Fatphobia in midwifery care.

I went to a midwifery study morning on obesity recently, (ie how to improve care for obese people receiving midwifery care) and I got a lot of good stuff out of it. I also (unsurprisingly, despite desperately hoping I wouldn’t) had to listen to a load of fatphobia.

So, obesity is the term applied when a person has a BMI of over 30. Personally, I think BMI is such a blunt tool as to be almost useless, I think the word “obesity” has a load of stigma attached to it and I think the move to classify obesity as a disease pathologies those of us with fat bodies. As a fat woman active in fat positive and body acceptance circles, I prefer to talk about “fatness” but unfortunately in clinical midwifery settings the preferred term practitioners use to describe our bodies is obese, so there you go.

The day was generally informative and not too problematic. There was really interesting stuff like how to support obese women with breastfeeding, and a round up of the latest research and evidence into care of obese women in pregnancy. But there was one speaker who, whilst she was undoubtedly incredibly knowledgeable in her field (how to reduce risks in pregnancy for women with elevated BMIs) – had filled her presentation with so much casual fatphobia that it undermined my confidence in her ability to give good care to people of size.

So what was it she did? Whilst setting the scene for her topic, she included a headless fatty slide in her presentation. There was no text, just a full screen picture of the torso of a fat person, to provide a thematic backdrop to her talking about obesity. It was on screen for minute or so for us to look at whilst she talked. These type of photos anger me because they completely dehumanise fat bodies, and are used without the consent or knowledge of the subject to illustrate presentations and articles that further dehumanise fat people. They are crass and add nothing, other than making me look out for further fatphobia.

She then went on to outline a case study of giving care for a woman who weighed around 20 stone, which would have been an excellent format to convey her information, as we were able to follow the woman from the case study through the antenatal, intrapartum and postnatal period and learn about ways we might need to change our standard care to meet her needs and reduce the risks she faced. (Different doses of certain medications! Earlier testing for gestational diabetes! Discussion of scanning vs palpating to determine the baby’s growth!) But the way she spoke about this woman was neither kind nor judgment free. Her commentary on the case study was relentlessly peppered with fatphobia. Like telling us that she discussed healthy diet with the woman in the case study, who told her what she ate on a usual day but ha! she didn’t believe her, come on! I got the feeling – obviously I cannot be sure – that the little digs she added in, the fatphobia, the undermining of what the woman told her, that these were the same sorts of things she would share with colleagues about fat patients.

She talked about the challenge of weighing a pregnant woman whose weight is above the maximum weight on standard scales, and in her case study this had to be handled by weighing the woman on the larger scales normally used for weight patients in their beds. To be honest, my understanding is that there are specialist scales available that can accommodate heavier people, and if health trusts are recognising an increase in the number of people in their care who are at these weights, it might be an idea to make some available. But if you need to use scales designed for a different purpose, ie for weighing patients in their hospital beds, do it with tact, kindness and humanity. The thing which made me question the speaker’s ability to do this? Whilst describing all this, she told us, whilst laughing, she couldn’t find a photo of the scales that she was talking about, so she included a photo of a huge set of industrial scales weighing a yellow pick up truck.

And I see these kind of comments in practice all the time too. Midwives question amongst themselves how a woman that weighs “that much” could have gotten pregnant. (Seriously, how do you think? And that question is relevant to her care in which way precisely?) When asked a woman’s BMI, a midwife saying “oh I don’t know, 100!” and then puffing out her cheeks and motioning a huge phantom body around her own, holding her arms out and waving them around. And this is what they say when there is a visibly fat colleague (me) in the room, which I imagine makes some people censor themselves slightly. I imagine the fatphobia is worse when there is no one fat in the room.

When confronted with fatphobia from midwifery colleagues like this, I have to remember I am seeing it through the eyes of a fellow health professional, and that even the most fatphobic practitioners might manage to mask their distaste for fat bodies when giving care to fat women. A friend of mine tells me that’s all we can hope for – that practitioners will go on thinking whatever bigotry they think but we can hope they will manage to hide it from the women they care for. But I want more than that. I want fat people to receive kind, compassionate, respectful healthcare not only because their practitioners have learned to hide their distaste for us. I want them to unpack and deal with their fatphobia to the point that they no longer have to hide it, because it’s no longer an issue. But as a fat woman who receives health care in other settings, I can say honestly even this isn’t happening a lot of the time.


Charlotte Cooper – Headless Fatties http://charlottecooper.net/publishing/digital/headless-fatties-01-07/
Health at Every Size – http://www.haescommunity.org/