On Pregnancy Weight Gain
Again this week I agonized (well, for about 4 minutes) over the side belly photos, thinking, “Why does my upper abdomen, which has no uterus in it yet, have to be thicker? Why does my back have to get thicker? It has no placenta or baby inside it either. This doesn’t look like just a pregnancy belly…” I will spare you all the boring details of my insecurities and share only what my dad said to make sense of this change in my back and thighs and butt and other places seemingly unrelated to growing babies. He said, “Your body is giving you some reserves to get you through labor and the time right after, and for breastfeeding. You need them. You’re not doing anything wrong.” This made me feel better.
I share this, at the risk of sounding overly-confessional, to talk about the issue of pregnancy weight gain. It is, after all, a health issue, and I work and dream and breathe public health. Sometimes our discourse around pregnancy weight gain focuses on attractiveness, body image and how to feel sexy, whether Kanye is going to leave Kim Kardashian because she gained so much weight, what happened to the skinny Jessica Simpson of Dukes of Hazard, blah blah blah. I think sometimes this kind of discourse can alert us to and help us discuss health issues (Jessica Simpson’s pregnancy weight with her first child was really unhealthy and carried with it risks that perhaps we could learn from instead of shaming her), but more often than not, it casts aside the much more important conversations about what is healthy or risky for mom and baby, and what can we do to promote healthy weight and healthy nutrition before, during, and after pregnancy.
I am a little bit worried about gaining too much weight during pregnancy. And I don’t mean just more than the Mayo Clinic recommended 25 – 35 lbs. for healthy weight (BMI of 18.5 – 24.9) women. Those make sense for some healthy weight women, and for sure underweight women need to gain plenty of weight. But those recommendations are considered excessive and not up-to-date by many health care and public health professionals, and are certainly not standard in all other countries with developed health systems. [Though to be fair, I have not done an exhaustive review of the literature on this issue so you may find evidence to contradict me.] What I mean is I don’t want to gain more than about 23 lbs. I am 5′2″, so what do I need more than that for? I don’t want a big baby and difficult labor that carries a higher risk of c-section and episiotomy and tearing. I don’t want to put any more strain on my spine, which is already troubled by spondololysis, a condition that could be worsened by excess weight gain. Nor do I want to increase my risk of gestational diabetes or preeclampsia (and I know there are multiple factors that contribute to this, sometimes totally unrelated to overweight or obesity, but still. REALLY scary stuff.)
So it concerned me this morning when I weighed myself and it looked like I am a little ahead of my weight gain goals for this early point in pregnancy–maybe I am doing indulging a little too much, exercising too little? I don’t think I am on a path to excess weight gain, but I want to be careful and thoughtful nonetheless. I believe the trick to managing a healthy amount of weight gain will require me to listen to my body and make good food and exercise choices without letting my ego (and therefore that useless monster, shame) have much to say. That is, without my eyes telling me that something is wrong because I don’t look like Beyoncé or Shakira did (they got certain blessings; I got different ones–c’est la vie), but rather, being thoughtful about my choices with my eye on the prize of my own healthiest body and the healthiest little brain and body of baby.
I wonder, then, what a popular discourse about healthy pregnancy weight would look like if it encouraged this–if it engaged neither in body shame nor in facile answers that fail to present people with the gravity of the health risks–and also, if it avoided that discourse I notice among many mommy communities of unthinkingly praising big babies without thinking of the potential risks. I know these healthy, middle ground discourses exist in the health world and in some families and communities and publications, and in high-quality prenatal care visits. (And I say high-quality because, unfortunately, this does not happen in all prenatal visits–the data on % of healthcare providers discussing maternal and childhood obesity with patients in Alaska is depressing, and personal conversations I’ve had with moms reveal that too many care providers fail to support patients with weight loss in between pregnancies as a way to reduce risk).
What would it look like if in health classes for teens and in sitcoms and in women’s magazines and in frank, honest discussions between friends, we could talk about the many diverse ways that a healthy pregnancy can look? What about if we talked about the risks of pre-pregnancy overweight and obesity and excess pregnancy weight gain in terms of having a baby born with too much insulin (and then getting hypoglycemic) or increased risk of baby having chronic diseases in adulthood? Or if we talked about the difficulties in checking on babies during labor or getting baby out of the birth canal or the complications in healing from surgery? Or if we talked about how lack of nutrition–which can, and often does happen even with excess calories–increases babies’ risk for diabetes and heart disease later in life? It seems to me, as a child of science and health, that knowing these things would help, and that people are not given access to this information in many of the media where it would be appropriate. It seems to me that if we all knew these risks from a young age, many more people could try to get healthy and support girls and women in getting healthy before having babies, and demand that their politicians and institutions and communities support these efforts.
But am I being naive in thinking that families would be able to invest more in health prior to and during pregnancy if they better understood the risks of excess weight and the benefits of a healthier weight? Am I universalizing from how I resolve problems? I know that knowing is only a very small fraction of what is needed for behavior change, and I know that the American (and global) obesity epidemic is about SO much more than behavior choices. It’s about urban planning and zoning, agricultural policy, transportation policy, subsistence hunting and fishing policy, school foods, environmental chemical exposure, predatory marketing, childhood and prenatal trauma that changes the metabolism and creates epigenetic risk factors for obesity, childhood trauma that predisposes children to eat as a coping mechanism or to protect themselves, low-wage and high-demand jobs that make it hard for families to cook, all sorts of things. The solutions are NOT just individual solutions, and it is unfair to portray them that way.
Still, it strikes me that we deserve to have more conversations about thorny areas such as pregnancy weight in ways that allow us to reject the discourses of shame and the narrow definitions of beauty that feed them, and that allow us to be real about our health and the health of our children. We at least deserve to know, and to think through and plan through what to do about it with our healthcare providers and with our communities and families and friends.
For me, my what to do about it is to say no more often to sweets and fried things and simple carbs, to make more opportunities for exercise, to feel great about the wild Alaskan salmon and blueberries and the garden veggies I am eating, and to feel whole and beautiful and content within the body that baby and I are sharing for these 40 or so weeks–whatever that body happens to look like.
Speaking of baby, here is the close-up of the painting from this week, which I had the opportunity to make using Lennart Nillson’s groundbreaking 1965 photo from the cover of Life magazine.
All photography in this collaborative mami-papi art project by my creative, supportive, much-more-easygoing-than-me spouse, Oscar Avellaneda-Cruz of Avé Photo.