Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Tuesday, September 06, 2016

Health/Pregnancy Perspectives 

"We're certainly not trying to say that any of the health-care providers that are referred to in the study is actually a eugenicist."
"What we're trying to say is that any time we refuse care in these areas [pregnancy], or potentially limit people's care, we could be unintentionally and inadvertently echoing some of these histories that we've seen in the past about who is it that society would prefer to reproduce -- and who they would prefer to not have reproduce."
Andrea Bombak, assistant professor, Central Michigan University

"Gals your size, OK, mortality rates are higher. So I go ahead and intervene, help you get pregnant here."
"Then you go down to [a birthing ward]. And then, boom! Pulmonary embolism."
Study interviewee narrating doctor's response

"They said, 'But I am exercising as much as I should be; I am trying to be healthy'. And they felt that wasn't being taken seriously."
"There was a real dissonance between the experience they felt they should have had, and the experience they did have. And there was just a lot of anger and a lot of sadness around that."
Deborah McPhail, assistant professor, University of Manitoba, co-first study author
Plus Size Babywearing

A new study has produced a paper published in the latest issue of Social Sciences & Medicine, the work of Canadian researchers writing of a situation within the medical community where overweight women are being warned of dangers inherent in excess body fat during the period of pregnancy and delivery. The earlier history of medical care was often faulted, citing the propensity of doctors to overlook their professional obligation to point out to their patients that being excessively overweight creates complications and conditions for disease onset.

Now that some in the medical profession have taken their obligations seriously enough to remind obese patients that pregnancy is fraught with risk for both the carrying mother and the child she will deliver, potentially impacting on health outcomes for both, they are being excoriated for being unnecessarily condemnatory and unhelpful. Women feel resentful when and if the issue of their obese status is raised to begin with, and all the more so when they see doctors' views as interfering with their intentions.
Where’s My Bump? Plus Size Pregnancy Woes

Grossly overweight women tend to resent any perceived slight in reference to weight. Obviously this is a sensitive topic and all the more so that self-guilt is also involved here, that lifestyle and neglect of healthy options have added risk to the health of women who are heavily overweight or obese. And where well-meant medical advice is taken as condemnation and a judgement of the manner in which these women live their lives; over-eating, consuming energy-dense and nutritionally-deficit foods matched with a sedentary lifestyle.

The resentment focuses on their desires to achieve what others are able to who are not burdened with obesity, and professional advice informing them of the risks they face as a result of their lifestyle choices. Rather than focus on the positive aspect of the situation, to take their lifestyle choices and turn them around with the goal of becoming healthier, the focus is on the anger they feel and the disappointment when informed that what they contemplate will become risky for them without first ameliorating their weight situation.

For the study, women reported to the interviewers how they dread prenatal appointments, with one woman describing a situation where she was refused fertility treatment until she shed 60 pounds. Which sounds completely sensible; a woman overweight by 60 pounds or more insisting on fertility treatment represents a blueprint for failure; the clinic where she sought treatment was reacting in a completely sensible, professional manner. IVF is a costly process with no guarantees of success even for women of normal weight.

Another interviewee reported to the researchers that her doctor suspected that a hormonal disorder was accountable for her infertility, and accordingly rendered his opinion that the situation revolved around the reality that the woman was "fat". His choice of verbal description was undiplomatic, but it was, after all, an apt summing up of the problem she was facing, and she had the choice to make an effort to lose weight and in so doing prove the medical hypothesis, or disprove it.

It was what the authors of the report viewed as moralizing, leaving the impression with women as being "always-already diseased and dangerous to their child", that they based their criticism on, as overworked "risk talk", sensationalizing the issue of obesity and pregnancy outcomes. The women who were complaining of their treatment by doctors were made to feel that they were viewed as "disgusting", or "bad mothers". The demographic that these women fit into is large, an estimated one-third of women in Canada entering pregnancy as obese or overweight.

Obese pregnant women are at risk for miscarriage, high blood pressure and gestational diabetes. Their fetuses are at increased risk of birth defects, according to the Society of Obstetricians and Gynaecologists of Canada, If that doesn't give pause for thought and concern, what does? Apart from which is the fact that obesity is one of the principal drivers of Cesarean sections, a surgical procedure itself not without risks.

"Overweight women do not deliver well", said Dr. Jennifer Blake, the chief executive of the Society, in a realistically uncompromising fact-telling. Furthermore, she said, in the United States, obesity contributes to a doubling and tripling in maternal mortality rates.

The Well-Rounded Mama

The study in question is a preliminary one, a pilot to a larger study underway. The study that led to the publication of the findings of the co-authors, interviewed 24 mostly white, middle-class women in two middling-size Canadian cities, whose principals discussed the experiences they had undergone while they were in the process of attempting to conceive, while they were pregnant, or while they were giving birth.

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