Supporting Fat Birth: A Fat Doula’s Take on Affirming Care

Supporting bodies of all shapes and sizes through all forms of reproductive health should not be a radical idea… but, here we are. So how can birth workers be the best advocates possible for humans of all body sizes and particularly fat birthers?

As a fat person and doula, I’ve come up with a few tried and true recommendations and points of advocacy for other birth workers.

4 Ways to Show Up for Fat Clients

Provider Choice

Ultimately, choosing a provider is totally up to your client. However, it’s important for you to know providers in your area who are not only fat-friendly but fat-affirming and practice body neutrality. If your client is able to switch or is looking for a new provider, having recommendations is a great way to support your client.

3 core things that I look for around fat-affirming care from providers are; accessible space (chairs without arms, birthing equipment, multi-sized blood pressure cuffs, etc.), openness to not tracking weight, and not using BMI as a measurement, reason for testing, or an indicator for how you birth (ie. “you can’t birth in the tub if you have a BMI above X”).

Click here to see my recent post on why BMI is BS

Weight Checks

During a pregnancy, it is often standard of care for providers to weigh their patients and track weight gain. For many people (not just fat folks), this can be triggering. Denying a weight check can be so intimidating, especially at first. I’ve supported many folks by providing practice sessions of what this can look and sound like during an appointment with their provider.

A simple “no thank you” often works well, but folks can also share their why if they’re feeling comfortable with that. A Boston-based dietician, Jessi Haggerty, recently shared her response when she told her provider she would be declining weight checks during pregnancy:

“I’d prefer to only take measurements that are diagnostic indicators (in this scenario it would be blood work, blood pressure, ultrasounds etc.) and focus on what I *can* control in terms of lifestyle factors like nutrition and exercise. For me focusing on how much weight I’m gaining will simply cause more stress since it’s largely out of my control” (See the whole post here)!

You can support clients through their perinatal journey by reminding them that their weight is not an indicator of their health. If they’re open and interested you can support them in declining weight checks or any procedure or intervention, as all interventions are optional!

Advocacy & Resources

The data surrounding birth is often fatphobic, so it’s important that you are sharing resources and evidence based information with your clients that you have reviewed. Make sure your materials are safe(r)* for your clients’ consumption.

*Safety is subjective and we can intend to make something safe and accessible and still fail at making it safe for everyone (reflection brought to you by the amazing JB’s instagram post on safety)*

Some of my favorite resources are Fat Birth, Big Fat Pregnancy, and Fat Positive Fertility. Additionally, there are times when you can step in or uplift your client’s voice. Advocacy is an important aspect of this role!

Modified Comfort Measures

Physical comfort measures are some of the best tools that we have as doulas and birth workers. I’ve learned a few ways to modify comfort measures to support people in larger bodies. These include using my legs for hip squeezes or counter pressure instead of my arms, ensuring that my rebozo is long enough, and using modified positions in bed when folks have an epidural.

There is an added layer of advocacy that can be done with hospital staff, as they are often not delicate or sensitive to helping move or position fat people. Sometimes this means talking to a nurse in the hall to help them understand modifications or client needs. This should be done gently and with consistent consent throughout. Positions that work for thin bodies can and do work for folks in larger bodies, just sometimes need some modifications!

Continuing Education & Committing to Fat-Affirming Care

This is a non-comprehensive list, meant to be a starting place for expanding access to fat birthers within your practice. I hope that this helps you explore more and dive into how to make your practice more accessible and safe for fat people and all birthing bodies!

To continue your education, I offer a class for providers and birth workers around supporting all bodies called Birthing At Every Size.