Fat vaginas can’t give birth!

Fat vaginas can’t give birth!

Being a childbirth educator, I get to hear the best and the worst from my clients of our maternity care system. This seems to be the new thing with obstetricians telling women with higher BMI’s that they can’t give birth vaginally because their vagina is too fat, and babies will get stuck.

Where is the evidence and factual information to support this?

There is none!

Fatty tissue does not deposit in the vaginal walls so how can it cause an obstruction?

What impact does this kind of treatment and language have on a woman who is pregnant and planning a physiological birth? Already the woman is being conditioned not to trust her body, that her body cannot perform the task that it is designed to do, and she is a failure and needs medical assistance.

What impact does it have on the woman after birth and during the postpartum period when she reflects on her experience and how she was treated, and spoken to and made to feel about her body?

What impact does a caesarean have on a woman with a higher BMI and recovery?

These are very important and valid questions, because birthing women today who have not experienced a birth where they felt respected or felt they were an active participant in the decision-making processes or have been subjected to negative language and false information remember these things, yet once the care provider is done, they move on and no longer consider the woman or her fat vagina.

What it shows is an unfounded bias by the medical model against plus-sized women, or could it be a lack of trust on the part of the chosen care provider in their own abilities to support plus-sized women.

This language is another way for woman to feel like failures, that they are inadequate, and are then coerced to hand over their autonomy to the “experts” who will manage their birth to ensure that their baby is born safe – it can’t possibly be left up to the mother to wait and birth her baby in her own time.

I get it!

I get that Obstetricians are trained surgeons and that is their expertise, and they have done many years of training to be in the position that they are today. You want them to be there in the event that things do start to go wrong, or deviates from normal. But their expertise means that they feel more comfortable and in control when they manage birth through scanning, testing, inductions and then if things are not progressing quickly enough, more interventions, which then opens the doorway for a likelihood of caesarean – a pathological birth rather than a physiological one.

There is an assumption that birth is not normal and needs to be fixed.

Studies have shown that women with a higher BMI may be affected by having longer first stage labours, but that doesn’t mean they will not progress normally if given time and left alone. The research shows that once women reached 6cm and were into the active phase of labour, the time was generally the same as someone within normal BMI for both the active and pushing phase.

This need to get a baby born within a certain timeframe is what is affecting a physiological birth from happening particularly for women with a higher BMI.

Dr Virginia Beckett, an Obstetrician and spokeswoman for the Royal College of Obstetricians and Gynaecologists, contradicted the claims of bigger women not being able to birth, explaining that it is the size of a larger baby and not the size of the vagina, which may lead to obstruction, which then leads to a necessary section, and it has nothing to do with “fat vaginas.” She was also quick to dismiss the notion that women should be concerned with the appearance of their vagina:

“We are keen to refute any suggestion which makes women concerned about the appearance of their vagina. Vaginas and vulvas vary widely in appearance, but their function remains the same, regardless of a woman’s weight.”

The real problem is the lack of education and understanding around physiology of birth.

Remember, when your birth is not going to plan, it is not because of a fat vagina, it might be a case of “impatient or risk averse care providers” who like to control birth that may be contributing to or even causing poor outcomes. For instance, women with a higher BMI, are strongly recommended to be induced (is that so the vagina doesn’t get any fatter?). They are also encouraged to have an epidural early as it may be harder for them to administer (well jeezus if you can’t do your job, then find me someone competent who can), and this can reduce movement and slow progress, or they are made to be on the bed due to continuous monitoring (yep because that works well with physiological birth), so they are not able to move around and stay upright.

Everything that a woman with a normal BMI needs to do to help her labour progress is what a woman with a higher BMI needs to do as well.

Use the BRAINS analogy to ask all the right questions to get the answers you need to make an informed choice on recommendations:

What are the BENEFITS of doing that?

What are the RISKS of doing that?

What are the ALTERNATIVES I can try instead of doing that?

What are your INSTINCTS saying – how does this recommendation make you feel?

What if you do NOTHING and allow yourself some more time – 1 to 2 hours?

STAY POSITIVE and give yourself some SPACE to consider what is going on around you and keep asking questions till you feel SATISFIED that it makes SENSE.

So, all the women with so-called fat vaginas I encourage you to be educated, research anything that you are told or recommended, ask more questions, get the evidence to support what you are being told from your care provider (#showmeyourcochrane), hire a doula, do independent childbirth education classes so you know and understand the physiology of birth and tools and techniques to provide you with comfort measures and relaxation, and have a supportive birth partner who believes in you and shares in your ability to birth your baby.