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Embracing Plus-Size Pregnancy: A Conversation with Michelle Mayefske, Doula, Childbirth Educator, and Author of "Fat Birth"

Tara of Nyssa recently chatted with Michelle Mayefske, doula, childbirth educator, author, and plus-size mom of five. Having experienced weight stigmatization throughout her pregnancies, Michelle learned to advocate for herself in the medical system, recognize fact from fiction in plus-size pregnancy, and ultimately deepen her awareness and acceptance of self.

Michelle now enjoys supporting mothers through body positive pregnancy/postpartum experiences in her work as a doula and with her international readers of Fat Birth. 

TS: Could you start by sharing a little about yourself and your work as a childbirth educator and doula?

MM: I’m Michelle, a birth and postpartum doula, childbirth educator, author, and mom of five. I became a young mom at the age of sixteen and went into my first birth fairly ignorant about what to expect. As a result, I did not have a great experience. Eight years later when I was pregnant with my second, I knew that if I wanted to have a more positive birth experience I would have to do things differently. This is when I started learning so much about birth and my rights within the maternity system. My husband learned how to be a great support person. We also had the amazing support of a doula, who guided us through my pregnancy and was present at my birth. That was the "point of no return" when I became a birth geek. 

I didn't jump into the world of fat activism until 2017. I had spent more than two decades trying all kinds of diets, essentially hating how I looked and always wishing I was thinner. After I gave birth to my fourth child, I found the struggle with body image issues and disordered eating very intense- almost debilitating. Through a random connection on Facebook, I heard about something called body positivity and down the rabbit hole I fell. I learned about body positivity, body neutrality, and the many forms of activism so many plus-size people had been doing for years. It was this intriguing feeling like coming home, coming home to a fat-positive community that understood what it meant to be fat in a world that explicitly does not accept you. It was during this time I married my two passions: birth advocacy and fat activism, which is what my work focuses on now.

"People of ALL sizes deserve dignified, respectful maternity care where there is no place for weight stigma."

In 2018 I built my website and Instagram account, sharing tips for plus-size folks during pregnancy, and ways they could prepare for a positive birth experience. I did not anticipate the number of people who contacted me to share their story of weight stigma experienced at the hands of family, friends, and the very providers who were meant to support them. These stories only motivated me more. Our culture is not kind to people of size and that needs to change. People of ALL sizes deserve dignified, respectful maternity care where there is no place for weight stigma.

My book, Fat Birth, was published in 2021 and I love seeing the impact it is having in the birth world. Alongside all of these exciting changes, I continue my work as a birth doula and childbirth educator. I have clients of all shapes and sizes, but one thing is always certain-- they all learn ways to advocate for themselves and make informed choices that feel right for them. I enjoy teaching them about physiological birth, how their hormones work, and how they navigate birth with confidence, no matter what path it may take.

Stigmatization & Body Image in a "Bounce Back" Culture 

TS: During your pregnancy, did you find you were discriminated against as a plus-sized woman, both within the medical system and/or your social circles? Did this treatment change after your babies arrived?

MM: I identified as a plus-size person during all five of my pregnancies and what is interesting is that the larger I was in size, the more discriminated I felt. This is also sadly validated by recent research on weight bias during pregnancy. Some family members would make comments about my size, noting my weight gain and how big I had gotten. Comments like "You know, what you gain now you will have to lose later,” stung in a way that is hard to describe. Why do people think it is okay to make body-focused comments so openly when someone is pregnant?

I had one midwife comment about my body size when I contacted her regarding my desire to birth at home during my second pregnancy. I simply inquired to see if she could support me, knowing that my high BMI could "risk me out" of the local home birth program. When I shared these concerns with her and became vulnerable, she simply responded with, "Wow, you are big." How is this helpful? How is this supportive? It's neither.

The most predominant thread running through my pregnancies was the idea that I should gain as little weight as possible. I was growing another human and being told to ignore my hunger cues so the number on the scale wouldn't increase. There was also a looming myth that "all big moms make big babies" during my pregnancies. So many of these myths continue to pervade maternity culture today. My BMI was brought up more times than I can count, but thankfully, I did not experience any of the horrendous treatment that often lands in my inbox.

"Our culture does an excellent job at promoting the idea that our bodies are damaged by pregnancy and birth."

Once my children were born, the highest level of pressure came from myself. Our culture does an excellent job at promoting the idea that our bodies are damaged by pregnancy and birth. We need to "bounce back" or "get our bodies back," which is simply impossible. Our bodies are never the same after we give birth. This is when much of my body hatred was at its highest- during a time when there was already so much rawness and vulnerability. While I never experienced weight stigma at my six-week postpartum visit, it was something I encountered constantly with my own GP. Every time I saw my doctor, the predominant advised solution was weight loss. 

Boundaries, Break-throughs, and Advocacy in the Medical System

TS: How did you practice self-care and advocate for yourself during pregnancy and postpartum, considering the stigmatization you experienced? 

MM: Prior to 2017, I did not do anything to advocate for myself. I simply accepted disrespectful treatment and the idea that the best thing I could do was lose weight. Unfortunately, what so many plus-size folks know from experience is diets simply do not work in the long term and the more you diet, the harder it is. Once I found my fat-positive community, that all changed. I learned ways to call out weight stigmatizing care. I learned how to set boundaries with my providers by doing things like declining to be weighed during pregnancy. I also told my providers that I did not want to discuss diets, weight loss, surgery, or BMI categories. If they wanted to discuss my health, we could do just that- chat about how I eat, ways I move my body, my quality of sleep, mental health, etc.

The most important thing I did during my last three pregnancies was find a size friendly provider. This is someone who supports plus-size people holistically, without a huge emphasis on weight or outdated BMI scales. They look at the overall picture of your health versus hyper-focusing on your size. This eliminated so much stress, worry and definitely contributed to more enjoyable pregnancies. 

Other ways I practiced self care included curating my social media feed, removing any content and unfollowing anyone who engaged in body shaming or diet talk. I also read as many positive birth stories as I could find and surrounded myself with people who respected my boundaries. Postpartum was much more challenging. I found myself always wanting to turn to dieting and struggling with body image issues. I had to actively decide to opt out. I had to choose a different path where I was practicing intuitive eating instead of dieting. I found ways to move my body that felt good versus punishing myself with exercise. My focus shifted to body respect and my overall recovery versus any form of weight loss. My scale was thrown in the trash and never replaced. It was and still is a journey I am on!

Knowing Fact from Fiction

TS: What are some of the most common myths/misconceptions about plus-size pregnancies, and how did you learn to separate truth from fiction? 

MM: There are so many myths! A few among the many:
Most plus-size people get gestational diabetes, hypertension, or pre-eclampsia. 
It’s more challenging to birth vaginally when your are plus-size.
All big moms grow big babies
And so much more!

The best thing I did was find actual research that looked at these topics. I think the most important thing is to look at a source: Are they exaggerating risk? Are they giving you statistics? It is so important to find reliable sources. 

TS: Please tell us about your book, Fat Birth, and how it has been received.

MM: I decided to write Fat Birth after discovering there are very few resources aimed at plus-size expecting parents that are not fear based. For too long people in bigger bodies have been told the same story of fat pregnancy- it is risky, complicated, and birth will be anything but straight forward. The reality is people of size have wonderful pregnancies and births every day!

I wrote Fat Birth to help change the way both expecting parents and birth professionals approach plus size pregnancy. It is a combination of a pregnancy guide and anthology of more than thirty brith stories submitted by parents across the globe. The feedback I've been receiving is wonderful. New parents reach out to tell me how much the book helped them prepare for birth and trust their body, while birth professionals express how it has changed the way they support their clients. I'm honored to be making a difference!

Wisdom for Plus-Size Mothers to Be

TS: What advice would you offer to plus-sized women going through pregnancy for the first time?

MM: These would be my top three tips:

- Find yourself a size-friendly provider if you can - someone who works with you, respects your boundaries, and listens to what is important to you.
- Sign up a for a private childbirth education class. Hospital-based classes do have their positives but they may also be teaching you more about their norms or guidelines versus advocacy.
- Access extra support, like a birth doula, if possible. There is so much research showing that doulas reduce the likelihood of interventions that have potential negative consequences for both pregnant people and their babies. 

TS: What are the most important qualities to look for in a size-friendly health care provider?

MM: I would class these as the most important qualities to look out for in a size-friendly provider: 

- Awareness of their own biases
- Provides compassionate support for people of all sizes and abilities
- Does not class you as high risk solely based on your BMI
- Doesn’t make assumptions about your eating habits and level of physical activity
- Has equipment suitable for use with people of size
- Treats you with dignity and respect
- Understands the importance of informed choice
- Respects any boundaries you create with them
- Acknowledges that you are the only expert of your body

"I deserve to take up space. I deserve to be myself, no matter my size."

TS: You set a very positive example for your children by embracing your body and educating others on plus-size pregnancy and motherhood. Have you also learned from your children about ways to deepen self-love and acceptance? 

MM: Thank you so much and 100%. I am learning from them every day. What I love most is how my kids throw themselves into situations. They are not afraid that their body (or their appearance) is going to hold them back. They see something they want to do and they go for it. They don't worry about what someone else might think. I admire that freedom and try to apply that more to my life. I deserve to have fun. I deserve to take up space. I deserve to be myself, no matter my size.

artwork by gee gee collins 


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