Episode 195: Lu interviews Jen McLellan of Plus Mommy to talk about the stigmatization of people in larger bodies during pregnancy, finding size friendly care providers, exploring pregnancy care options, myth busting misconceptions, self-advocacy, and relative vs. actual risk.
Jen McLellan is a certified childbirth educator, wife, and mother to a charismatic 9-year-old. She’s the host of the Plus Mommy Podcast, published author, speaker and founder of Plus Size Birth, the premier resource for all things plus size pregnancy. With over five million page views on her blog, Jen is passionate about plus size pregnancy, body love, and navigating the bumps along the road of parenthood.
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Lu Uhrich: Welcome to Episode 195 of Real Health Radio. You can find the links talked about as a part of this episode at the show notes, at seven-health.com/195.
Real Health Radio is presented by Seven Health. We work with women who feel obsessed with and defined by their bodies. Using a non-diet, weight-neutral approach that combines science and compassion, we help you to transform your physical, mental, and emotional health. We specialize in helping clients overcome disordered eating, regain their periods, balance their hormones, and recover from years of dieting, binging, exercise obsessing, and body hating by learning how to connect with and listen to their bodies.
We’re currently taking on new clients, so if you’re ready to get the support you deserve in healing your relationship with food and your body, please don’t hesitate to contact us. Head over to seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. That address again is seven-health.com/help, and you can also find it in the show notes.
Hi there, everyone. If you’re a regular listener of the show, then you know by now that we’ve been giving away a book from our resource list with every episode. It’s our way of saying a simple thank you to you, our Real Health Radio community, while also asking for your support and feedback through rating and reviewing the podcast.
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That’s all for announcements, so about today’s episode. I’m always honored to speak with our guests, but recording this one felt special. It was like I was talking to someone I’d known for years, a dear and brilliant friend. The conversation was dynamic and informative. At times it was even emotional, yet all the while, there was this thread of joy and hope woven in everywhere. Jen McLellan is nothing short of amazing, and I’m so happy to introduce her to you today.
Jen is a certified childbirth educator, wife, and mother to a charismatic 9-year-old. She’s the host of the Plus Mommy Podcast, published author, speaker, and founder of Plus Size Birth, the premiere resource for all things plus size pregnancy. With over 5 million page views on her blog, Jen is passionate about plus size pregnancy, body love, and navigating the bumps along the road of parenthood.
Though we didn’t plan it this way, it seems quite fitting that this podcast all about pregnancy, which is one of the many ways you can become a mother, would drop this week, days before we celebrate Mother’s Day here in the U.S. Happy Mother’s Day to all the mamas out there, and no matter where you are or what you’re celebrating, whether you’re a parent or ever hope to be one, whether you identify as plus size or not, no matter how you journey to motherhood – and really, no matter who you are – rest assured that there’s something for you in this episode, because Jen doesn’t only talk about plus size pregnancy.
She tells us about her own body relationship, finding size-friendly care providers for whatever your needs may be, how to be a compassionate ally, the difference between actual and relative risks (which is where my inner nerd was thriving during this interview), and a low moment in her life and work that led ultimately to the life and work she knows and loves now. It’s a great chat, so let’s get to it.
Hi, Jen, and welcome to Real Health Radio.
Jen McLellan: Thanks so much for having me. I really appreciate it.
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Lu Uhrich: It’s an honor to have you on the podcast. I’m really looking forward to it as a woman who has been pregnant, as a mom who – before we recorded, I was just talking to you about having kids home today unexpectedly – and also as somebody who has such a wise and passionate voice in the area of plus size pregnancy, I’m excited to talk to you. But before we do, could you introduce yourself and what you do in your own words?
Jen McLellan: Sure. I know you read my bio, so that sums me up. I would say I’m a mom first, and that led me into this work that we’ll share all about. But I’m a mom who had a story to tell, and that story changed my life and catapulted me into becoming certified as a childbirth educator, focusing in on supporting people of size during pregnancy, birth, and postpartum, as well as trying to conceive.
I’m a public speaker, an author. I get to travel the country speaking to organizations about how we support people of size in the healthcare world, and mom conferences, and I’m most proud of collaborating with the National Institutes of Health recently on a Pregnancy for Every Body initiative. And I’m the host of the Plus Mommy Podcast. So I do a lot. [laughs]
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Lu Uhrich: Yeah, you do, and there’s a lot to unpack there. I think where I’d love to start, if you’re okay with it, is just to talk about – we do this often with our guests, but to talk about your own relationship with your body, because I’m assuming that some of that has fed into the experiences that you had that created the story that you had to tell.
Jen McLellan: Oh, all of it, yes, and it continues for sure. I grew up a chubby girl in southern California. I’m sure growing up a chubby girl anywhere is difficult, but it was especially difficult in a world next to Hollywood where you are always fed these messages that you have to exist in a thin body. I just really never did.
That was really tricky to navigate. I have a history of dieting and going to Weight Watchers when I was young, and all of those things that really played into this distrust of my body and not loving my body or even thinking that I could love a body that was larger. So that was really difficult growing up in that way.
Lu Uhrich: Then as you did get older, what happened? How did your body image and your relationship with your body evolve?
Jen McLellan: It got worse, really. The older I got, the more I ate those messages of self-hate. When I was 19, I was going to community college, and I joked that it was high school with cigarettes. [laughs] It didn’t feel much different. I hungered for a change, so I got on a plane and moved to Denver, Colorado on my own when I was 19 – which was wonderful and exciting, but it also put me in a vulnerable position without a lot of support from family and no friends. I continued to do harmful things to my body to try to fit in.
Thankfully, I ended up meeting a wonderful man who loves me for me and we got married. When I got pregnant and we were ready to start a family, it was the first time in my life that I was eating and not dieting. I wasn’t dieting; I was listening. I didn’t even know what intuitive eating was, but I was doing it. I was listening to what my body needed. I was touching my belly in a loving way, in a way I had never touched it before.
The big catalyst, the thing that changed my pregnancy, my life, was that I hired a doula, and doulas support you with physical, emotional, and educational support during pregnancy. They’re not care providers, but they’re trained birth professionals. I hired a doula and I wanted an unmedicated natural birth, and she was basically like, “You should have a home birth. Why are you doing these certain things?” I was like, “I’m high risk. I can’t have a home birth. I don’t trust my body.” She was like, “Okay, that’s fine if you don’t want a home birth, but you should be working with midwives.” I was like, “What? But I’m high risk.”
She was the first person to tell me that I wasn’t high risk, because everything on the internet told me I was. Every single website told me that because I had a high BMI – I’m comfortable sharing my weight, and I self-identify as fat – I weighed 299.9 pounds when I stood on the scale at my first prenatal visit.
So I just assumed that everything that said I would develop gestational diabetes, I would have a cesarean birth – and thanks to the comments sections in 2010, I read that I was a horrible person for wanting to become a mother as a fat person. I believed everything that I had been set to believe my whole life.
This doula was just like, “Get over your weight. You’re healthy.” No one had ever said that to me in that way. It was so powerful, and I was like, “Yes ma’am.” [laughs]
I set up an appointment with a midwifery practice at Denver Health, which is a county hospital, and it was shocking to me to sit with this midwife that said the same message, only in a compassionate way, like, “Your body is incredible. You’re doing water aerobics and eating these foods that fill your body. Of course you can have the birth outcome that you want.” She was like, “You’re not going to have the posh comfy couch hospital prenatal visits. This is a county hospital. We have plastic chairs. But you’re going to have really great healthcare.”
I learned so much from that experience. We think when we get pregnant it’s all about how nice the office is and what meal they serve after you give birth. Really, those things are so not important at all. I switched to a midwife, and at the age of 30, it was the first time a care provider ever touched my body with compassion. That changed everything. It changed how I felt about my body during pregnancy. To this day, it gives me chills and it helps me to advocate for myself in healthcare, always.
So that was the real shift of “oh my goodness, my body is really strong and capable, and I can have a healthy pregnancy.” And I did. I gave birth on my knees in a hospital. Everything was changed after that.
Lu Uhrich: Wow, there’s a lot that I have questions about there because I think there’s so much valuable information and insight to offer. I’m curious, if we rewind, before you hired your doula and your doula was like “Listen, you can do this. Who said you’re high risk? Let’s figure this out. Get a midwife team,” before that encouragement, were you working with a more traditional practice? And how was that experience, if you were?
Jen McLellan: I, like most people, just went to the same OB I had been going to because there’s a comfort level there. Annual exams can be very intrusive, and when you exist in a larger body – I mean, if you exist in a body of any size, that’s an intimate experience. So it was just easier to go with the person who had already seen my vagina. There was comfort there.
I remember her being like, “I’m glad you’re 30.” The focus was “I’m glad you’re not older, and we’ll just see how this goes.” I was never outwardly shamed, but I never felt empowered.
I empowered myself. Everything online was negative about plus size pregnancy. It was all like “obesity and pregnancy, dun-dun-dun.” On my own, I had researched my risk for a cesarean birth is so high; statistically it’s over 50%, at the time I thought – now knowing, at my weight, it was about 80%. I needed to be proactive with my health, so I was going to water aerobics three times a week and loving it. I was being physically active. I signed up for prenatal yoga. I was eating nutritious foods.
So I intuitively was listening to my body and doing things that I encourage people of all sizes to do during pregnancy. It was coming from a place of love. On my own, I was going down this journey, but I wasn’t getting that support from the healthcare community until I switched to the midwifery model of care.
And I want to be clear: there are incredible size-friendly OBs, absolutely. I’m not saying anything negative about the obstetric model of care. It’s just a different model of care. You have to decide what model of care is best for you. For me, it really was women-centered care and the midwifery model of care.
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Lu Uhrich: Wow. You mentioned it before, and I heard you say it again, this idea that, upon becoming pregnant and recognizing what your body was doing, you just naturally became an intuitive eater. We didn’t really get into the details, but you mentioned you were doing some harmful things to your body as a result of your body image and your relationship with your body. My assumption was – and I’m sure listeners’ assumptions – you were probably dieting, undereating, overworking it, things like that. Was the shift like a snap of the fingers?
Jen McLellan: Oh yeah. I had done everything on the list of harmful things around dieting and restriction and binging and purging – all those things. Any diet, I had tried it.
The shift was just so intuitive. You read all the things online about pregnancy and what you should and shouldn’t be eating, so then part of that diet culture brain that I had grown up with was like, “I have to do all of this and I have to do it right.” [laughs] But then I started to really listen to what my body wanted. I craved so much watermelon. We went through a watermelon a week. It was watermelon all the time. We still make jokes about it.
It was such a shift from when I think back to when I was getting married. In my office, I put up this sign on my door that said “Don’t feed the bride.” Ugh, I look back and I just want to hug that little bride-to-be and be like “You poor thing.”
I did none of that type of stuff when I was pregnant. I didn’t say “I can’t have cake because I’m pregnant.” I just ate a slice of cake until I was satisfied. Just intuitively, I was like “Okay, I’m done.” Or I’d eat the whole piece and I wouldn’t feel bad about it. It was so powerful not to feel shame about food, not to think of it as good or bad. I’m sure I did a little bit of that, but it just was really learning about intuitive eating without even knowing there was a book on it.
Lu Uhrich: That’s something that happens so regularly. My clients know this of me; I’m always like, I’m not happy that you got sick or I’m not happy that your body is in a position where suddenly the signals are amplified – and pregnancy could be one of those, which of course, they’re happy and I’m happy for that too.
But my point being, a lot of times this happens around illness when my clients suddenly have an experience where they’re down with the flu or they got the stomach bug or something happens and they’re like, “Oh, my body actually does talk to me. I know exactly what I want to eat and when I need hydration and when I need rest and how not to move right now.” Because suddenly, when your body is in a new state, whatever that state is, it can begin talking louder, and you can get the messages more clearly.
That’s the same sort of thing with pregnancy, so I’m not at all surprised how suddenly your body was doing this other job of sustaining your life and now the life that was growing inside of you, and it was like, “Hey, I’m going to speak up here. Turn the microphone up because I’ve got things to say,” and you thankfully were so receptive to it. Despite having been in what sounds like a disordered eating/diet culture/negative body image history, you were still so receptive to that amplified voice of your body.
Jen McLellan: Yeah, and I think it wasn’t just nutrition. Think about it; I put on a bathing suit and did a group exercise class and was excited about it and loved it. I don’t think I ever would have gotten to that place if I hadn’t done it pregnant. Let’s hope I would’ve, but I look back and I’m so proud of that girl that was like “I read water aerobics can be great during pregnancy.”
I’d always had gym memberships and been active in a larger body, but I never routinely stuck to anything because something would be triggered or someone would say something. I had never routinely exercised without taking a break for so long and felt so good about it, and it really also changed my relationship with exercise. Like, “Oh, I don’t have to work out to lose weight. I can work out because it really makes my body feel good,” and then I slept like a baby.
It was all these things that we know about the benefits of exercising, eating intuitively, but unlearning everything that I had learned wrong about why you eat certain ways and why you have to exercise, and just realizing that I do these things because it makes me feel good. Not to punish myself, but to love on myself.
Lu Uhrich: Yeah, for sure. It sounds like between the things that you were learning about yourself and your body – movement, nutrition, rest, all of those things – and the messages you were getting from your midwives, it really sounds like there was this Health at Every Size focus. Which isn’t necessarily, for the people listening, to say anyone at any size is always healthy, because we know people in all size bodies can be healthy or unhealthy.
But doing health-enhancing behaviors, having health-enhancing mindsets, policies, facilities, like the midwife community – those are all more indicative of health than this idea, like you said, of “I have to lose weight” or “I have to eat exactly this way” or “I have to force and punish myself through movement.” There really is another, more compassionate way to approach health, and it sounds like that’s where you were at.
Jen McLellan: Absolutely. No one had ever told me that I could be healthy as an almost-300 pound woman. That message had never been there, even though all my blood test results were always golden, I never had high blood pressure. I never had anything to say I wasn’t healthy; I just had all these messages and even care providers saying I wasn’t because of my size.
All that did was make me continuously gain weight and punish myself my whole life. And that’s really powerful. When we talk about Health at Every Size and retraining how we look at larger bodies, we know and we have studies to prove that shame is not an effective tool. Shaming people doesn’t help them to want to have access to moving their bodies in ways that feel good or learn about nutrition in a way that’s not diet-focused. Shame is not effective.
That’s so incredibly important, and I want people to continue to hear that message. It’s not just people of size sharing their stories; it’s now all these studies that we have to prove that when people of size feel shamed, especially by their care provider, they are less likely to receive routine care and more likely to gain weight. So it’s the opposite effect of what a lot of care providers want to accomplish.
Lu Uhrich: Right, exactly. I do have some questions for you about this, even about – and we can get into it in a little bit, because first I want to find out how you started Plus Mommy and all the things that you’re doing.
I do have some questions around this idea that I do know that there are some risks for people in larger bodies who are pregnant, but I begin to question, because of the work that I do, because of what I know and understand about Health at Every Size and weight stigma and oppression, can we really say that those risks for a plus size pregnancy are related to being plus size more so than related to the bigotry and the stigmatization that happens inside and outside of the medical community? I don’t know.
Jen McLellan: Oh, we’ll dive into it all.
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Lu Uhrich: I’m so excited. I’m so excited to hear this from you. So you were pregnant, you worked with the midwives, you gave birth on your knees, had your son, and then what happened? How did your life change to now, you are the woman for plus size pregnancy? How did that come about?
Jen McLellan: Oxytocin when you give birth is – I had never been so high in my life. In that moment of giving birth, I was like, I’m forever changed. How could I ever hate a body that could do something so magnificent? Why had I never believed that my body was capable, my body was worthy? It was just this shift. Obviously, so many hormones coursing through your body. [laughs] But I was like a warrior, and it was amazing.
And then you learn about postpartum and you have this infant to feed and you never sleep. [laughs] So while I was still feeling these shifts in how I viewed my body, I was also adjusting to motherhood. My son is 9 now and I joke that I’m still adjusting.
He was born in August of 2010, and while I was navigating through those first few months, which are so hard – shout out to anyone who’s in it right now – I just felt called to tell my story, and it didn’t go away. I was like, there has to be another narrative of what it’s like to be plus size and pregnant. I would spend hours on Google Images, looking for people who looked like me pregnant. There was no Instagram at the time. There was no hashtag #plussizepregnancy. It was so difficult to feel like I was normal and that I could have a healthy outcome. And then here I did. I had a completely healthy pregnancy, and I gave birth on my knees. I wanted there to be another story out there.
In April – I’m coming up on my 9-year anniversary – on April 6th of 2011, I started a blog, having no idea what it was to blog. I knew nothing. I picked the longest name ever: Plus Size Mommy Memoirs. I had no idea that this would become my career and my life. I just wanted to tell my story.
I remember setting up the Facebook page, because Facebook was the big thing back then, and thinking, “Wow, it would be so cool if I got 50 followers in a month.” I was getting 50 to 100 followers a day because no one else online at the time was having this conversation, especially around plus size pregnancy.
It just took off. I realized, thankfully within a month, that this wasn’t about me. This wasn’t about my story. I needed to create the resource that I couldn’t find when I first went on that day – when I got that positive pregnancy test, I immediately went online and googled “plus size pregnancy,” “fat and pregnant,” “obese and pregnant,” and could only find negative information. I found one or two positive things.
I coined Plus Size Birth then in May of 2011, thank goodness. But my community had already latched on to Plus Size Mommy Memoirs, and they had turned it into PSMM. It really became a part of them. So on social media, I always stayed as that Plus Mommy, but the core of my work and my website was Plus Size Birth. I ended up shortening it to Plus Mommy because it’s more marketable, honestly.
But yeah, that’s really what happened. I just felt called to share my story, and then immediately realized that it wasn’t just my story. It was countless people’s story. I can share a little bit more about how it evolved, or we can move on to more topics, but let me know.
Lu Uhrich: I am curious, because that’s exactly where I wanted to go with it. Hearing you talk about how this was your story and you didn’t hear and see any other stories out there, so you brought this to the public through your blog and through Facebook, but you said it wasn’t just your story; there were other people. Obviously, if you’re getting 50 followers a day and more and more people coming and following and wanting to hear what you have to say, it’s because they might have similar experiences or their own experiences to share too.
How did it shift from being your blog to being this company and this community? I do want to know that.
Jen McLellan: In June of 2012, I was the breadwinner of my family. I had a background in nonprofit work. I was a volunteer manager for the leading end-of-life advocacy organization, Compassion and Choices. My whole work history was end-of-life advocacy, so I did a lot around advance directives, helping to get laws passed around aid in dying, training budding volunteers, doing some public speaking. All of that set me up for this birth work that I do.
But I thought that was my life’s purpose, really. I was so passionate about body autonomy for end of life and having choice in care when you’re terminally ill. And I got laid off. The same week I got laid off, just a few days before the layoff occurred, I had a miscarriage.
So within a matter of a couple days, I went from thinking our family was growing and so ready for this second child, I had a career that paid – my husband only had to work part-time and he was a full-time dad – our life was so beautiful and perfect, and I had this career that I had been doing for over 7 years, and there were so many exciting things happening in that advocacy world, and then it was all taken away from me. It was devastating.
I became severely depressed. It was one of the hardest times in my life. I felt like my body had failed me, and that was really hard to reconcile because I thought my body was amazing through everything. I’m so glad we talk way more about miscarriage now, but even just a few years ago, it was still so stigmatized, and it continues to be.
And then I no longer had the income and the fancy medical insurance and all of the things that made our lives very simple. It was 2012, so the economy was horrible. Unemployment had been extended because that’s how bad it was.
I remember by the fall, my friends and family – thank goodness – were like, “Okay Jen, we realize that you went through a lot, but it’s time to shake that off because you have something here.” At the time, I had 13,000 followers on Facebook, which was a big deal back then, and my website was getting thousands of hits a day. They’re like, “You have something.”
I remember my mother saying, “You’re going to look back on this time and what happened as a gift.” Sorry, it chokes me up saying that because that felt like a stab to the heart at the time. But I did, and in the fall I took my first certification course on becoming a certified childbirth educator. I realized I had built this great community and I was helping all these people and I was writing all these articles about all the resources – I couldn’t find where you find affordable plus size maternity clothes, and I had started talking about how you find a size-friendly care provider. But it was a lot of like “when will you start to look pregnant?” and the struggles around that when you’re plus size.
Then I realized, this is all well and good, and I’m so impacting people’s lives, but I’m not able to create change. I felt so called, and because I had that work experience of working directly with doctors and hospice nurses, I knew some ways to interface with the medical community and some language to use. But I knew I needed some credential, and there wasn’t enough time to pause and go get a degree. [laughs] I knew this all had to happen fast.
So I became certified as a childbirth educator and immediately started public speaking. That really catapulted Plus Size Birth to being recognized as the go-to resource for plus size pregnancy. Since then I’ve written a book called My Plus Size Pregnancy Guide about everything you could want to know about being plus size and pregnant. The site Plus Size Birth gets 90,000 hits a month. I do this work full-time now, and it’s changed everything for me.
I’ve been able to support thousands upon thousands upon thousands of people and also really helped to create change in the medical world and in the birth world. It’s tiny itty-bitty little baby steps, but I’m proud of the change that has been occurring – and it’s not just me. I don’t want to say that. It’s not just me doing this work.
There are so many people out there advocating for themselves. Doulas helping their patients to advocate. Midwives that are size-inclusive that are doing this work, and OBs as well. It is so many people coming together to say, enough is enough; we need to meet people where they’re at and support them with evidence-based compassionate care. So it’s not just me.
But I am thankful that my website and my work is really looked to as a very strong resource in this field.
Lu Uhrich: I’m so appreciative that you shared that story, especially the emotional part of your mom saying “Hey, you’re going to look back and be thankful for this,” because I think about how you needed that – even if you didn’t believe it at the time, even if you were like “No way, Mom” – you still needed that voice of “It’s going to be okay. Let me support you in this. I believe in you.”
What’s interesting – and I don’t think ironic or coincidental at all – is now you’re that voice for so many plus size pregnant women who are coming to your resource, and you’re saying, “It’s going to be okay.” You’re being the voice of even your doula. You had that one personal experience, and now I love to see the ripple effect of how it is changing tons of lives, all the time. I’m so grateful that you started that blog.
Jen McLellan: Thank you. It just exceeded over 5.5 million page views since I started, and that to me is just mind-blowing that so many people have come and found this resource, and that it’s everything that I searched for that I couldn’t find. That I’m really, really proud of because I don’t want anyone to feel how I felt, feeling that it couldn’t have a healthy outcome, because that’s so far from the truth.
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Lu Uhrich: Yeah, let’s get into that a little bit. We’ve talked about how there are so many common misconceptions when it comes to women in larger bodies who are pregnant and what that means for their pregnancy, for their child, and for themselves.
Some that I’ve heard would be the idea that it’s harder to get pregnant, or – you had even talked about in your own experience, your own assumption was “I’m high risk because I’m in a larger body,” or that the babies are at higher risk for complications. Essentially, there is this idea culturally that it’s just unhealthy to be fat and pregnant.
I would love to hear, what are those other ideas or things that women in larger bodies are hearing about themselves when it comes to getting pregnant, from conception to pregnancy and even postpartum? What sort of things are they up against?
Jen McLellan: I believe in sharing evidence-based information. That’s really important to me. If we look at the evidence, yes, absolutely, there are increased risks. When you exist in a larger body, you do have some increased risk. I think it’s really important that we talk about that, because when we know our increased risk or we know things that we need to be aware of, it empowers us to make choices in our lifestyle that can help to reduce our risk.
By that I mean it’s the same for people of any size during pregnancy. The importance of moving your body and exercising and really eating nutritious foods. I think intuitive eating very much should be a part of pregnancy for every body. But making choices with our nutrition to feed ourselves and our babies in ways that help us to grow and to be healthy. Those things are so incredibly important.
When it comes to the actual risks, yes, there’s an increased risk for gestational diabetes, preeclampsia. Those are the two that we hear the most. There are others. There’s an increased risk of stillbirth. Yes, it does take longer to get pregnant.
But all of these increased risks are very small. The one that I hear the most is gestational diabetes. It seems to be this thing that even care providers who have a bias against people of size just assume that their patients will develop gestational diabetes. When we look at the research, depending upon your BMI, we’re really looking at around a 15% risk of developing gestational diabetes if you have a higher BMI. I can give you studies and stuff to put in the show notes.
What I like to say to people when I go speak at conferences – I spoke at a labor and delivery nursing conference recently – is the importance of flipping the script. We’re still providing the same information, but instead of saying that you have a higher risk of gestational diabetes, I say “You have an 85% chance of not developing gestational diabetes, and here’s what you can do to reduce your risk even further.” We know that physical activity and nutrition can play a role in helping to reduce that risk.
So a lot of my work is presenting information, but in an empowering way that we say – like with preeclampsia, if you already have high blood pressure, then yes, you have a much higher increased risk of having higher blood pressure throughout your pregnancy. Or because you exist in a larger body, yes, you do have a higher increased risk. But nothing says that you are going to incur these risks, and nothing says that there’s this one thing that only people of a high BMI are going to incur because of their size.
So it’s really important to me that people go into their pregnancy feeling that they can do everything possible to reduce their risk and to have a healthy outcome, and that if they do incur any risks of complications during their pregnancy, to hold onto the truth that it happens to people of every size.
I just don’t want people to spiral down, like “I became a statistic.” I hear that a lot, and it’s like, now is not the time to feel so badly about yourself. Sure, go there for a minute, but it’s really a time to take that information or take a diagnosis and just allow it to empower you even further to walk down a path of breaking up with diet culture and really understanding how food can fuel and love on your body, and how to be active in ways that make you feel good.
Because as parents, we want to impart all of this to our children. Pregnancy is this incredible time to change our relationship with food and exercise, and how we approach healthcare as a whole.
Lu Uhrich: There’s so much that you said there that I was like “yes, and this, and this,” as you were talking. First of all, the idea that I know for myself, being in a privileged body – in the medical community, nobody’s looking at me; I fall within whatever the normal – I can’t stand BMI, but –
Jen McLellan: Yeah.
Lu Uhrich: Ta-da, for the medical community, it really works out for them. They don’t have to go through their spiels about being lower or higher on the BMI scale for me.
That was the same for me when I was pregnant and I got to walk right in and, in this privileged body, not have what seems to be – because now, doing the work that I do, working with women in all different size bodies who have had many different experiences, one of the things a recent client said to me was one of the most hellish experiences she ever had in her body in terms of how other people treated her was being pregnant, and the medical community focusing on her size instead of her pregnancy, instead of the baby in her body. I’m hearing that from my clients as they have either gone through it or are going through it while we’re working together.
But for myself and my own experience, I wasn’t hearing “you’re at more risk of this” or “you’re at more risk of that,” which again is this idea of speaking to your patients with relative risk. Like “compared to” – I don’t know, I don’t care about someone else. Like you said, what is my actual risk here, and how can we say it in a way that reframes it to say, instead of “you have a 15% chance of gestational diabetes,” “you have an 85% chance of having a healthy pregnancy here.” I think that is so important.
Another thing you said that I just want to call attention to is this idea that risks happen across the board. If you are a human who can or has gotten pregnant, any of these things, any of these complications can happen to you. No one is immune. I myself have had multiple miscarriages, a C-section, an extremely high risk pregnancy – and again, in a body that’s privileged when it comes to how I am treated in the medical community.
Jen McLellan: Yeah. You said a lot. I was getting excited in the background. BMI, I don’t think people really – BMI was established in the 1900s by a statistician. It was never intended to be used the way it is used today. And the fact that it is still used in the way it is today is just mind-blowing to me. Yeah, it’s very, very, very frustrating.
00:41:20
I’d love to explain relative risk versus actual risk. You just did a brilliant job of it, but digging into it a little bit more because I think it’s so important that we understand the differences.
It is very common for people of size to be told and to read, “You have a much greater risk of developing gestational diabetes,” and what I’m hearing more and more is “You have a much greater risk of having a stillbirth.” So I pulled up some numbers, and I’d love to walk through it.
A relative risk is a rate compared to another rate. We’re comparing someone with a BMI of 20 versus someone with a BMI of 35; that’s a relative risk. Then the actual risk, like you said, is “What is my actual risk of this?” I know that stillbirth is very triggering, but it is something that I want to use as an example here because it’s how people are being – I would even say manipulated by the medical community to make decisions for their healthcare that aren’t necessarily evidence-based.
We look at the cesarean birth rate for people of size is astronomical, and that’s where I really challenge that there’s a lot of bias against how people of size are treated in the medical community, and we have studies to back this up, versus that 80% of people with a BMI over 60 actually have to have a cesarean birth. Then for people with a BMI over 40, it’s almost 50%. They’re really, really, really high numbers to me that don’t make a lot of sense.
When we look at stillbirth – I have this example of this woman, Sarah. Sarah with a BMI of 35 is told she is 78% more likely to experience a stillbirth during a pregnancy. What does this actually mean?
For someone with a BMI of 20, their risk is 40 stillbirths per 10,000 pregnancies. I want to break that down. That is a 0.4 chance, so 0.4 of having a stillbirth during pregnancy. Sarah with a BMI of 35, it’s 72 stillbirths per 10,000 pregnancies. Sarah’s risk is actually 0.7. So we went from 0.4 to 0.7.
When we’re just comparing the two numbers, yes, she is 78% more likely to have a stillbirth during pregnancy when we’re comparing it to a BMI of someone who’s only at 20, but Sarah’s actual risk of having a stillbirth is 0.7%. I hope that makes sense. It’s easier to see it on a slide, but I hope it drives home the message that we need to be asking our care providers, when they say, “Your risk is so much higher,” ask them, “What is my actual risk?” and I wouldn’t be surprised if they can’t answer it for you.
There’s studies, and we have studies on obesity and pregnancy – and I hate the ‘o’ word – but we have these studies and we have to look at what’s behind these studies. Was every person of size evaluated in the study? Did we look ahead of time to see if they already had high blood pressure, if they already were prediabetic? The answer is “I don’t know” or “no” or “maybe.”
We’re just starting to see more studies – there was one out of the UK around looking at woman on their second time of pregnancy who were indeed low risk, did not have high blood pressure, did not have any signs of being prediabetic. We see lower risk profiles for these women with a higher BMI than first-time moms with a lower BMI.
There’s so much to it, and it’s a lot, and it’s overwhelming. At the end of the day, I want to say, yes, people of size have increased risks during pregnancy and we need to talk about them, but they are nowhere near as astronomical as they are presented to the medical community, and we need to use that information to empower ourselves to be healthy and physically active and working with a size-friendly care provider throughout our pregnancy.
Lu Uhrich: Thank you for explaining that so thoroughly. The way you explained it is so easy to understand, and hopefully people are realizing the trauma and the fear mongering that’s involved with someone saying, “You have a 78% higher chance of this horrifying thing happening as compared to someone else” instead of really hearing, “You have a 0.7” – is it 0.7%?
Jen McLellan: Yeah.
Lu Uhrich: Yeah, 0.7%, I’d be like, I have more of a chance of a bird pooping on me, probably, than actually having that experience. But when you hear it compared – I think what it is, and I think what really bothers me as somebody who is paying attention to these things is the idea that everything in the medical community and our culture at large is in the context of what “normal” is – a tall, thin, white woman.
But essentially, what’s “normal” is this one body type, and now every recommendation we give to you, all of the treatment we give to you, any conversation we have with you is always going to be in comparison to what we would like to be, would like to say, for our own beauty ideals, is the “norm.” Which actually isn’t even the norm when it comes to sizes.
I can only imagine, because it’s not something I’ve experienced personally, the pain of constantly feeling like all of my health advice, all of the conversations around me and my body and my pregnancy and my child, are in the context of comparing me to something else that is seemingly better in the medical community’s eyes, just based on the way that they posture these statistics in conversation.
Jen McLellan: I do want to be sure to say when we say statistics – and I’ll give you this article on stillbirth if you want to put it in the show notes – your risks do increase as your pregnancy progresses. With stillbirth, those numbers do go up for people of all sizes, so I don’t want someone to say, “I heard on Real Health podcast I only have a 0.7% stillbirth risk.” That’s earlier on during your pregnancy. You can definitely read it.
But the point of it all, and I’ll link to the study as well – the study is linked in the article – the point is exactly everything that you just said and that I’ve heard from a lot of people, that they are told on their first prenatal visit that they need to have a cesarean birth based only upon their BMI.
There is nothing put out there by ACOG, which sets the standards and guidelines for maternity care, that says someone with a high BMI should have a cesarean birth based only upon their BMI. There is plenty of evidence and research to show that a caesarean birth is not the ideal outcome for a person of size, and there are much greater increased risks during surgery and postpartum.
So I firmly believe, and I’m thankful there are studies now to show, that care provider bias does play a role in how people of size are treated. There’s one study that shows that more than 50% of physicians view obese patients as “awkward, unattractive, ugly, and noncompliant.” 74% of medical students in another study exhibited implicit weight bias, explicit attitudes that were more negative towards obese people. Another one showed the majority of registered nurses and nursing students believed that fat people “liked food and overate and were shapeless, slow, and unattractive.”
These things are so – it hurts to hear. But now these studies show all these things that people of size have been saying forever and are now backed up in stories, so now we’re having classes where medical care providers are taught how to treat people of size with compassion. I’m glad it’s happening, but it’s 2020. [laughs] Oh my gosh.
00:50:25
Lu Uhrich: Yeah, absolutely. That gets into the question that I had earlier that you were like, “oh, we’ll get to this.” Hearing that, hearing all of these statistics and outcomes of the way that people in the medical community feel towards individuals in larger bodies, I can’t personally look at any statistic, any outcome around the number of cesarean births, gestational diabetes, some of these other risks, and go “Oh yeah, that risk is definitely based on body size and weight, then,” because clearly, in any of these experiences with the medical community, there’s stigma and oppression happening. So how could I differentiate “is this really about your body size or is this about the bigotry of the communities you’re in?”
Jen McLellan: Right, and that’s why I focus on – let’s focus on how to be healthy throughout our pregnancy, and let’s focus on connecting with a size-friendly care provider, because if we’re doing those things, we’re helping to reduce our risks no matter what they are, no matter what the percentage is.
How I define a size-friendly care provider is someone who provides evidence-based compassionate care. I have a list of things that I define that as, and I can read them off for you.
When I was at that nursing conference recently, it was a room of just over 100 labor and delivery nurses, so I read this – I’ll read it to you – I read this to them, and it’s on a slide and it’s short, and then I asked them, if they self-identified as a size-friendly care provider, to raise their hands.
Let me read this to you. A size-friendly care provider is compassionate; aware of their personal biases; provides individualized care; no high-risk classification based only upon BMI; does not make assumptions about nutritional or physical activity by the way someone looks; and treats patients with dignity.
I don’t think it’s too much to ask for any care provider to say, “Yes, I raise my hand to all of those things on this list,” right? It was shocking to me that under 20 people raised their hands. The majority of the room did not raise their hands. It totally took me off guard, because I wasn’t prepared for that, naïvely. [laughs] Even after doing this work for almost 9 years, I was not prepared for that.
So it’s really important to me that I then go through the list of all the larger equipment. I always start this conversation about what it is like to be size-inclusive by using the very clear and easy example of a chair without arms. If you walk into a lobby, or let’s say, Lu, you, existing in a smaller body, walk into a restaurant. You know that you can literally sit anywhere, most often. You are an able-bodied person. You can sit in most chairs.
I, however, cannot. Existing in a larger body, I navigate the world differently. When I walk into a healthcare provider’s office and all the chairs have arms, it is very likely that I don’t have somewhere comfortable to sit. What that says to me is I’m not welcome here.
I want this to be heard for not only practitioners listening, but if you have friends that exist in larger bodies and you go to a restaurant with them, if you arrive earlier, don’t pick a small booth. Watch out for chairs without arms. Nearly all restaurants have one that they keep in the back, just in case. Just be mindful that people in larger bodies exist in the world a little bit different. If you just show an ounce of compassion, it can change how someone feels about their body and how they feel they have access to healthcare, they have access to go out in public and be treated with dignity. It is such a small thing that cuts so deep and goes so far.
Lu Uhrich: Absolutely. I know there are apps out there – I’m actually looking, hoping, fingers crossed, to interview one of the creators of the AllGo app, which is right now based in Washington and it’s about restaurants specifically, like you said. It’s for people in larger bodies to be able to communicate with each other, sort of like Yelp reviews but for restaurants and spaces especially – are they designed for, is their staff aware of, compassionate, kind, are they giving as much credence and attention to people in larger bodies as they are to people in smaller bodies in terms of the way that their restaurant is designed, the way that the facility looks and feels and accommodates people?
I think that’s so important. I’d love to see an app like that for all the things, for medical offices and for other places and public spaces as well.
Jen McLellan: Yep, Rebecca. She’s coming on my show on Thursday. We’re recording, and I will connect you to her, Lu, because she is doing incredible work, her team is. I know it’s still in beta, and like you said, it’s just in those two states, but I definitely foresee it going everywhere. And it needs to.
Even Roxane Gay was coming to speak in Santa Fe and I really wanted to see her, but I knew it was at a very, very old theatre, a historical building, and I just knew that the theatre seats in really old theatres are not accommodating to people of size. Was I going to miss seeing an author who I deeply admire? No. Did I need to call ahead and make seating arrangements for myself? Yes. Did I show up and they didn’t have it all noted and I had to advocate for myself in that moment? Yes.
But I did it, and I got to see her, and it was harder and it was embarrassing, but I did it. And that’s a lot of the work that I do on Plus Mommy and the Plus Mommy Podcast. How do we navigate the world in a larger body, and how do we as plus size moms and all that comes with that, and parents? And also, how do we unpack years of diet culture and just focus on intuitive eating and moving because we love our bodies?
All of this stemmed from my pregnancy. So yes, my mom was right. I’ll have to call her, Lu, after the show and thank her again and tell her she was right, it was a gift what happened, that catapulted my work.
But ultimately, going back to the size-friendly care provider, I just think that it’s so, so important that we as people of any size – any size – find the very best care providers for ourselves. You do it for your kids, right? If you’re a parent, you research the heck out of your pediatrician. Did you do the same for your doctor? Ask yourself that question. It is so important.
00:57:40
Lu Uhrich: You mentioned the seating, which is something you can walk right into a waiting room and see. One of the first things, you walk in the doors of a new medical facility, you can see, “Is there a place for me?” What other indicators to people have when they walk into a place? They’re pregnant, they’re excited, they want to get proper care and treatment for their pregnancy; are there other clues they can pick up on that they are, indeed, at a size-friendly provider?
Jen McLellan: Yeah, and on my website – I’ll give a little shout out – I have a free guide on how to connect with a size-friendly care provider. It’s the signup for my newsletter on PlusSizeBirth.com. But just a few things from that that I can share.
It starts even before you show up in that lobby. It starts with researching the care provider. Back in the day – still today, but internet dating, if you were dating before you got pregnant and scoping out someone online, you googled the heck out of them. Google your prospective care provider. Read reviews. Read for anything that shows signs that they might not be size-inclusive.
Ask people in your community. If you are newly pregnant or trying to get pregnant, join local Facebook groups. That’s such a wealth of information there. And if you feel comfortable saying, “Hey, I’m plus size and I’m looking for a size-friendly care provider. I just found out I’m pregnant,” it’ll be so interesting for you to read who’s recommended, who’s not recommended.
Doulas are the gatekeepers to their community. They know which care providers are the best for VBAC, which is vaginal birth after cesarean, locally. They’ll know who you should go to. They’re also becoming a lot more educated about size-friendly care providers, and I have a resource list of size-inclusive doulas. Doulas are knowing to keep an eye out for these things.
So I think the research piece before you even show up in a doctor’s office is so incredibly important. I think it’s important to research the midwifery model of care and the obstetric model of care, and then you decide what’s best for you.
But once you’ve narrowed down that list – and obviously, we have restrictions with medical insurance as well or what access you have to healthcare – then when you show up, look at that lobby. How are you treated by the front desk staff? That’s so important. It starts there.
When you’re taken back, the first thing we do is get weighed. How do you feel about that? You are a mentally competent adult. You have every right to not do whatever you don’t want to do during pregnancy or not during pregnancy in healthcare. I don’t think we realize that we have the ability to say no. We have the ability to fire our doctor. We are owed informed consent on everything, and informed consent isn’t just saying “Yes, I approve this procedure.” It is you understanding all the pros and cons of the procedure and consenting to that.
For something as simple as getting on a scale, if weight is triggering to you, then you can say, “I’m going to stand backwards. Please don’t say the number.” “I weighed at home. Here’s my number. I’m not going to stand on the scale.” Or you simply say, “I don’t want to be weighed.” Will you get some pushback from that? Absolutely. Will you take the time to be open-minded to why they want you to be weighed? I think that’s so important. Weight is one measurement that we are so stigmatized to, and I understand that, and you certainly don’t need to get weighed if you sprained your thumb and are going in for that. [laughs]
But during pregnancy, it is helpful because they’re able to look for any red flags if your weight dramatically increases or decreases. So I’m going to advocate for it for you if you feel comfortable getting weighed, but you don’t have to see the number. You don’t have to be told the number. Stand on that scale backwards with no shame. I will cheer you on. So that’s really important.
Another thing that is so critically important is the correct size blood pressure cuff. If your medical facility or home birth midwife does not have a large adult size cuff that’s being used, if you have larger arms, then run. Do not have your blood pressure taken by a cuff that doesn’t fit your body because you will get an inaccurate reading, and you will be told that you have high blood pressure. There are countless stories of people being put on medication that didn’t need it just from the wrong size cuff being used.
If you have to undress, do you have a sheet or do you have a gown that fits your body? This is so incredibly important because when you feel covered, that gives you your dignity. It makes you feel comfortable. It makes you feel able to advocate for yourself and ask questions. But when we are literally naked and not covered, we are so vulnerable.
All of these things are so important. And when you get into the room, is there a chair without arms in the room? This isn’t just about the lobby. Can you sit comfortably in that exam room, where you don’t necessarily have to sit on the exam table? Because the exam table is another place where we feel vulnerable. You can’t always feel completely comfortable advocating for yourself when you’re sitting there versus sitting on a chair, where you’re more eye level with your care provider.
The body language your care provider uses when they touch your body, when they’re talking to you. How do they make you feel? One question that I always encourage people to ask is, “What is your experience working with people of size? Do you have any specific guidelines during my pregnancy that I need to be aware of now?” That will give you a clear indication of if they’re telling you you’re going to be tested monthly for gestational diabetes when we know that people of size should just be tested in the beginning of pregnancy – and what they’re looking for there is to see if you’re already pre-diabetic or diabetic – and then when everyone later on in pregnancy is tested. That’s the norm. That is what ACOG says. But if you’re being tested more than that, that might be a red flag.
Sorry, I could keep talking on and on, so I should stop. But ultimately, listen to your intuition. What is your gut telling you about all of this? And do not feel afraid to get a second opinion or to switch care providers. You would do it for your kids; do it for yourself.
01:04:30
Lu Uhrich: I really appreciate that advice, and I thank you for being thorough because these are really important things for people to hear who are in bodies of size, who are experiencing prenatal care and going through that.
But I also think it’s important for those of us who aren’t, whether we’re not at the place of or desiring to be pregnant, whether we’re not in a larger body, whether we’re practitioners or we work in a medical community – I think this is so important to hear and be aware of too. At the end of the day – and I’ll say this on every single podcast episode I host; people might get tired of me – but at the end of the day, it is not people in larger bodies who are responsible for creating safe spaces and communities for themselves.
I’m so glad that you are advising people to advocate for themselves. I think it’s so important because they are worthy of that. We all are worthy of advocating for ourselves. But at the same time, hearing this is hopefully giving information and insight to everybody so that they want to create safer spaces and they want to call out when a space isn’t safe, and they might be able to speak up for and advocate for their sister, if they’re accompanying them at a prenatal visit, or their partner or their friend.
These are like micro-aggressions that happen all the time towards people in larger bodies that just go unspoken and un-thought about so often.
Jen McLellan: Thank you. Thank you for what you said and what you do. We need thin allies and we need people – it’s not that much to ask for, right? It really, at the end of the day, isn’t. I think we have this misconception about what plus size pregnancy is, and people think it’s people who exist in much larger bodies like I did, or all these sensationalized TV shows on TLC that make me cringe.
But when we look at the statistics, 60% of women in their childbearing years are classified as overweight or obese. So we’re really looking at the majority, and we need to be cognizant of that and be aware of that in our work. Instead of thinking of it as “there’s this crisis,” it’s like, no, we need to slow down, take a deep breath, and start treating people – treating teenagers. My God, if I had been touched by a care provider with compassion when I was 16, I can only imagine how that would’ve changed my relationship with my body back then compared to when I was 30.
So we need to be really focusing in on evidence-based compassionate care versus scaring people into making choices and decisions that aren’t necessarily in the best interest of their health, physically and emotionally.
Lu Uhrich: For sure, and I appreciated your advice too about informed consent, and it’s always okay to ask why, and your practitioner or your doctor should have an answer for you that sits well. If it’s “Why do I need to step on the scale today?” “Because we’re administering a medication that’s weight-based” or “Because we want to make sure that you haven’t had any major changes or shifts in weight that could be indicative of other conditions.” “Okay, great. If I don’t have those, don’t tell me.”
That’s a much more informed, peaceful experience than just being thrown on a scale and someone shouting a number at you and really not having context for it, but maybe hearing a tone of voice – or, like you said, just not having that compassion that you talked about.
What you said also is so true. Yes, we always have to talk about opportunity and access and availability of care, but when and if it’s possible, these people work for you. That’s something I try to tell my clients all the time. Your doctor works for you. They should answer to you. They should be available for your questions, and they should be able to explain what they’re doing and why they’re doing it. They should be able to tell you specifically why they made the choices they have, and what other choices are available to them and to you. All of that. That’s a part of their job.
Jen McLellan: Yes. We forget that we’re paying for this service. [laughs]
01:08:45
I would love to share a resource on how to get informed consent, how to really know if this is something that you want or need. Obviously when we are giving birth, there are sometimes emergent situations where care providers don’t have time to give informed consent. “This is an emergency. You need to have a cesarean right this minute.” There are those times that happen.
But more often than not, there is pause. There is time for you to really decide if you want to be induced or not, if an induction recommendation is being made, if you want Pitocin or not. There are so many times during labor and birth where we actually have a lot more opportunity to ask questions as opposed to just say yes.
This acronym is not only for those who are pregnant; it is definitely for something that I’m using for the rest of my life, and I hope others will too because it really helps you to understand what you are consenting to and what your options are.
It’s a childbirth educator’s best friend. It’s called the BRAIN acronym. It’s BRAIN. I can send you this meme, this image I have, too, if you’d like. Or you can find it online. Childbirth educators love it. So here we go.
B: What are the Benefits?
R: What are the Risks?
A: What are the Alternatives?
I: Always listen to your Intuition.
N: What happens Next, or if we do Nothing?
If you’re being faced with a decision around your healthcare. Let’s say even you’re not pregnant and a care provider is recommending major surgery. Pull out this list of questions and sit there and be like, “What are the benefits? What are the risks? What are the alternatives?”, listening to your intuition the entire time, and then “What happens next or if we do nothing?” Then you are given full informed consent to make that decision. That is so much different than being handed a piece of paper, being told what they’re recommending, and you signing away.
Lu Uhrich: I love that. I’m going to use it now for myself and for others. That’s perfect, and so succinctly shares what informed consent really is and should be.
Jen McLellan: Yeah. Use it for kids, too. This is something we can use for our whole lives in medical care, and I think it’s such a handy tool. Just use your BRAIN.
01:11:25
Lu Uhrich: Thank you. I love that. If we make a shift from the medical side of pregnancy and postpartum to the social or cultural side, there’s still a big gap there. There’s still a need for representation. When I think about things like breast pumps or baby carriers or so many things that, based on your body size or your ability status, there aren’t necessarily tools created for everyone, clothing created for everyone. What other hurdles are there in being a plus size woman in a pregnant body outside of the medical community?
Jen McLellan: Oh yeah. If you don’t even have access to maternity clothes that fit you, then you clearly get the message that you shouldn’t be pregnant, which is so far from the truth. It’s such a shocking reality when you go online and realize how limited the options are around maternity clothes. Really the only in-store experience you can have, which still only goes up to a 3XL, is Motherhood Maternity. I know Walmart has some options, Target goes up to 2XL. The options are really, really limited.
Thankfully, there’s more online stories, but there is something about being able to walk into a maternity store and see other people pregnant and shopping. It is so disheartening to walk into Motherhood Maternity and have to walk all the way back to the one tiny rack that has 1X, 2X, and 3X, and that’s it. It is so frustrating, and it was just as frustrating when I was pregnant in 2010 as it is today.
Thankfully we have a lot more online resources. I of course have a ton on PlusSizeBirth.com. Etsy is awesome, a wonderful place to find gorgeous plus size maternity gowns.
That leads me into saying that maternity photographs of people of size were something that I could not find, hardly any, when I was pregnant. So I never thought that I could take pictures or should take very many pictures. Obviously, I have some selfies – although back then, it was flip phones, so my selfie quality is pretty sad. [laughs] My husband took a few pictures of me, but I have a handful and that’s it.
I’m so thankful that social media has really changed the landscape of pregnancy for people of all sizes. I do something pretty powerful when I talk at birth professional conferences. I have these screenshots of pregnancy magazines, and they’re all thin Caucasian women. So I say, “Did you know that only thin Caucasian women get pregnant?”
Everyone laughs, and then I unpack how wrong that is that people of all sizes, colors, abilities, people who have bellies that don’t look like this traditional “D” – and very often when you are plus size and pregnant, you have a belly that looks more like a “B” than a “D.” The most popular article on my website is “What’s a ‘B’ Belly?” because no one had talked about it. There wasn’t an article on that, and yet I had a “B” belly, so maybe people I know have a “B” belly.
It’s just normalizing these experiences. When we see images of people who look like us pregnant, it really starts to shift and help us to realize that “Oh, I can look this way too.” And even if you don’t look pregnant until the very end or maybe don’t ever look pregnant, there are some wonderfully skilled photographers that can help you have these gorgeous maternity photoshoots that you maybe didn’t think you had access to until you saw someone else in that photo. I think those things are so, so important.
You said breast pumps. It’s really the phalange that’s more important than the actual pump, so just knowing that, and knowing that people of size have lower outcomes of breastfeeding numbers, and I think bias plays a role in that. I’ve heard from people and had my own experience because I have large breasts – again, not everyone of size has large breasts and all these assumptions that are made – but I heard, “Be careful that you’re not smothering your baby.” When you hear something like that, it makes you terrified every time you nurse.
We do know from studies that the best thing to really help people of size, but of any size, with improving breastfeeding outcomes is to connect with an IBCLC. They’re the highest level of certification for getting breastfeeding support with a lactation counselor, and I think that is so important. I fully regret not getting that support when I was having my own struggles, so I encourage everyone. It is worth the money, because you will spend more money than you ever thought possible with formula.
But I want to be clear, as someone that did become a formula feeding mom, there’s no shame in that either. You do what you have to do in the best capabilities that you can, but I just want you to know that there are resources out there that I didn’t realize I should be tapping into. So I have plenty of stuff around plus size breastfeeding as well.
But yeah, baby wearing has gotten better because there’s a lot of women in the baby carrier industry that are like, “Um, carriers should be size-inclusive from the bat.” So carriers like Ergo and Tula and many wraps are actually size-inclusive, and I have a great list. So thankfully that.
But the clothing industry in and of itself is finally catching on that plus size people have money and we want to spend it on clothes, and this is just now happening way outside of maternity clothes. I know maternity clothes will get there and we’ll catch up, finally, but we’re not quite there yet.
Lu Uhrich: Thanks for sharing all of that. The photography side of it and seeing plus size women throughout their pregnancy is something I still don’t really see a lot, unless it’s on your website or your Instagram account or shared in other pregnancy spaces. I am seeing a little bit more of it. But besides Ashley Graham and Tess Holliday, I don’t think that anybody has gotten – if we’re thinking of magazines and articles and cover stories, I can’t really think of anyone besides, like you said – can you imagine? – “only thin white women can get pregnant.” That’s what we see, day in and day out, in these publications.
Jen McLellan: I’m kicking myself because I can’t remember her name, but she is that awesome actress in Orange Is the New Black that just had her baby, and she’s a woman of color and she was really bold and outspoken about her pregnancy and frustrations. I remember her name on the show, but I don’t want to say her wrong name. I have to look it up. But she has definitely been wonderfully outspoken. She has her baby now.
But yeah, it is really limited. I will say I’m very happy that the hashtag #plussizepregnancy has reached almost 50,000 images being shared. I think that that’s incredible. There’s a stigma to even identifying as existing in a larger body. It took me a very long time to be okay saying I’m a fat woman. So even if people exist in a larger body and take photos, they’re not necessarily hashtagging themselves as plus size.
I think there’s a lot more imagery out there than we realize, but I’m not seeing as many online magazines and print magazines embracing people of size. It’s starting. The shift is happening, finally, but it has been a very, very long, long fight to get to even where we are at now.
I’ve been fortunate enough that I’ve written articles for Today’s Parent and Lamaze and CafeMom and so many that I’ve really worked to put myself out there and help to start to change that narrative. I was recently featured last year in 2019 in Glamour Magazine about being a plus size mom. That was something that was shocking to me. I was like, “Me? Wait, Glamour Magazine? Am I being punk’d?” [laughs]
I never imagined myself in Glamour Magazine because that’s a space where I thought fat people didn’t exist. But they did this whole big exposé, almost, on being a person of size, from fashion to motherhood to everything, and talking about how we need to be inclusive. It was like, wow, it’s finally happening. Because there’s just so much shame when you don’t see yourself, and it only continues to perpetuate the negativity that I thought I had to feel about my body until I was able to see people embracing and loving themselves at any size.
Lu Uhrich: That’s where I was going to go next. It’s Danielle Brooks.
Jen McLellan: Yes, Danielle Brooks.
Lu Uhrich: That’s the actress on Orange Is the New Black. I’m actually looking at her Instagram now, with all of her beautiful shots of her pregnant body.
01:21:15
I was going to ask you: what’s the outcome, then, and the implications of not being represented in these spaces, whether it’s clothing or photography. You started talking about that, but I’d love to hear more. What does that mean, then, for plus size pregnant women?
Jen McLellan: When you don’t see yourself represented, when you don’t see yourself included, you immediately think there’s something wrong with your body, that there’s something wrong with yourself, that you don’t have access to things that other people do. Then it’s so easy to believe the messages that you cannot have a healthy outcome. So then you don’t fight for healthy behaviors that will only help you have a better outcome during your pregnancy.
I’ve heard so much of then they get tied back into emotional eating and dieting, and I hear incredibly self-destructive things, like people being told “I don’t want you to gain any weight during pregnancy,” so then people just stop eating.
I just interviewed someone for my podcast recently who did that. Her doctor said, “You should probably stay away from carbs.” Don’t ever tell a pregnant person to stay away from carbs. There’s such a difference between “Hey, we’re seeing some significant weight gain. I’d love it if you felt comfortable talking about nutrition. Can you journal what you’re eating?” Pros and cons there. That can be triggering for people with disordered eating.
But really looking at nutrition and making recommendations – highly recommend connecting with a size-friendly nutritionist. Working with a nutritionist during pregnancy can be wonderful, and it’s actually a recommendation that ACOG has for people of size, to work with a nutritionist. There’s such a difference between working with a nutritionist to help you even probably eat more than you ever realized you needed to be eating, helping you actually eat, than starving yourself or really making self-destructive choices because you are coming from that place of shame and belief that there’s something wrong with you.
Lu Uhrich: Just the idea that this pregnancy and this choice in one’s life isn’t embraced, or isn’t embraced in the same way as people in more privileged bodies, I think is just so gut-wrenching for me to consider, because it’s for many a really magical, and for some a long-awaited time in their life. Not for everyone, but for many people it is.
You had mentioned earlier in this interview, thanks to the comments section, being concern trolled and people telling you how awful you are if you’re in a larger body and you’re pregnant. Those sort of things are just so unlovely, and not how you want to feel when you’re doing this new thing in your body and carrying a new life along with it.
Jen McLellan: Oh yeah, absolutely. And it isn’t just the concern trolls online. It’s your mother-in-law, it’s your best friend, making comments that can be very hurtful. I hear often assumptions about gestational diabetes and “When are you going to get it?” It’s just this idea of the minute you get pregnant and exist in a larger body, you don’t exist, you can’t have a healthy outcome, you can’t embrace your body, there’s not a place for you. It’s so destructive.
That’s why it was so important to me from the beginning to show images of people who didn’t just look like me plus size and pregnant, but people of color and people in LGBTQ communities. So many different stories that it has been important for me to share because I’ve always wanted anyone who exists in a larger body who got pregnant to find themselves and to know that they’re not alone.
You feel so alone. It does take, often, for people of size, longer to show, longer to start feeling movement. If you come to pregnancy already having a belly, you’re going to measure ahead during your pregnancy at all times. But those things aren’t talked about, and they’re not normalized.
Just know that this is your experience, and it’s okay. There are people who exist in very small bodies, and they have a different pregnancy. It looks different for them too. But that’s okay as well. You’re pregnant. Now’s the time to tap into and love your body like never before. I think now’s the time to really focus not only on your physical health, but your emotional health and your mental health. That is so important.
We talk now a lot about postpartum depression, and I’m so glad, and that’s so incredibly important. But we don’t talk about depression during pregnancy, we don’t talk about anxiety during pregnancy, and all these things that you’re afraid to see a therapist or you’re afraid to get help when you’re pregnant. You shouldn’t be afraid because asking for help is a sign of strength. It’s really important that we talk about these things far more often, and when you don’t feel that you’re represented and you feel that you’re being shamed, it can only elevate all these things that you’re concerned about and further depression as well.
So it’s really important that you know that there are outstanding resources out there, like Postpartum.net. Yes, postpartum is the focus of their work, but they also have so many mental health resources around pregnancy as well.
01:26:50
Lu Uhrich: I think that aspect is so important – we talked about it earlier – because those experiences that we’re having in our minds and in our emotions as we’re going through pregnancy also affect the physical aspects of it. Our physical health.
They can affect the physical health of our pregnancy in a way that – what we don’t want and we don’t need any more of is this idea that “it’s because of your weight that there’s these risks or that these things are happening.” It very well could be because of stress, and there’s a lot of stress involved, like you said, in feeling, from the onset in these situations, othered and unwelcome or not represented. I’m so glad that you’re taking about that, because the mental health aspect is really important the whole way through, and even during trying to conceive. We’ve kind of talked about it all.
Jen McLellan: I was going to say a quick, easy example I remember. I was about 6 months pregnant and I was walking around the grocery store, grocery shopping, and I was just rubbing my belly like I liked to do, pregnant. I just remember I was in the produce section and I stopped for a minute and it hit me, like: I’m a person of size walking around rubbing my belly. People probably think I’m hungry, but no one knows I’m pregnant. It felt really isolating.
And here I was doing water aerobics with a friend that existed in a very thin body, and everyone was doting on her. Everyone wanted to touch her belly, and no one, not a single person, asked to touch mine. That was really hard. I haven’t told that story in a while. That was really hard.
And everyone – not every single person, but so many people were complimenting me on my weight loss because my body did change while I was pregnant. So that was just reinforcing other messages that weren’t healthy. It was like, “Oh, you’ve lost so much weight.” I’m like, “No, I’m pregnant. My weight is shifting, my body is shifting.” Yes, I did lose some during pregnancy, but it was because I was loving on and treating my body unlike I ever had before.
It’s just so important for people listening, if you have someone you know who’s pregnant and exists in a larger body, ask them – don’t do it without asking, but ask them, “Can I touch your bump? Can I touch your belly?” Because when you exist in a larger body, you so often feel invisible in that experience. You want to have annoying strangers want to touch – not everyone, but I did. I wanted to have people acknowledge that I was pregnant too, and I was glowing and I was beautiful. I wanted that, and I didn’t really have that except for from my friends and family and loving coworkers.
So yeah, it plays a lot into your mental health, which can impact your physical health as well, for sure.
Lu Uhrich: You’ve brought this up a few times from the point of doctors and the difference in their level of compassionate touch based on BMI and body size, and elsewhere, as you then worked with your doula and midwives. And here again, just acknowledging a bump and saying, “Hey, can I touch your baby bump?”
There’s this thread of – it’s called skin hunger, this idea of people in larger bodies not being touched and not having that connection, whether it’s because of things like the bias in the medical community or because our culture is set up not to be inviting and welcoming in other places where maybe we’re less likely in larger bodies to get a massage or get a pedicure or have these experiences where our bodies are being compassionately touched. So then on these occasions, wow, that would truly feel so isolating.
Jen McLellan: Yeah, it does. It does. So yes, touch all the bumps with permission. [laughs] It’s so important.
01:31:00
Lu Uhrich: We’re getting close to the end, and I want to be respectful of your time, but I’m wondering as we’re wrapping all of this up and we’ve talked about the medical side and also the cultural and social side of what it means to be a plus size pregnant person and to have these experiences, what’s the one thing you’d want to leave with the Real Health Radio audience? Is there one thing you want us to know, something we haven’t yet touched on, or something you want to further drive home about being a plus size mommy?
Jen McLellan: It’s my biggest soapbox, which is why we talk about it so much, and there are a million different things that I can say, but I will continue to push and drive this home, any opportunity I have: you owe it to yourself to connect with a size-friendly care provider, not just during pregnancy.
I’m struggling with it now. I am continuously trying to find a doctor that doesn’t mention weight loss surgery before they touch my body. That has happened twice now. It is so hard. I know. I sympathize with it. I’m there. But you really owe it to yourself – and I don’t care what size you are. You owe it to yourself to work with a care provider that practices evidence-based compassionate care and that makes you feel good about yourself, and more importantly makes you feel comfortable enough to address your healthcare concerns.
Do not put off or stop going to the doctor because you’ve been shamed. I’ve been there. I was training for a 5k. I had just done a 5k and was getting over having strep throat, and I had to get in to get an inhaler to help me breathe again, and I couldn’t get in to my regular doctor, so I saw this person that was just like, “Maybe you’re just so big that you need to be on oxygen.” If she had just taken 3 minutes to look at my chart, that I got cleared to do a 5k – the result from that is that I didn’t see a doctor for almost 2 years, and I gained 60 pounds. And I knew the statistics, but I let it destroy me.
So I just really, really want to drive home all these messages of advocating for yourself, but also, if you exist in a smaller body, like Lu said, look out for people of size. Be inclusive of people of size, from having chairs without arms to – I don’t care who you’re parked next to in a parking lot, don’t park on top of another car because the person might not be able to get in and out of their car comfortably because of these tight parking spaces with bigger cars.
Just be mindful of all of these things that help people of all sizes to walk through the world with confidence. A level of feeling accepted can change people’s lives.
Lu Uhrich: Thank you for that great advice. I’m wondering now, what’s your hope for the future of plus size pregnancy? If you could wave a magic wand and get it all, what would you like to see?
Jen McLellan: That I’m out of business. That Plus Size Birth is no longer needed, that that site doesn’t need to exist. That everyone is treated with compassion and dignity. That every single store that carries maternity clothes carries them well beyond a 3XL. That I don’t need to be around.
And thankfully, I’ve seen some of that shifting, especially with Instagram and images. But like you, Lu, pointed out, you don’t exist in the same bubbles I do, and you don’t see people of size represented as much as I do. So that was good for me to hear as well.
But my ultimate goal is to no longer be needed. I would love that. I’d have to find something else, but I would love for there to be a day and time when I’m no longer needed, when my work and my voice is no longer needed.
Lu Uhrich: I had a feeling you were going to say that. I’m like, I know I’m going to ask this question and Jen’s going to say that it’s just “pregnant,” that it’s just “birth,” that we don’t have to tack the “plus size” onto it and we don’t have to have these specific spaces where pregnancy is embraced for all bodies, but that it’s embraced for all bodies everywhere.
Jen McLellan: All bodies, all colors, all identities. Not everyone who gets pregnant identifies as a woman. Just pregnant bodies. Be inclusive of them and provide people with the medical care they need, the clothing they need to be pregnant in comfortably and to embrace their body – the clothing they need, if they are nursing, to chestfeed or breastfeed their baby. It’s so hard to find maternity nursing bras. All of these little nuances that people don’t think of where we have a huge market of people ready and willing to spend so much money for these products.
So yeah, I hope that it just becomes pregnancy, and I hope that by doing that, we can change the cesarean birth rate for people of all sizes. There’s so much. There’s so much work that needs to be done.
Lu Uhrich: Totally. But I’m with you. That’s what I always say. I’d like to be out of a job. I hope my clients – I love them, and they can come back as long as they need me, but I’m always like, “My whole point here is that you never have to come back.”
Jen McLellan: Yeah.
01:36:25
Lu Uhrich: I totally get that. But for now, we’re here, we’re doing this work, and you have a Plus Size Pregnancy Guide. I’d love for you to share a little bit about it and tell our listeners where they can get their hands on it, because what you have to share and offer is so valuable and so necessary right now that I’d love for them to have that access.
Jen McLellan: Thank you so much. I wrote the book on anything and everything to know about being plus size and pregnant. I just stuck to pregnancy, so it doesn’t even go beyond, because there was so much that isn’t talked about in regular pregnancy books.
It’s a lot of the things that we’ve covered here, but in way more depth – where to find maternity clothes, encouragement for having pictures taken, tips for connecting with a photographer that’s size-inclusive, nutrition, physical activity, and all your increased risks, but more importantly, how you reduce your increased risks, and things to look out for. And it’s all written in that compassionate, evidence-based, positive information that I so hungered for.
Give me the facts, give me the information, but give it to me in a way that makes me feel empowered. And connecting with a size-friendly care provider, knowing that it’s not just the care provider; it’s also where you choose to give birth. That’s so important. Doulas, all of that information.
You can find it on PlusSizeBirth.com. There’s the My Plus Size Pregnancy Guide, and then since I’m a podcaster now and launched a podcast 2 years ago, I have all this great audio equipment, so I also turned the book into an audiobook. So you can get the audiobook version that comes with the guide as well.
Lu Uhrich: That’s perfect. Yes, tell us a little bit about your podcast and about where else on social media and online listeners can get in touch with you or learn more from you, because I’m sure there’s going to be a lot of people who want to get more.
Jen McLellan: Thank you. My kid, like I said, is 9 now. We never did end up having that other child. I realized, while I love plus size pregnancy and I will always be working on Plus Size Birth – hopefully not always, but at least for probably the next couple decades – there’s so much more that I’ve identified as a person of size. Flying while fat, getting healthcare, talking about other issues that aren’t always talked about of being larger. Like you said, massages, or I have a whole podcast episode on getting a Brazilian wax as a person of size or getting any type of waxing or those services.
I wanted to start talking about plus size lifestyle, so I launched the Plus Mommy Podcast, which has been this wonderful adventure, and I get to connect with and interview powerhouses in these spaces. That has been a wonderful journey.
You can find anything related to plus size and trying to conceive, pregnancy, and postpartum over on Plus Size Birth, and then I have the Plus Size Birth Facebook and the Instagram that I’m working really hard to grow larger. But all the more fluffy, body love, body empowerment messages are found, and where my major followings are, over on Plus Mommy. The Plus Mommy Facebook is at like 178,000 and the Plus Mommy Instagram is at 25,000. So you will know that you are not alone, and I talk about it all. [laughs]
Lu Uhrich: Thank you. We’ll make sure all of those links plus the other things that we’ve talked about here in this interview are all in our show notes so listeners can find them there, and then go and say hello to Jen, because it sounds like you have a great community already built there, ready and waiting for people to come and join.
Jen, thank you so much for joining me on Real Health Radio. It was wonderful to chat with you, and I look forward to connecting again soon.
Jen McLellan: Thank you so much for this opportunity, and truly, thank you for the work that you do. I appreciate you.
Lu Uhrich: Thank you.
01:40:30
That’s it for this week’s episode. I hope you enjoyed it. Before I say goodbye, I want to leave you with a recommendation. This time, it’s a movie. I’m going to stray from my typical love of documentaries, books, and podcasts here and give a shout out to Adrift.
I guess it’s not straying too far away from a documentary because it is based on a true story, but Adrift, which is currently streaming on Showtime right now – I’m watching it for free; Showtime is giving away their service in the midst of this pandemic, so if you’re listening and at the time of listening you can hop on that train and get some free Showtime, do it.
But again, Adrift is based on a true story. It’s the story of Tami Oldham, who’s played by Shailene Woodley, and Richard Sharp, played by Sam Claflin – who I love – and the two of them fall in love and determine to sail around the world, though they couldn’t anticipate that they would be sailing directly into one of the most catastrophic hurricanes of history.
I don’t want to give the story away because it definitely kept my interest (and also gave me a borderline state of panic for the entire 2 hours-ish that I was watching), but in the wake of the storm and with no hope of rescue, Tami has to find the strength and determination to save herself and Richard.
If you’ve got a few hours to spare and appreciate a good “based on a true story” type of movie with awesome effects and two of my favorite actors, then check it out. I swooned, I laughed, I cried. Hopefully you’ll feel all the feelings too. And if this doesn’t sound like your thing, then skip it – but maybe don’t skip the free Showtime offer if that’s still happening. Watch something you enjoy and then meet us back here next week for another great episode of Real Health Radio.
Until then, you can find us at seven-health.com/, and the show notes to this specific episode can be found at seven-health.com/195.
As I mentioned at the start of this episode, Seven Health is here for you and continuing to take on new clients. If you’re interested in working together to heal your relationship with food, body, and yourself, or if you simply want to find out more, head over to seven-health.com/help and apply for a free initial chat with us there. Have a great week!
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