Fighting Fat Bias and and the Fear of Faulty Cervixes

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A birth story titled “A Curvy Gal’s fight for a Natural Childbirth” was posted on My Best Birth by a woman named Jenne who had something of a conflict with her midwife after refusing an unnecessary induction.

Jenne was curious about her midwife’s recommendation that she get a “Miso” induction.

I was scheduled to get induced initially two days before my due date, but thankfully, I rescheduled. I made this induction appointment after a midwife (one of many at my OB practice) told me that going beyond my due date might put my baby at higher risk of stillbirth. The literature does point to pregnancies that go beyond the 42 week mark as being at higher risk, but I wasn’t even at 41 weeks yet. Of course if a medical professional says, “if you don’t do what I am saying, you may hurt your baby”, you listen. She explained my options: I could have a mechanically induced labor to ripen the cervix (“but who wants to have a catheter inside them?” she added) or I could have a “Miso” induction—which she presented as if it were as harmless as having a cup of Miso soup — “you come into the hospital, we give you a small dose of medicine to ripen the cervix overnight, and you’ll probably sleep through it and go into labor the next morning”.

The midwife was talking about Misoprostol, or Cytotec. Jenne researched the risks of the drug and had questions for her midwife.

So how could she justify scheduling me for an induction that posed so many risks for myself and my baby? This midwife clearly did not believe in my body’s ability to birth. She probably assumed I would have a failed induction and need a cesarean. After some research, I called my midwife to say that I did not want a Miso induction, and that I wanted to wait and go into labor spontaneously. 

Her midwife responded with some that sounds like it belongs on My OB Said What?!?


 “Well, in my experience, women with BMIs higher that 26 tend to have cervixes that won’t dilate without chemical induction.”


Jenne was concerned. Not only is the Body Mass Index badly flawed, in part because no distinction is made between body weight from muscle and body weight from fat which labels a broad segment of the athletic and similar healthy populations as overweight and obese, but because the idea that a hypothetical 5’ 7” woman weighing 168 pounds (a BMI of 26) would be hopeless in labor without chemical induction is ludicrous. View the BMI Project for a reality check.

Okay—first I was being pressured into induction because of the increased risks of a long gestation to my baby and NOW she’s saying that because I am a curvier gal, my body is somehow clueless about giving birth (by the way, I had NO other risk factors in this pregnancy—no gestational diabetes, no elevated blood pressure, etc) I have since searched high and low for ANY medical study that supports her belief and have come up with nothing. I argued with her that I’d like to give my body the chance to go into labor on its own—at least through the weekend (agreeing to the postponed induction with the foley catheter instead). She was condescending and doubtful, but ultimately said it was up to me.

Jenne noted in the comments that it also “seemed like [the midwife] had a personal prejudice against larger women. I later heard that she referred to patients who had gained too much weight during pregnancy as her “walking wounded”.

In order to gather as much information as she could about actual risks and benefits of induction, Jenne contacted Henci Goer, who hosts the Ask Henci forum on the Lamaze International web site.

I wrote an email to Henci Goer, author of wonderful book The Thinking Woman’s Guide to a Better Birth in hopes for some insight. Henci was so encouraging about my body knowing exactly how to birth. She also sent me links to research about induction—particularly the dangers of Cytotec. Luckily, I also had the support of my wonderful doula, Rachel, who encouraged me to wait it out—reminding me that most first time moms average a gestation of 41 weeks and a day. The day I went into labor naturally marked that average—I was pregnant 41 weeks and a day when I had my baby!

Jenne went into labor spontaneously, labored at home for as long as possible and had a wonderful hospital birth experience.

I went to the hospital at 2:00 pm and my 7lb 9oz son, Nathaniel Hayden Lima, was placed in my arms just two and a half hours later. This birth was the most incredible experience of my life so far. I was truly blessed with a beautiful and merciful birth.


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