was working in end of life, health care advocacy, like evidence based information is so important. Like I, as a person who has been pregnant, wanted to know what my increase risks were, so I could do everything possible to have a healthy outcome. I think knowledge is power. It's how that information is disseminated to people. It's how we talk about it. That is so incredibly important. And that's what makes the difference. Because when we look at studies, we can see that when people of size are made to feel badly about themselves and their bodies, they are less likely to receive routine medical care and more likely to gain weight.

Speaker 3: Jen: So I say this time and time again, when I speak at conferences, it's not that long ago in Utah at a labor and delivery nursing conference. And I said, shame is not an effective tool. We have studies to show that shaming patients, we know we're plus-sized, we have lived our whole lives in a body that gets treated differently by your society and absolutely by the medical community. And I I've said this time and time again, that, you know, at the age of 30, when I was pregnant, my midwife was the first care provider to ever touch my body with compassion. That changed everything for me. And she empowered me to be even more healthy with my pregnancy and to believe in my body in ways that I hadn't. Up until that point, every single doctor's office was so focused on the number and the size of my body and not conversations about nutrition that I had with my hospital-based midwifery practice than I'd ever had with a doctor in my whole life.

Speaker 1: Nicole: Wow. Wow. Wow. And just even like how you say the perspective and I'll admit a big reason why I wanted to have you on this episode is this is something that I know that I have gotten wrong as a provider. I think that I have not done a good enough job of caring for women and providing the appropriate compassion and perspective on things. So this is as much about me learning as it is giving information to our audience. And I think the fact that you said like people see, okay, it's a 17% increase risk, but what about that flip side number? That's so much higher. And the most likely thing is that you're not going to get it.

Speaker 3: Jen: And it means so much to me that you say that, and you want to have this conversation. Cause we all have our own biases, right? Clearly we all have. But when we go to see a healthcare provider, we're expecting evidence-based, compassionate care, that is an expectation. And that is not often met when you're a person of size or a person of color or a black person. Like there are so many instances where people aren't getting the care that they should be getting. And as you said in your recent podcast episode, it impacts the black community with the, you know, mortality rates for women and babies. And we have to have these really important, difficult conversations because we have to create change.

Speaker 1: Nicole: 100%. So when a woman who is plus size is pregnant, what are some things that she can do in order to have her very best pregnancy and birth experience? What are your top three or four tips?

Speaker 3: Jen: Sure. So the first two are going to come of no surprise because they're for people in every body, right? We want people to be proactive with being physically active, moving their body. I often talk about water. Aerobics has been this amazing way to tune into your body and your baby. And finding something that you can do routinely, going for walks, starting a walking group, you know, with friends if we're working in an office or, you know, or friends socially distancing appropriately in a park, you know, you need to find something that will be a routine activity that is enjoyable and feels good because we know the importance of being physically active. And then the second thing is nutrition. We also know how approaching food in a maybe different way than for people who have existed in a larger body that have been so focused on dieting.

Speaker 3: Jen: And I want to be clear. I'm not saying that everyone is, but for many people that exist in a larger body, they have spent their lives cycling up. So we know that dieting doesn't work and that 96% of diets fail and you end up regaining all of the weight you lost plus more weights. And so pregnancy is this incredible opportunity to change your relationship with food and to look into intuitive eating, which means listening to the cues that we are all born with and know when our body tells us I'm hungry, I'm full. And then working with your care provider and working with a nutritionist, you know, ACOG recommends that people with a higher BMI work with a nutritionist. And I recommend that too, because I found in my own life, working with a nutritionist, taught me so much, like I thought I knew it all.

Speaker 3: Jen: I've spent my whole life dieting, but that's not the way that we need to be fueling and feeding and loving our bodies. We need to learn a different way about food. And what I found is I feed my sons so much different than I fed myself before I was pregnant. And there's something beautiful about that. And we worry so much about this obesity crisis. And I said this, like if we worked with people of size with compassion and talked about nutrition and intuitive eating and changing relationships with food, that will be carried down to generations. And we empower people to love their bodies and take care of their bodies and nourish and nurture their bodies. That is the lessons that I teach my son. And I'm no longer ashamed of food or sneaking food. I mean, they see it all, they know it all. So those two things are so important and obviously vitamins and water. And, you know, we could go on and on, but the main difference for people of size, the third key that I really focus a huge majority of my work around is connecting with a size friendly care provider, whether you have a vaginal birth or emergency cesarean birth. Out of all the years doing this work, speaking to thousands upon thousands of people of size, the difference wasn't how that birth outcome was. It was how they were treated during it.

Speaker 1: Nicole: Gotcha. Gotcha. So let's get into more detail then about what a size friendly care provider is. What does that look like? What does that mean?

Speaker 3: Jen: Absolutely. So I define a size friendly care providers, what we've already mentioned that care provider who provides evidence based, compassionate care. And we can break that down a little bit by saying, you know, it's a care provider that is aware of their personal bias. Like you even mentioned, like, you know, you've had some times in the instance in the past where you realized, well, maybe I brought my size bias into it. So being aware and working through their own bias, and there's some resources I can provide to you to put in the show notes for care providers to address their own bias, but it has a lot to do with, do I make assumptions about a person's nutrition based clearly upon their size and nothing else? And I can tell you so often I hear from women who say, you know, I went into my care provider's office, having a, you know, a water bottle that you can't see through and them saying, you know, you really need to cut out your Pepsi habit and I'm drinking water.

Speaker 3: Jen: And I don't even, I don't even like syrupy soda, but they just assumed. And so the minute we make assumptions about someone's body, often as a patient, we're no longer going to listen to what a care provider has to say, because you're making me feel uncomfortable. And that's where the brick wall goes up and we don't move forward together. And we really need to move forward together because we're both wanting the best interest of our patients and their babies. So really important, and compassionate, which I think is so important in maternity care, but all care provides individualized care. I unfortunately have heard so many stories from people who were told on their first prenatal care visit that they need to have a cesarean birth based only upon their BMI. And I'm like, where is this coming from? ACOG doesn't state that, that's not even evidence-based. We know that there are greater increased risks for people of size, for cesarean birth. Absolutely cesarean births are necessary and save lives and are needed, but it shouldn't be the go to for people of size.

Speaker 1: Nicole: I can tell you that drives me insane when I hear people say that it's like, please, like we don't want that. When we know that the cesarean could be more complicated, potentially don't we want to like, do everything we can for a vaginal birth, you know, that's the best all around. So I have never quite understood that.

Speaker 3: Jen: And I think it's important to note when we're talking about people of size. You know, I think we so often think of the sensationalized TLC shows like 600 pounds. And pregnant no, according to the BMI, we're looking at 60% of women in their childbearing years in the United States are classified as overweight and obese. So I'm talking about women who are under 300 pounds telling me that their care providers are saying that they must have a cesarean birth. And it just blows my mind. You want to hear something wors? People are also told that their vagina is too fat to birth their baby.

: Nicole: Jen, please stop it. Are you serious?

: Jen: Oh, I'm a hundred percent serious. And when people are like, I don't believe you, I'll do one posting, I'll do it. After I talked today, I have a huge Facebook following and I can do one post and you will read story after story of people sharing the ways that they've been shamed by their care provider. But one of them that does come up often is that they are told that their vagina is too fat. So they must have a cesarean birth. And when I talk about this in front of hundreds of professionals, I walk them through it and say, how do you think this impacts not only this woman's views of her body for her birth, but also intimacy with her partner in the future, how she feels about her body in general, how she teaches her kids to love their body? If she's been so distraught and told these things that are so emotionally harmful. And the flip side of that is there's no evidence.

: Jen: We do have slight increased risk for shoulder dystocia and soft tissue dystocia, but there's no evidence to show that someone's vagina can be so fat that they can't birth their baby. There are other reasons why we might not be able to have a vaginal birth. Absolutely. But telling someone that their vagina is too fat. And I hired the same researcher that I worked with recently. And I said, will you please dig into this again? Cause I just want to, like, this was a few years ago when I looked at the evidence and I was like, I just want to refute this with a final article that is like providers stop, it's so, so incredibly damaging to a person's life. Not just their birth, not just that two minutes in a doctor's office.

Speaker 1: Nicole: I'm not lying guys. We record just audio and no video. But if you could see video, my mouth is literally hanging open right now. I am embarrassed for our whole profession that we would tell anybody that because it's so ludicrous and not based on anything.

Speaker 3: Jen: And you know, as an OB that you might want to use a larger speculum for a person of size, it might be more comfortable for them, but you would probably want to use that speculum for a patient that's had multiple births. Like our body has changed. Our bodies are different, no vagina's the same. But just because I exist in a large body with a high BMI doesn't mean that I can't have a vaginal birth based only upon my weight. And whenever I talk inevitably also like midwives and home birth midwives that come running up to me afterwards and like my big moms are my best pushers, like where's this coming from? And it comes from bias and it's really, really damaging.

Speaker 1: Nicole: Very much so, that absolutely 100% needs to stop. I mean, all of it needs to stop, but I've just, I've never heard that. And I'm just mortified of that cause it's just based on absolutely nothing. Oh my God. So are there some specific questions that you, that women can ask in order to ascertain whether or not a provider is size friendly?

Speaker 3: Jen: Sure. And I wanted to add one more thing.

: Nicole: Please do.

: Jen: I think it's really important that we don't classify people as high risk based only upon their BMI, because what happens is we limit their options in childbirth, we limit options to the midwifery model of care. We limit options to birth center birth. And there's been a lot of studies, especially in birth centers, looking at risk profiles. And that if we do have someone with a high BMI that goes into pregnancy healthy with no high blood pressure, no signs of being prediabetic, you know, we do have healthy outcomes and that's really important to me. And every time ACOG gives their committee opinion on obesity and pregnancy, I always hold my breath. I'm fearful of the day where we do start saying that people based upon their BMI should be classified as high risk.

Speaker 3: Jen: Do I feel that additional testing is important like around gestational diabetes? Absolutely. Do I feel that additional oversight is needed? Absolutely. But I also know when we look at the evidence that the majority of people of size that go into pregnancy healthy, have healthy outcomes, and that's what we need to base this on and meet people where they're at with their pregnancy and provide them with individualized care. And that's how we can help to reduce this hysteria and birth rate that is astronomical for people of size. We're looking at a BMI over, sorry, I should have had these numbers right in front of me for someone with a BMI, I think it's like over 40, it's like almost 50%. And when you look at a BMI closer to 50 or 60, it's 80%. 80% of people have a cesarean birth. And I believe that care provider bias plays a role in that number because we're not giving the opportunity for people who exist in much larger bodies to even attempt a vaginal birth

Speaker 1: Nicole: 100%. And there's actually pretty good evidence that women of size, and forgive me, I'm still working on saying the best terms, but plus size women, women of size that labor may be longer. And we need to give more time. We need to be more patient.

Speaker 3: Jen: Yeah. I mean, it takes longer for oxytocin to course through our bodies, there are certain things that are just going to take longer, but yes, we have the evidence to show. And I definitely talk about that, but it's just gonna be a little longer and that's okay. I mean, fetal monitoring on a person of size is so much harder for labor and delivery nurses. Absolutely. But there are tricks and tips and I've had interviews, the labor and delivery nurses that have learned how to support people of size in just slightly different ways to get the monitoring that is so critically important, especially if someone's having a medicated birth and that's where it just comes to meeting people where they're at. It doesn't make it more difficult. But do we all want people to have healthy and empowered experiences? Yes. We want healthy outcomes and it's just going to look a little different when we support people of size. And thankfully technology is advancing in some ways, and there are some monitors like the wireless patch monitor that does help and works well with people of size, works, not perfect, but it works a little better than that. So yeah, it's a lot of just meeting people where they're at with, with compassion.

: Nicole: And this is the same thing we, I mean, we really have to do it for everyone, but I think that we, we have this bias where we physically look and see someone and it puts up this block or we are, you know, form these opinions that are completely for the most part, not supported. And it doesn't help that we live in a society, like the background of our society doesn't help either.

Speaker 3: Jen: No, it, it really doesn't. No, you were asking about what are ways that people can connect with a size friendly care provider. And then also this first piece really plays into how you can be, any care providers listening, size inclusive. And one way when I give talks that I clearly show in one photo, if a provider or a massage therapist or a restaurant or any place really is size inclusive in one image, it's a chair. So if a chair has arms, it isn't going to work for everyone. It isn't going to work for a lot of people of size. And so if I walk into a doctor's office, which I have, and there's only all these small chairs with arms, what that tells me is I can't sit comfortably. I am not welcome here. I don't have a place to sit. I don't have a place to be.

Speaker 3: Jen: And so then that leads me to question, do you have a blood pressure cuff that will fit my body? Which is often an adult cuff, which is the wrong size blood pressure cuff, is being used. That can be very dangerous and give people inaccurate results. Will there be, you know, if I need a larger speculum, which is pretty common, but I'm just saying like, what weight does the scale go up to? Will I be given options around weight? If weight is very triggering for me, you know, will I be treated and met with compassion? Will I be provided with a gown that will cover my body? Because if my body isn't covered, then I am stripped of my dignity in a moment where consent and respect is so incredibly important for exams and for care providers looking at and touching my body. So it is very important that we're aware of the needs that people of size have during pregnancy. And actually, when you think about all these things, it makes it more comfortable for everyone absolutely. And that's what's really important. There's not that many more things. I mean, yes, in a hospital birth setting, depending upon the people there, there might be more needs that are quite more expensive. But when we're talking about base prenatal care, we're looking at blood pressure cuffs, chairs without arms, scales, gowns, that type of equipment.

Speaker 1: Nicole: Gotcha. Yeah. Those aren't things that are like terribly expensive or add additional cost at all. Yeah. Yeah. So, and it looks like you can probably tell fairly early whether you feel like someone is going to be a size friendly provider. And I'm guessing that if you, what are your biggest pieces of advice is if someone is not a size friendly provider, then keep looking until you find someone?

: Jen: Oh yeah. And I have a whole guide that people can download for free on my website. That's like 20 pages on how to connect with size friendly care providers. So it walks them through starting with how do you even get names of people who might be size friendly? And I have a list of size friendly care providers. I need to make sure you're on that list. But it's just a reference list where people have sent in names of care providers that treated them with compassion. So there's many a disclaimer to use your best judgment, but it's just a list and encouraging people to join local mom Facebook groups, and asking in that group, if you feel comfortable. Hey, I'm plus size is anyone else plus size that has a care provider that they really liked? So if you're doing it locally, you know that you're going to find someone in your area.

Speaker 3: Jen: And so narrowing down that list. And, you know, I say, you know, we do Google potential dates. You know, when you're dating, we need to Google our doctors and read reviews and do research and then ask questions, make observations, and have a frank conversation with your care provider. What is your experience working with people of size and are you going to have any additional testing or guidelines that are important for me to know now on this first prenatal visit? Cause I often hear stories of a bait and switch where care providers appear to be size friendly in the beginning. And then at the end they start making like, okay, well, we're going to have to start testing every visit for gestational diabetes, even though you pass the three hour, or, you know, we really need to schedule this induction when there's no evidence, biggest signs that we need to be scheduling in induction and you just, things start to shift.

Speaker 3: Jen: So I think it's important to have frank and ominous conversations and then ultimately listening to your intuition and your gut, and then you can fire your care provider, switch models of cares, which facilities. That's another really important thing is looking into the facility you're choosing to give birth or home or birth center. I mean, there's so much to it, but at the end of the day, yeah, it's really listening to your intuition and is this care provider the right fit for you? We're paying a lot of money for these services, so we ourselves should be our own best healthcare advocate because we're going to be that advocate for our kids. So why can't we do it for ourselves and model that behavior for our children?

Speaker 1: Nicole: 100%. And we will for sure link to your website and everything in the show notes, that sounds like a really great guide for people to have. Okay. So I want to switch gears for a second and although most of my audience is pregnant people or people within the birth space like doulas or childbirth educators, lactation consultants, I want to know some things that you want providers like me to know about caring for plus size women. Maybe you've said it before, but if you said it before, I think is worth saying again, what are some things that you want us as providers to know? And especially how to approach that conversation about, like you said, the realities of the increased risk, you do it so smoothly and like fluidly. So suggestions that you have.

Speaker 3: Jen: Sure. I mean, we've talked about so many things that I think are critically important. One of the things that's really important that we haven't talked about is relative risk versus actual risk. Relative risk is comparing one risk to another. And Rebecca from the Evidence Based Birth, you know, it was brought up on my podcast and when I was on hers, but it's so important that we're actually talking, especially to people of size about their actual risk. Because if we tell someone, you know, you are four times more likely, so I'll look at gestational diabetes, I pulled up that number for you. So you're four to five times more likely to develop gestational diabetes. If you have, you know, a BMI over 40 versus someone with a BMI at around 25. So when I hear that I'm four to five times more likely in my head, I'm like, what's the point? I'm just going to get it.

: Jen: And oh my gosh, I'm so upset and why did I even get pregnant? And then it's all this like doom and gloom. And it makes me feel really badly about myself. But if I'm empowered and told, you know, you have a 17, about a 17% chance of developing gestational diabetes and I'm going to work with you to help reduce that risk even further, because we know with nutrition, it can really help to make a difference. And, you know, you have, like I said earlier, like over an 80% chance of not developing gestational diabetes and going from there. So it takes the same information, we're not beating around any type of bush, or tiptoeing around risk. We're saying yes, there is an increased risk. However, let's work together to reduce that risk. And it's actually far less than society leads us to believe.

Speaker 3: Jen: And that has been so frustrating to me, all these articles and, you know, it's the media. Everything's sensationalized. They really only share the relative risk. And it is scary to hear that you're four to five times more likely. But when we look at well, if the percentage is originally, you know, really low and we double that, but it's not. So if I am looking at it right now, so if we look at someone with a BMI of let's look at 25 to 30, they have a 6.7% chance of incurring gestational diabetes. Whereas someone with a BMI of 35 to 40 has a 13 percent and a BMI over 40 is 17. So when we look at and hear, oh, well, yeah, six times two is 12. You know, it's like, oh, okay. Like I get why it's higher. Yes. But still 17 to me, is it 50%? It isn't 60%. And yet when I read articles online, it makes people feel defeated and these people are already pregnant and we need to support them. And we also can have a big conversation about preconception health and support and treating people with compassion too. And I don't want to continue to share really alarming things, but I've also had people share with me that their care providers talk to them about termination just based on their BMI. And that is, that's terrible.

Speaker 1: Nicole: That's terrible! I mean, I believe that that's a personal choice, but that is not a reason to end a pregnancy. Like that's not yet, there are some serious medical conditions where it puts a mom's life at risk and, and even then it's a discussion, but I've kinda like, I'm speechless literally.

Speaker 3: Jen: Yeah. And I haven't heard that very often. It's been like two or three times, three times. Yeah. So I'm not trying to sensationalize, like when we're working with people who are pregnant, they are pregnant and we need to empower them to be as healthy as possible. And how do we do that? We do that by showing them compassion and not being afraid talking about the evidence, but talking about it in a way that empowers them to change, possibly change. Like for me it changed my relationship with food buying. I had never tried water aerobics before all this, all the ways that I have changed my relationship with, you know, there's a meme that I made. You know, I exercise because I love my body and not because I hate it. Because for most of my life, I thought I had to be physically active to lose weight.

Speaker 3: Jen: I didn't think about all the other incredible benefits that come along with being physically active. So changing those mindset changes, people's can change, possibly change people's lives and change their children's lives and create a healthier community. Does that mean that people are all of a sudden going to lose a bunch of weight? And I don't think that that should ever be our focus. I think our focus should be health, and not a number on the scale or a number on the BMI chart, because there are a multitude of reasons and we can talk about PCLs and we can talk about so many other reasons why sometimes people of size are people of size. And so we really need to meet people with compassion. We also have seen some studies that, you know, people of size have higher, greater risks of people have a history with sexual assault. So it comes to that behind closed doors experiences with care providers, if someone has a history of sexual assault and they're working with a care provider that already makes them feel really uncomfortable and scared, it just compounds their history of trauma and can lead to birth trauma, which can lead to postpartum depression, which can lead to so much. And at the end of the day, all I'm asking is that we meet people with compassion and provide individualized care.

Speaker 1: Nicole: Yes. I mean, and it's not that hard. We need to just stop. You know, what we do is we see a person of size and I mean, I'm just going to be really honest here. I think what happens is providers look at them and they, they automatically write them off. They say they have no willpower, they have no control. They must just sit around and eat constantly. They come up with these terrible things. And I'm not saying, I think that. I'm just saying that I think this is what comes into people's mind. And that happens in society in general, those horrible assumptions, even though we know that weight is very complex, actually, in what contributes to the things that a person ending up to be a certain weight. And then we just write people off and we don't even give people a chance. And it's like, you're saying, just start with compassion, stop writing people off from the first second you meet them and then actually do something to empower them. Like, that's it.

Speaker 3: Jen: Yeah. And from your personal experience, and I'm sure working with your colleagues and, you know, medical school, you like, you've heard the bias right from their providers. And we have studies to show that. So there was a study done and it showed that more than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant. And then I think that noncompliant piece is accurate because if I'm walking into a care provider with a history of being mistreated based solely upon my size, yes, often my defenses are up. They are. And that's why we have to work together to build that trust because maternity care should be a mutual two way street. There needs to be a lot of informed consent, a lot of sometimes difficult conversations, but it has to have that foundation of trust and respect and compassion because we're both working for the same exact outcome, healthy mom, healthy pregnant person, healthy baby. That is what we all want.

Speaker 1: Nicole: And for us as care providers, that's also an opportunity, like you said, like you didn't know some things before pregnancy that you learned during pregnancy that have since carried on into your life afterwards, you know, in yours, and your children's life. So like, it's just, iit's just such a missed opportunity. And we have so much room to improve and, and do better with those things.

Speaker 3: Jen: Yes, yes. All of us, all of us. Yeah.

Speaker 1: Nicole: So as we wrap up, I would love for you to tell us a little bit about this initiative that you were involved in with the NIH. For those who don't know, the NIH is the National Institutes of Health and it is the premier organization for health in our, our country and research and guidelines and all those kinds of things. It was called pregnancy for everybody. So tell us a little bit about that.

Speaker 3: Jen: Yeah. When I got the email from NIH at the end of 2016 that they wanted to talk to me, we set up this conference call and we started talking and I started crying and I'm like, sorry, I know that this is like so unprofessional, but gosh, I'm choking up right now. You have to understand, like to have a major organization want to hear the consumer perspective, what it is like to be plus sized and pregnant, that was such a massive shift because, you know, look at the Mayo Clinic and look at all of these other big organizations, look at their pages on obesity and pregnancy and its relative risk. It's all the increased risk. And there's not information on how care providers can empower people and support people of size and how patients can be patient advocates. And that doesn't, that didn't really exist.

Speaker 3: Jen: And so to have NIH realize here we are, they were working on many different initiatives around maternal mental health and other big things. And this was a massive collaboration of leaders in maternal health that are on this committee, looking at things in our maternity healthcare and wanting to create shifts and make improvements. And they flew me out to Maryland to speak on campus, little me with like all these midwifes and pediatricians. And I, in that moment, I realized that that obese people that I put on such high pedestals and I felt so honored to be there. Like they brought me in as the expert to have this conversation as their guest. And it's so helpful that I got that. They were like, wow, your dress is really pretty.

Speaker 3: Jen: So helped me to normalize that here's this opportunity. And so when I was asked to speak, they have this amazing podium with like all my slides set up and I asked for a wireless mic because I wanted them to see my large body while I talked about the experiences of people of size during pregnancy. And at one point I even like grabbed a chair because the chairs around the massive boardroom table with all these fancy mics, it didn't, it didn't really work for me. It really didn't. So they were so kind and brought me a different one, but I brought the chair with arms and I put it in the middle of the stage area and I sat in it and I showed how my body was really uncomfortable and overflowed. And then it hurts. And none of that was prepared. I had a presentation prepared, but I just knew that this was this opportunity that I could make everything that I'd worked so hard for so many years, the opportunity to get in front of leaders in maternal health and say all the things that I've said to you during our time together and to really create change.

Speaker 3: Jen: And it was so like, an amazing experience and ACOG spoke after me. And they were saying now, I'm not sure if I'm supposed to say people with obesity or not. And as Jen said, and I was like, it just felt like this, like I was, I was heard, but it wasn't me. It was the thousands upon thousands and thousands. Like I have 178,000 people on Facebook that are a part of my community. It was all of them that I carried with me and said, we all want the same thing. Right? I've said this time and time again, like we all want the good outcome. We just, we get there in different ways and we need to get there from the foundation of compassion and changing how we treat people. And so then this was, I spoke in January of 2017, the initiative didn't drop until the end of 2019.

Speaker 3: Jen: We continue to have these conference calls and they did focus groups around language and it was so beautiful. What came out of me speaking about the consumer perspective? It was, it was incredible. And then when they came out with the name Pregnancy for Every Body, I about like dropped my cell phone when I was reading it, I was like, wow, how did we go from this obesity initiative to, for everybody? It was like, it was so, so incredible. And, yeah, and then that it really is an initiative to educate plus size people about their healthcare and also, healthcare providers and how they can best support people of size. And it was, it's just, it's incredible. And it, unfortunately it landed right around Thanksgiving and then COVID hits, but we haven't been able to do as much as we had originally hoped that I wanted to help them with promotions. But, I think we'll get back together. There are some things that are really incredibly important that we all need to be focusing right now around black maternal health and prioritize that. But when we're ready, I want to get back together and collaborate more and really push this initiative because it's so, so important that we are putting out resources to care providers that just simply talk about, hey, maybe don't use the word obese when talking to your patients.

Speaker 1: Nicole: Sure, sure, sure. And I hate to think that it has to be an either or. I think we can work on things, you know, simultaneously and I'm hopeful that, you know, once things kind of settle down, cause right now it's crazy right now. Jeez. I mean, yeah. But that you'll be able to do some of the promotion things and all of that. Good, great stuff. And you mentioned you have a huge following on Facebook. I'm going to ask you in a minute where people can find you. But the last question I want to ask is what is your very favorite piece of advice that you'd like to give to expectant moms?

: Jen: Oh, I think, you know, we can say for people of all sizes that you just deserve to work with a care provider that treats you with compassion and dignity, and that empowers you to believe that your body can have a healthy outcome. And if there are risks that you incur along the way that they can empower you to make the healthy evidence-based choices throughout your decision making process. So for people of size, that is a size friendly care provider. If you want a VBAC, that's a VBAC supportive care provider. You need to find someone who believes in your body's ability. And I think that that is so incredibly important. And it is a game changer in the outcomes for people of size. So connecting with someone and knowing that you have to be your own best advocate. And like we said earlier, you're going to advocate for your kids. You're going to spend forever finding that right pediatrician for your kids. And you need to do the same for yourself because you are so worthy.

Speaker 1: Nicole: You're 100% right. And this, and I know I just said that was going to be the last question, but this just popped up in my mind. I know that I've seen as I, and I personally have evolved as a provider. And I believe that our hospital based birth has evolved and we obviously still have work to do, but we've made progress. I'm curious what you've seen over the course of your work. Do you feel like we're doing any better or is it still about the same? And we just need to know of you know, get going with this? What is, what is your experience been with women over the course of your work?

: Jen: And it has been beautiful to finally see a shift. And that shift really hasn't happened until the last like two years. And that we're seeing a shift in care providers. We're seeing a shift in being handed a gallon that fits someone's body instead of two gowns that don't fit your body at all. And you can wear one in the front and one in the back, like we're seeing a shift in meeting people where they're at. We're seeing a shift in doulas talking about how they're size friendly and promoting their services as being size inclusive and doulas are really the gatekeepers to their community. So they know who the size friendly OBs and midwives are. And that's so important that doulas are doing their own work on biases too. So we're seeing this wonderful shift with that said there's still much work to be done.

Speaker 3: Jen: I mean, really that NIH initiative is one of the very few websites that even don't just talk, most websites just talk about increased risk for people of size and not how people can have healthy outcomes. So there's so much more work that needs to be done, but it has been amazing. I mean, when I started this work, Instagram didn't exist, right? So it took forever for me to find images of people of size who were pregnant. And so when I started my work, it was so important to me that people could come to my website and see someone who they identified with. So whether they were white, black, you know, whether they were in a relationship, in a same sex couple or whatever, I wanted them to know that they could see themselves because that there wasn't that out there in the world. And now it's so beautiful to just pull up a hashtag plus size pregnancy.

Speaker 3: Jen: And there are over 45,000 images of people who all look different and have different abilities. And it's so beautiful because you know that it's normal. And I think that's so much of what I want to do. And I know that makes some people cringe, but just normalized plus size pregnancy that yes, you can be pregnant at any size and then let's work to help you have a healthy outcome. And if you don't see people that look like you represented, then you feel that there is something wrong with your body. And when you feel that way, you doubt your body's ability and just goes so much to see that one image can have such a great impact and to see yourself and to know. Hey, my belly might look more like a B than a D, you know, when I give talks, I show these pictures of pregnancy magazines that are primarily thin Caucasian women. And that's so far from the reality of what it looks like to be pregnant. And I hope that we continue to see the shift in what it looks like to be pregnant. So everyone feels represented. And that way everyone feels empowered to advocate for themselves in the best interest of themselves and their pregnancies.

Speaker 1: Nicole: Love it, love it. That's a beautiful way to end. So where can people find you?

Speaker 3: Jen: Sure. For all things plus size pregnancy from trying to conceive to pregnancy birth and postpartum it's www.plussizebirth.com. There, I have my book, my Plus Size Pregnancy Guide. There's also an audio book for those of us that are so busy, and it walks you through everything you could want to know about being plus size and pregnant. I also have that free guide on how to connect with a size friendly care provider. And then I, my kid is 10 now. So while plus size pregnancy will always be my baby, my other baby, I like to talk about motherhood. I like to talk about that advocacy, like to talk about body love and body image. And so Plus Mommy is where you can find me like my main Facebook and Instagram at plus mommy. I also do have Instagram at plus birth because that's so important. But I have the plus mommy podcast, which is, I'd love to have you on, that really dives into so many different topics. And the tagline is from bumps to bellies. We talk about it all in the same place you're listening to this podcast.

Speaker 1: Nicole: Awesome. Perfect, perfect. Perfect. Well, thank you so much for coming on and for educating as all myself included. I so appreciate your time, Jen.

Speaker 3: Jen: I appreciate your work so much, Nicole, thank you so much for everything you do. And for having me on your great show.

Speaker 1: Isn't that a great episode? I so thoroughly enjoyed that conversation with Jen, her energy and passion for her work really shines through. And I'm grateful that she was able to come onto the podcast and share some of her knowledge with us today. Now, you know that after every episode I have something called Nicole's notes where I talk about my top three or four takeaways from the episode. So here are Nicole's notes from my conversation with Jen.

: All right, number one, although you have increased risk, if you are a person of size, number one, it doesn't automatically mean that you will have problems. And in most cases you actually will not have problems. We need to do a better job of focusing on the positive aspects. And then number two, there's a lot that you can do to help mitigate the risk associated with being a person of size and pregnant. You can move your body more. You can work with the right provider. You can see a nutritionist. As Jen mentioned, ACOG, the American College of Obstetricians and Gynecologists who sets standards of care for obstetrics in the US recommends that people of size should automatically see a nutritionist during their pregnancy. So there are things that you can do to help mitigate that risk. It is not automatic that you are going to have problems during your pregnancy, just because of your weight.

: Number two, everyone deserves evidence-based compassionate care. I know that should not have to be said, but it does. Everyone deserves rvidence-based, compassionate care. As Jen mentioned, it's not so much the outcome of the birth. Like don't get me wrong. People have a certain outcome that they want and desire for their birth, but really it's how you are treated at the end of the day, in terms of how you feel about your birth experience. And everyone deserves to be treated with compassion, to be treated with dignity, to be treated with respect and receive care. That is based on evidence, not myths, not made up things like you automatically have to have a C-section because of your size or that your vagina's too fat. That was just crazy. That's absolutely ridiculous. So everyone deserves evidence-based compassionate care.

: And then the final thing, everyone wants a healthy mom and a healthy baby, and we need to work with people and give them the tools and information to help them do that, to help them be healthy and help them have a healthy baby. There's this sort of myth I think, or big misperception that somehow people of size don't care about their health and that's not true. It's just that it can be hard to maintain weight. It is not an easy thing to do. And instead of writing people off, we need to help them as best as we can because everyone, again, once a healthy mom and a healthy baby.

: All right. So that is it for this episode of the podcast, be sure to subscribe to the podcast in Apple podcast, Spotify, Google play, wherever you're listening to me right now. And of course I'd love it if you leave an honest review on Apple podcast, it so helps the show to grow. It helps other women find the show. And I do shout outs on episodes from those reviews. And I want to ask, are you plus size and pregnant? How has your experience gone for you? I would love for you to share your experience in the All About Pregnancy and Birth Facebook group. This is a free community on Facebook of supportive moms, great place to be. And it's run by my community manager, Keisha, who is an experienced doula. I'm in the group a bit as well, but really the best part of the group is being able to connect with other pregnant mamas just like you. So I would love to hear your experience with being plus size and pregnant in the group. Now next week on the podcast, it is a birth story episode. So of course I'd love for you to come on back next week. And until then, I wish you a beautiful pregnancy and birth.

Speaker 1: Thanks so much for listening to this episode of the All About Pregnancy and Birth podcast. Head to my website t www.ncrcoaching.com to get even more great info, including free downloadable resources on how to manage pain and labor and a warning signs to look out for after birth. You'll also find information on my free online class, on how to make a birth plan, as well as everything you need to know about The Birth Preparation Course. Again, that's www.ncrcoaching.com and I will see you next week.