Thursday, December 24, 2009
I was Christmas shopping yesterday and was appalled by many of the toys available. Call me old-fashioned, but I really think that kids do best with more of the "classic" toys. I urge you to consider more of these kinds of toys and only a few of the more modern toys in order to create a better balance for your kids.
Classic Toys That Promote Imaginary Play
I strongly prefer toys that actively promote imaginary play. I think this is an underexercised muscle in many children today and I see great benefits in kids when they get lots of time to indulge in imaginary play scenarios.
The best toys my kids have gotten over the years include (in no particular order):
Dress-Up Costumes - All of my kids have really enjoyed dressing up. I get dress-up clothes from garage sales, toy stores, Goodwill, theater costume clear-out sales, you name it. I keep a big bucket of them in a closet and have some hooks available around the closet to hang up the most commonly-used ones. I try to provide a wide variety of capes, hats, coats, ties, dresses, scarves, shirts, and shoes and let them decide what they want to wear, in whatever combo they put together. I do have some specialty clothes (princess dresses, pretend armor and crowns) but I also have lots of very generalized, every-day stuff. They love it. Even my teenaged girl still dresses up occasionally (she has Renaissance-y and witchy skirts, pants, vests, shirts, and hats) and my oh-so-cool teenaged boy will dress up on occasion if the little ones are putting on a play. I think dress-up clothes are some of the best toys for imagination around.
Train Tables and Train Sets - These promote lots of imagination and engineering; try the non-electronic trains for maximum imagination value. Thomas The Tank Engine has lots of fun characters (avoid the gag-worthy videos) but is more expensive; Brio has a lot of quality tracks for a much cheaper price. Wooden tracks are superior to the plastic ones if you can afford them; my sister-in-law was given a great set by a neighbor, so always look around before you buy. I found a good train table to be worthwhile because it contained more of the sprawling messy nature of the trains. Lots of matchbox cars and a good car-play rug are a good adjunct to train sets.
Pretend Kitchen Sets- Both boys and girls love imaginary kitchen sets and shopping accessories. I've had both plastic kitchens and wooden ones, and I have to say the wooden ones are better if you can afford them (check Craigslist for give-aways). Be sure to accessorize with wooden or plastic food, dishes, shopping baskets, etc. A good tea-party set (in tin or non-breakable materials) is a must and gets frequent usage in our house. Even my teenagers have been known to sometimes still take part in tea parties given by my little one (especially if actual food is served at the party). We've gotten a lot of mileage out of these toys, and they are well worth the investment.
Play Silks - These are just rectangular pieces of hemmed silk, tie-dyed into vibrant colors, like the ones shown in the picture accompanying this blog post. They are very cheap and easy to make yourself (see Dharma trading company); making your own is much cheaper than buying online (although you can get nice ones likes the ones above at magiccabin.com). Kids without much practice in imaginary play can be a little puzzled for what to do with playsilks at first, but in kids who have strong imaginary play skills, these become anything and everything, from superhero capes to rivers on the ground to skirts and veils to flags and fort-building materials. My kids have really come to love these and I now consider them to be one of the most indispensible childhood toys around.
Playhouses - I hesitate to call them dollhouses because that sounds like a "girl" toy and implies a house shape is mandatory, but most kids like some version of a playhouse. They can be traditional dollhouses, tree forts, castles, or gnome/fairy hutches, like ones found at Magic Cabin. You can make your own more cheaply than you can buy, but for those who are not crafty, I prefer the durability and look of the wooden ones over the plastic ones. Melissa and Doug have a cute "Fold and Go" dollhouse that is portable, and saves space if that is a consideration; not everyone has room for a giant dollhouse and this toy was really useful to us when we lived in a smaller home. But whatever size or shape it takes, be sure to have some sort of playhouse toy for your kids.
Animals and Doll Figures - These are the best toys for kids! We get lots of small quality plastic or wooden animals of various kinds, and just let them have at it. There's tons of good imaginary play from these figures. I have more of a love-hate relationship with most dolls (I hate Barbie-type dolls) but the soft squishy cuddly dolls or stuffed animals seem to be wonderful for kids. They like to dress them, feed them, and take care of them like babies. Good for role-playing and working out sibling issues! Accessories like mini-strollers or mini-slings add a lot of fun and flexibility for minimal price.
An Army of Toy Soldiers - We're not talking violent or graphic stuff here, just your basic green or tan army guys, like the ones seen in Toy Story. I was pretty opposed to these at first, not wanting to promote violence, but I have to say that my kids love these. They spend lots of time setting up elaborate scenarios and can spend days on a "battle" in very imaginative ways, but I don't see them becoming more violent from playing with them. I think it channels a very natural instinct for them, in a more constructive way than might otherwise happen, so I've decided I'm okay with this toy after all. The bonus is that these are very inexpensive, so it's easy to get a giant set of them.
Action Figures - My kids have always loved action figures. Although I tend to favor classic wooden toys, I'm not above a good plastic action figure if it's well-made and not gimmicky. My kids play a lot with Star Wars action figures or the various superhero action figures. Although we discourage a lot of media-associated toys because we feel they tend to suppress imagination, we've found that our kids do a lot of good imaginary play with these particular figures so we have made an exception and invested in more than a few. And, well, it just feels good to the sci-fi nerds in us to have our kids playing elaborate Star Wars scenarios! (Another big favorite that promotes a lot of physical activity are plastic Jedi Lightsabers. Oh, the epic battles our yard has seen!)
Classic Games - I like classic games that promote thinking, interactive play, and fun. I tend to de-emphasize the really competitive games, although we do have some of those too. For little kids, we really like "Snail's Pace" and "Hi-Ho Cherry-O," "Penguin Pile-Up," "Hiss" and games like that. For medium-aged kids, we like "Uno," "Rat-a-Tat Cat," "Chutes and Ladders," "Trouble," "Sorry!" and "River Crossing." For older kids, "Risk," "Monopoly," "Blokus," "Break the Safe" and "Scrabble" etc. are good games. And of course, you can't forget the classic board games like checkers and chess.
Art Supplies - Kids love to do art, so it's handy to have a kitchen cabinet or toy chest dedicated to art supplies for them to access when needed. Tablets of cheap, recycled paper, colored pencils or block wax crayons, stamps and stickers, and playdough (you can make your own pretty cheaply) are classic things kids never tire of. (We let our kids paint too, but these supplies are kept in the parent-only cabinet so we control when and where the painting is done. I let kids make messes, but I'm happier about it when it's not a surprise.) Art supplies are generally cheap and the paper is recyclable when you're done. It's really helpful to have a child-sized table to do these activities on too. A kids' activity table was one of our best investments when they were younger.
Fort-Building Supplies - Kids love to play forts. A few big sheets, old blankets, silky curtains, sofa cushions, old giant boxes etc. can combine to make a great fort and keep kids occupied for hours on end. The advantage of forts is that they can be constructed from materials on hand or from inexpensive thrift store items and therefore are dirt cheap. This was one of our kids' favorite activities when they were young. Now that they are older, the forts have moved outside and gotten bigger (tree houses!), but they still love forts.
Blocks and Construction Sets - Kids love to play with blocks and similar toys. Wooden blocks, marble runs, Legos, Lincoln Logs, etc. are all great construction and engineering toys. These can be messy around the house so I like to have plastic bins to corral the mess between construction parties. I also liked the giant Lego-like blocks that snap into each other and store away under desks or counters and such; these often became part of the fort-building materials.
Outside Activity Toys - These seem obvious but I'll mention them anyhow. Soccer balls, basketball hoops, climbing/sliding toys, swings, mitts, frisbees, jumpropes etc. should be a part of every kid's toy options. Obviously your outside play area influences what you get but these things can always be taken to a park too. One option I was very leery of was a trampoline but I've found my kids love it. It really allows them to go burn off energy when they need to, and they play with it a lot more than they do the far-more expensive swing set right by it. Although I was hesitant to get one at first, the trampoline really has been one of our better buys for sheer exercise and excess energy-burning value.
Sensory Perception Activities- This category include things like water tables, sand boxes, seed trays, mud pies, etc. Kids love these. They can be kind of messy so they tend to be outside summer activities at our house, but I know pre-schools that have built indoor versions of water tables and seed trays out of cattle troughs or a little extra lumber and it works just fine. If you have the room and don't mind a little mess, these are great toys for kids.
These are a few of my favorite classic toys; what are yours? Please share them in the Comments section.
What About Electronic Toys?
I have to be honest; I am not a fan of electronic toys. I've observed for some time that kids' imagination abilities atrophy if given too much electronic stimulation or junky toys. They tend to inhhibit kids' abilities to entertain themselves; if my kids play too much electronics, I hear "I'm BORED; there's nothing to do!" comments a lot more because they can't remember how to entertain themselves. It overstimulates them too much and then they crave that same high level of stimulation constantly. Frankly, it overloads their systems and I feel it just isn't healthy for their brains.
For some kids, electronics can be addictive, and less time gets spent on more healthy play activities, like outside play, sports or just running around in nature. Some kids are more prone to this than others; my younger son tends to be far more addicted to electronics than my other kids, so we really have watch his use levels in particular. However, I notice that a high use of electronics negatively affects the behavior of all of my kids, which is the main reason we limit it. It's good that they all have limits, frankly.
We are not purists and do not forbid all electronics---this is part of the modern world and they have to learn how to deal with it constructively---but we really try to help them learn to use it in a healthy, gradual way. Therefore, we limit the amount of time and frequency that they spend on this kind of activity (computers, TV, electronic games), and it really does seem to improve behavior, academics, and general daily attitude.
Here's what we've done to find a reasonable balance; this is just our solution and doesn't have to be yours, please note. It's simply the best compromise for our situation and our particular kids. Your kids' needs may dictate a different solution.
We do have computer games and a Wii at our house, but they are not allowed to play with it during the school year (except on major school vacations, like now). On vacations when they are allowed access to it, play is generally only allowed after dark so that they are more likely to spend time getting plenty of exercise, imaginary play or reading. This allows them some electronic play but keeps them from sitting in front of it obsessively and never doing anything else.
Some parents we know allow more regular play but set specific time limits (a half-hour each day, an hour on weekends); we set the length of a session more by ear. A lot depends on your particular child's personality; some kids do better with regularly-scheduled but strictly-limited times, while others do better playing less frequently but more self-regulated.
Our kids seem to do better with the latter; we get less whining, more non-electronic play time, and less "jonesing" for electronic time. However, for some parents the other way works better. I think you have to experiment and see what works best for your own particular kids.
TV time is another part of the electronic picture. I know some parents who don't allow any TV at all, and others who allow it constantly. I'm not a fan of either approach. I prefer to allow it but limit what they watch and how much.
To be honest, we struggle more with limiting TV than with limiting computer and Wii time; we as parents like our TV-time so it's easy to let theirs get out of hand if we're not careful. However, we certainly allow far less TV than most of their peers get, and I know we are much more careful about what they watch than most parents. And they don't get TV in their bedrooms at our house; watching is a communal activity so we can monitor more of what they watch and how often. Still, the amount of TV watching is something we have to constantly remind ourselves to be aware of, especially in the cold winter months.
Most people don't think about TV as an electronics activity, but it takes up significant leisure time for kids, just as electronic games do. Too much of it inhibits their physical and imaginary play time. Generally speaking, many kids today suffer from electronic over-stimulation and an under-exercised imagination and could do with a lot less TV and electronics time.
I have to say that toy decisions and the struggle over how much and what TV/electronics to let them play have been some of the more unexpectedly-difficult parenting decisions we've faced.
Before I was a parent, I really didn't think this would be difficult. I would have agreed that limiting TV somewhat and avoiding the more obnoxious and violent toys was a good idea, but I would have pooh-poohed the idea of limiting computer time so strictly or promoting classic imaginary play toys so strongly.
But now, in the reality of raising kids and seeing the effects of various playtime choices, I have to say that some of my opinions and choices have changed.
I can watch how my kids respond to various toys and activities and see how changing those activities changes their behavior. For example, I notice how much better-behaved my kids are when they have regular time for intensive physical play, every day. I notice that my kids behave very passively when they are in front of the idiot box, which in theory can be useful.....until the TV goes off and they have to work off the overstimulation their brains have been experiencing. I also notice how much more whining there is about filling down-time when there is a lot of electronic play going on, and how much more in-fighting among siblings there is when they are trying to share computer time.
On the flip side, when we restricted electronic play to school vacations, the kids were noticeably more even-tempered and happy (after the initial whining) and more able to self-regulate their play. And I noticed that the kids did better in schoolwork and got along better with each other when they engaged in more imaginary play and less electronic play.
Now, of course there are barriers to more classic toys. If you clicked on any of the toy links provided above, you may have noticed how expensive many of these classic imagination toys are. Yeah, it's true, some of them are not cheap. However, I'd note that electronic toys are just as expensive, if not more, but the classic toys last longer. And not all of the classic toys were expensive; some can be gotten pretty cheaply, or made for very little money at home. Furthermore, you don't always have to pay full price for the expensive items. Many can be gotten through secondary sources like thrift stores, Craigslist, or eBay.
So don't let pricetag shock keep you from investing in some of these classic toys for your own kids (or nieces, nephews, grandkids, whatever). They really are worth the price.
In my opinion, it's okay to buy some electronics and let your kids have some TV time. It's part of our modern world and kids have to learn to deal with it sooner or later. Just please emphasize the classic toys that promote imagination more, make sure your kids get plenty of opportunity for fun physical activity, and please, please don't let electronic devices (including iPods and texting) be your kids' constant companion. Find a reasonable compromise of these activities that works for your family.
Remember, kids need meaningful human interaction, plenty of fun and healthy movement, and lots of free-play imagination time. It's up to us as parents to make sure they have it.
*Illustration is of play silks from the Magic Cabin online catalogue.
Wednesday, December 2, 2009
I commented on her blog, but the more I think about it, the more I think it deserves its own post here on my blog too. So I'm going to hijack the discussion over to here.
This is part of a new trend towards "bariatric obstetrics." The idea is that the "obese" mother is at SUCH INCREDIBLY HIGH RISK that she is better off delivering at a hospital that is specially equipped for her needs and where doctors can specialize in such "high-risk" deliveries.
Although some folks setting up these policies may have good intentions, what they are actually doing is "ghettoizing" fat women.
By taking away low-risk care options for fat women, they virtually guarantee a high-risk, high-intervention, high-complication delivery for them.
But no one is actually studying whether switching to special "bariatric obestetrics" practices and hospitals actually improves outcomes among "obese" women. They just assume it does.
And it assumes a level of extreme risk for all fat women when many don't experience that at all.
Yes, pregnancy in women of size has more risks of some things, like gestational diabetes, pre-eclampsia, macrosomia, etc. Yes, some women of size have complications. You'll never hear me pretending otherwise. And sometimes a woman of size does have complications that needs a higher-intervention approach or a higher-risk hospital or practice.
But many women of size have healthy pregnancies and births, and many more probably could if they access to proactive, low-intervention care via the midwifery model of care.
If fat women don't have any complications, do they really need a high-risk practice or location, based on weight alone? Do they really benefit from it? Or does it cause more harm than benefit?
And even those who experience mild complications, can't they usually still be cared under the midwifery model of care and benefit from that model?
Research shows that when comparing clients of the same level of risk, midwifery clients experience fewer inductions, fewer augmentations, fewer epidurals, fewer episiotomies, and fewer cesareans, yet their outcome is just as good or better.
Some research suggests that women of moderate risk also benefit from the midwifery model of care. Although not specifically addressing obesity alone, Cragin and Kennedy 2006 concluded,
Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.To take away the choice for that low-intervention model across the board based only on size, regardless of actual complications, is a total miscarriage of justice.
And I think that's the thing that has me most enraged....the paternalistic, condescending attitude of making my decisions for me, for my own "good"....because I'm fat. Taking away my best chance of having a safe, unintervened-in birth....because I'm fat.
As Susan Hodges of Citizens For Midwifery states, "How much 'risk' does it take to supercede the mother's right to bodily integrity?" Or self-determination?
I've got news for these folks. My weight does not give you the right to make my choices for me or to dictate whom I can see or what kind of birth I am "allowed" to have. This is my body, and *I* get to decide.
Unable To Access Low-Tech Care?
Unfortunately, I think that more and more in the next few years, we will see fat women denied the right to obtain low-risk maternity care, the right to see midwives, and the right to have homebirths or birthing center births.
It's already happening. Some birth centers already deny access to women above a certain BMI or weight limit. Some homebirth midwives/doctors turn away "obese" women, even those without complications, simply based on their weight.
Some homebirth midwives want to serve women of size but know that if there is a transfer or anything goes wrong, the authorities in their area will skewer them for daring to care for an obese woman at home.
(It's already happened; a friend of mine recently planned a homebirth and her midwife backed out on her for this very reason. She eventually found another midwife but it was not easy to find one so late in pregnancy. Fortunately, the birth went fine and no one got taken to task for serving a fat woman at home....but the fact remains that the fear of this caused her first midwife to desert her, and near the end of pregnancy too.)
So more and more fat women---even those who want alternative, low-tech care---are being forced into the high-tech medical model, one in which "morbidly obese" women often end up with a nearly 50% c-section rate---or more.
In fact, even being forced to be in the hospital with an OB isn't enough now. Some hospitals (like this one above in the UK or this one in Australia) are forcing fat women into specialized centers, so that they can't even access the low-risk, low-intervention hospitals.
And some regular OB practices refuse to care for obese women, requiring them to instead see high-risk OBs....regardless of whether they actually have any complications or not.
To these providers, the mere fact of being "obese" is complication enough, even without any actual complications to inconveniently complicate their biases, so to speak.
In other words, the hyperbole of risk around fat mothers is so out of control now that we are ghettoizing them. And it's only going to get worse.
Show Me The Money, Baby
The real question here is whether the centralizing of "obese" women together into specialized centers and under the "high-risk" umbrella improves outcomes or not.
My bet is that it simply leads to an atmosphere of unchecked and unquestioned intervention, and many many unnecessary cesareans.
But we don't know that because no one is documenting the outcomes. As far as I can tell, no one is even asking the questions.
Where is the proof that these bariatric specialties improve outcome?
Where is the publication of the protocols routine to these bariatric obstetrics practices? Are all these women being told to diet during pregnancy? Are they all being induced early for fear of a big baby? If they go outside the approved protocols of xxx pounds of weight gain or xxx pounds of expected baby size, are they just automatically sectioned?
Where is the documentation of the intervention rates of these practices? What is the induction rate, what is the c-section rate, what is the VBAC rate, what are the complication rates?
Where is the prospective study of high-tech, high-intervention specialized bariatric care for obese women, compared to a control group of women of similar size and complications who instead are exposed to the low-tech, low-intervention midwifery model of care?
Show me the money, people. Ah, but that's the problem right there. This is a new cash cow in obstetrics these days....the specialized practice of "bariatric obstetrics."
Just think of all the money they can charge insurance companies to force these women to see bariatric specialists! Just think of all the money they can charge for "specialized" bariatric equipment! Just think of all the billable services they'll "need" in the hospital! And just think of all the extra money from all the extra c-sections!
Sorry, I don't care if you have no financial incentive to study this or not. You have to SHOW ME that this high-tech, high-intervention, high-risk attitude towards birth in "obese" women actually improves outcomes before you dictate where I "have" to give birth in order to birth "safely."
PROVE IT. In a good study, with a good control group of similar fat women being treated in a true low-intervention midwifery model to compare it with.
Until then, stop taking away the rights of women of size to birth where they want to, to have equal access to low-tech birth, to have equal access to "alternative" techniques like waterbirth and full mobility in labor.
Stop forcing fat women to have early epidurals "just in case," mandatory internal monitoring, and automatic confinement to bed. Stop pushing fat women to induce labor early "before the baby gets too big." Stop sectioning fat women whose weight gains or whose baby size fall outside your definition of "desirable." And stop forcing women into bariatric obstetrics practices and high-risk hospital wards if they don't want it or need it.
Stop ghettoizing fat women, damn it. And stop telling us how and where we are "allowed" to give birth. These are our bodies and our babies, and we are the ones who get to have the final say.
Friday, November 27, 2009
And for those with and without children, take a moment to consider thankfulness to your own mother, or to whomever was important in a positive way in your life.
*Painting called "Maternal Kiss" (1896) by Mary Cassatt; image from Wikimedia Commons.
Monday, November 23, 2009
As most of you have heard by now, the press picked up the story recently that Lincoln University in Pennsylvania requires all their students to be weighed and measured, and if their BMI is over 30 ("obese") then they are required to take a Fitness For Life course at some point before graduating. No Fitness For Life course, no graduation....but only for the fatties. (You skinny folks, you obviously don't need any fitness courses.)
This offends me on so many levels I can't even tell you....but I'm going to try.
- First and foremost, it is not the college's business. THEIR FOCUS SHOULD BE ON LEARNING, PERIOD. They are an institute of higher learning, not a institute of higher fascism. Whether I'm fat or not has nothing to do with my academic abilities or accomplishments and should have nothing to do with whether or not I get a college degree. College is about learning, it's about academics, it's about hard work and accomplishment. The work I have done during college should dictate whether or not I get my college degree. Whether I'm fat and whether or not I exercise is completely irrelevant and should have no bearing. GAH!
- This policy assumes that all thin folk are perfectly fit and have no poor eating or exercise habits. This is absurd, as others have pointed out. BMI is no marker for good eating or exercise habits. We all know people who are thin but who eat crappy and rarely exercise. They are simply blessed with skinny genes, but that doesn't make them healthy, for heaven's sake! And there are a lot of fat people who eat a lot healthier than a lot of thin people, but because of differing genetics, they'll never be thin. That doesn't mean they need re-education camps or drastic measures. BMI is a lousy marker for habits, period.
- If their objective is to promote fitness for life, THEN THE REQUIREMENT SHOULD BE FOR ALL STUDENTS, WHATEVER THEIR SIZE. People of all sizes can benefit from a greater emphasis on fitness if it's properly done. I don't really object to the idea of a P.E. requirement for college because exercise is a good counterbalance to the mind exercise of academics, but if it's going to be part of graduation requirements, it should be required for all. Singling out only the fat students is wrong, and no one needs a scarlet letter F on their transcript. It's shaming and has potentially long-lasting discriminatory effects.
- If they are going to have a PE/fitness requirement, then it should only be about fitness and health (not weight judgments), and it needs to be accessible for people of different abilities. It needs to be a class that people of varying athletic talents can be successful at. If your objective is for people to want to exercise their whole life and thus be more healthy, they need something they feel successful at and can do joyfully. A fitness class in which students are lectured at negatively, shamed, or forced to do activities unsuitable to them or that they are really bad at is not going to acheive that objective. They need to seriously look at their objectives and see if their activities really dovetail to them.
- This course has great potential to backfire. College is a hotbed of eating disorders and this kind of approach may well worsen that. Is that really the kind of healthy outcome they are looking for? Is there a way for them to track whether they are achieving their objectives in the long-term, or whether they are actually making things worse?
- They assume that more exercise will automatically result in weight loss and less obesity. But as the wonderful Marilyn Wann pointed out (comment #32 in this article), "Science shows that regular physical activity magically makes people healthier; it does not turn fat people into thin people." I think many of us who have tried the exercise "cure" can attest to this. We should exercise because of the health benefits it can bring, but to promote exercise as a sure-fire way to weight loss is misleading and a good way to turn people off to exercising when it doesn't magically succeed in keeping all that weight off.
- Fat people face enough discrimination as it is. There are enough barriers in place to our success; we don't need to add more. Fat people of color face even more barriers. Do you really want to make it more intimidating for fat folk to go to college? Don't you think that a requirement like this would be humiliating enough to keep some people away from college? Think through the possible implications this class might have.
- This policy sets a precedent for other schools and you know that other fitness fascists at other schools are going to say, "Ahhh, what a great idea!" Now, some folks point out that if you don't like this college's policies, don't go there. But the problem is the precedent. Let it be "okay" in one place and soon enough all the colleges will have policies like this---or harsher. Taken far enough (and you know there are health fascists out there who would like to do this), this could lead to policies that might well keep a whole class of people---fat people---from access to higher education degrees or to a certain quality of university. Discrimination is discrimination and it shouldn't be in place anywhere. And especially not in a place of higher learning where the emphasis should be on academics.
My college had a PE requirement for graduation, but at least it was for all students, not just the fatties. I was still in my dieting years, so instead of the fun stuff like dancing, I took a fitness course in order to try and halt the strong weight gain I was experiencing (from PCOS and undiagnosed hypothyroidism, but that's another story).
The course was probably much like this course would be. The emphasis was on improving fitness and getting lots of exercise with a view towards encouraging life-long exercise. They didn't mandate losing weight, but we were weighed at the beginning and end of the class as part of their tracking of our progress.
I exercised more in that class than I ever did in my life (and I was not a sedentary child). We ran laps, ran up and down stadium steps like crazy, swam laps, biked, lifted weights, you name it. I was worse than my peers at things like running and stairs, but I was significantly better than most of my peers at things like bench press and swimming. Basically, I did OK.
All this time, I was also going to Weight Watchers in an effort to rein in my weight gain. But by the end of the semester, I had gained 25 pounds, all while doing a huge amount of exercising and being on Weight Watchers. (And no, it wasn't from muscle gain either.) The coach was so incredibly disappointed in me; I could see in his face that he thought I was lying about food and must have been binge eating like crazy. But no, I wasn't; not at all.
That was beginning of the end for me in terms of dieting. I still dieted for several more years, mind, but it was the beginning of the end of my belief in the validity of the formula of calories in/calories out, that if I just exercised more and ate less I could lose weight, and that it was all about habits, period.
I did pass the class, but thank God I took the thing pass/fail. If I hadn't, it would have messed up my GPA and might have lost me my magna cum laude status. I completed all the assignments and did everything they asked....but because I couldn't match some of the benchmarks of the skinnier people and because I gained weight instead of losing it, my grade was docked.
(Thank goodness the university let people take this PE stuff pass/fail! That way it couldn't ruin my college GPA the way it torpedoed my 4.0 GPA in high school.)
Sadly, the long-term legacy of the class was all negative. I went away with an increased hatred of exercise. I exercised less after that class rather than more. I went away with shin splints and some significant pain, and a real distaste for athletic trainers and gyms and everything associated with them because of their judgmental attitude. It had the opposite effect than they wanted and to this day, I still struggle with negative attitudes towards exercising. Even as I read all the research on the benefits of exercise and knowing I feel better when I exercise, I struggle with actually doing it sometimes.
So while I'm sure the coaches and administration of Lincoln University have the best of intentions, I'm afraid they may end up having quite the opposite effect they intended. Is that really a productive use of this course?
It's an alarming policy, no matter which way you look at it.
Monday, November 16, 2009
The previous Healthy Birth Practices we discussed were:
3. Bring a loved one, friend, or doula for continuous support
In my opinion, although this is helpful anywhere, this may be particularly helpful to women who are birthing in the medical model at a hospital, and especially women of size birthing in the medical model at a hospital.
Historic Birth Support
As the Lamaze care practice paper on Continuous Support During Labor notes, there is a long history of providing support for women during childbirth, but who provides it and how has changed over the years:
In times past, women learned about childbirth from their mothers and sisters. Stories and family traditions helped women to have confidence in their ability to give birth. Family members and women friends surrounded the laboring woman, offering her encouragement and support. Babies were born at home with a midwife.
Then, early in the 20th century, birth moved into the hospital. No longer could family or friends be present with a woman during labor. Nurses offered support, but they had to care for several women at the same time. Their responsibilities were divided among other patients, so the laboring woman was often left alone.
During the 1960s, Lamaze International and other childbirth organizations succeeded in changing the rules, so that fathers could be present in the labor room. Fathers give special, loving support to their partners and deserve to be there for the birth of their child. No longer did women have to labor alone.
Currently, women are rediscovering the value of having additional support during labor, especially from individuals who are experienced with and knowledgeable about birth. Women often assume that a nurse or midwife will stay with them throughout their labor. Sometimes this happens, but most often, other duties prevent care providers from being with only one person continuously.
So, bring a loved one, a friend, or a doula with you for continuous support during your labor. You will receive the emotional and physical support you need from one or more caring individuals. Before your baby’s birth, decide who will provide this support, and make a plan with them.The important thing to note here is that women have traditionally sought out and gotten labor support for a reason, because this support often plays an important part of helping a woman through labor and having a more positive birth experience.
Of course, there is no one "right" way to give birth. Different choices are right for different people. The important thing is that women have access to all choices, that they have adequate information about the pros and cons of these choices, and that when they make choices, their choices are respected.
However, labor can be stressful and emotional, and women and their friends and family are not always aware of the variety of care options available or the pros and cons of each. Therefore, it helps to have labor support personnel who are experienced with birth, knowledgeable about the variety of choices available during birth, and willing to support the mother in her birth wishes, whatever they are.
That's where a doula comes in.
What is a Doula?
A doula is a person who provides professional pregnancy and labor support. This is their career, so they tend to be more experienced, have more training, and be more educated about birth choices than a family support person might be.
A birth doula is a person trained and experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth.Some doulas only work during labor itself, but most doulas work with women before and just after the birth as well. They give emotional support and information as needed during pregnancy, provide support and encouragement during labor, and then give early post-partum and breastfeeding support.
Doulas do not make medical decisions for you and they don't intervene with the hospital staff. They are not there to tell you how to give birth or what your choices should be. It's up to you and your partner to make your own medical decisions and to advocate with staff on your own behalf.
Doulas are an important addition to overworked nurses and doctors who have a limited time with each patient. Partners, friends and relatives try to help out as best they can, but they may not have the experience or knowledge to help very well. Thus, doulas play an important role in helping "fill in the gap" in providing much-needed yet experienced labor support.
Common Concerns Over Hiring a Doula
When discussing hiring a doula, several concerns commonly crop up. These are usually based on misconceptions about doulas and what they do.
Too often, partners are expected to advocate for their loved ones with very little preparation. And because they are emotionally involved with the mother, they can become overwhelmed by the strong emotions a birth can bring and forget what they do know. That's why it can be helpful to have an objective and experienced eye to remember what questions to ask, what position changes may help, what techniques can help lessen pain, and what the pros and cons of a proposed intervention might be.
Another point is that the birth can be tough on the partner as well as the mom. A doula can be much-needed support for both the mother and the partner. She can help the partner remember comfort measures that might help in labor, she can give a second set of hands to help with rubbing and holding and other physical tasks, she can stand in while the partner takes a bathroom or meal break, and she can give much-needed emotional support to both the mother and her partner.
Another fear of some women is that a doula might be judgmental if they decide to choose an epidural, pain meds, or other interventions like induction, breaking the waters, or a cesarean.
The truth is that there are all kinds of doulas out there. Some do tend towards pushing a natural childbirth agenda, but others know that they are there to support the mother in whatever choices she makes. Many know how to optimally support a woman with an epidural, or how to make the best of challenges like induced labor. They should know how to roll with the flow and still help you find the very best birth experience under the circumstances, without judgment.
Also remember that birth sometimes carries unexpected surprises, and sometimes the person who really wanted an epidural doesn't have time to get one, or the person who really wanted a totally natural birth ends up with interventions. Having a birth attendant and doula that are flexible, non-judgmental, and who have a wide range of skills and experiences can be helpful in meeting the unexpected with grace and flexibility.
Another reason many parents don't hire a doula is the added expense. Doulas are not usually covered by insurance plans, and adding any extra cost during the expensive time of pregnancy and birth may not seem worth it.
Doulas vary greatly in cost, from very expensive to very cheap. Generally, the cost is several hundred dollars, but that may go up or down depending on how experienced your doula is, how much training she has, and the general cost of living in your community.
For further information about hiring a doula, contact:
- Doulas of North America - www.dona.org
- Birthworks - www.birthworks.org
- Childbirth International - www.childbirthinternational.com
- The Organization of Labor Assistants for Birth Options and Resources - www.tolabor.com
Click here for questions to ask when interviewing a doula. It's best to interview several doulas before you decide, and to take your time to be sure this is really the right person for you.
What Does Research on Labor Support Show?
Numerous research studies show important benefits to mothers and babies of continuous labor support by a loved one, friend, or doula. Labor support is a safe and effective practice with no negative side effects, yet the practice is underused (Sakala & Corry, 2008).
According to a review of studies from the Cochrane Pregnancy and Childbirth Group—a part of the highly respected, international Cochrane Collaboration that identifies best care practices based on research—continuous support for women during labor and childbirth is clearly beneficial (Hodnett et al., 2007). Study findings indicate that, compared to women who do not receive continuous labor support, women who receive continuous, one-to-one support are less likely to:
- have cesarean surgery;
- give birth with vacuum extraction or forceps;
- have regional analgesia (e.g., an epidural);
- have the need for any analgesia (pain medication); and
- report dissatisfaction with or negative feelings about their childbirth experience (Hodnett et al., 2007).
Because women of size tend to be subjected to more labor interventions and restrictions and have higher cesarean rates than women of average size, professional labor support is probably even more important for women of size.....yet some women of size may be hesitant about hiring a doula because they fear judgment about their size and needs.
Many women of size know all too well that society views their bodies with disgust and judgment, and makes many assumptions about how they "must" be eating or behaving simply because they are fat. Certainly this is often true in the medical community, but sadly, this is often also true even in the "alternative" birth community.
Women of size may fear that a doula will judge their bodies harshly, or they may feel embarrassed or hesitant about exposing their curves, sags, and bags to even more people. Or they may want to avoid yet another person who will assume that they have "bad" nutrition and exercise habits that "need" fixing. Or if they do have food issues, they may be embarrassed to discuss these and face the kind of moralistic judgments that often come from folks who do not have these struggles. Fear of judgment is one of the main reasons women of size don't take advantage of doulas more often.
Furthermore, knowledgeable support for the special needs of women of size is often lacking among doulas and labor/delivery nurses. They may not know how to physically support larger women during labor, they may not realize the tremendous importance of a correctly-sized blood pressure cuff, they may be hesitant to support women of size in laboring in water, they may not question some hospitals' protocol for encouraging internal fetal monitoring and early epidural for "morbidly obese" women, and they may not really believe that fat women are capable of birthing normally.
This may lead many fat women to choose to only have loved ones with them for support during labor. But although friends and loved ones can provide good support during labor too, they may have their own secret fears, concerns, or judgments about pregnant women of size.
Women of size need to know that there are doulas out there who won't be judgmental about their body, who won't assume that they have terrible habits simply because they are big, who won't try to "fix" them or sniff in disdain if they end up having a cesarean or less-than-perfectly-natural birth.
Continuous labor support during labor and birth can lower the risk for cesareans or other operative birth (forceps or vacuum extraction), it can lessen the need for pain medications and epidurals, and mothers who have continuous labor support report less dissatisfaction with their birth experiences.
Tuesday, November 10, 2009
Junonia carries a lot of great stuff in many ways, so I do generally recommend them as a company----but I've also been disappointed by some of their stuff before. Many things have been fine, but I've ordered more than a few things from them that really disappointed me...which is bad cause they are not cheap. And just when I find a type of swimsuit or fitness pant that I do really like from them, they discontinue it. Augh!
Lipedema -- sometimes spelled lipodema or lipoedema -- is a hereditary condition which causes patients (almost always women) to store excess fat in the lower body, particularly the lower legs.
Are there any other decent companies out there that specialize in sports, fitness, or cold-weather gear for women and have extended plus sizes? (I'm not talking about Lane Bryant or Roaman's or Just My Size, I mean companies that specialize in this type of item.) I'd love to have some more options to choose from.
Tuesday, November 3, 2009
Granted, I hate crew neck shirts because they feel too snug around my neck, and we probably do generally want a little more room in the neck than thinner folk.
Sunday, October 25, 2009
The second Healthy Birth Practice is:
2. Walk, move, and change position
Walking around, moving, and changing positions make labor and birth easier and more comfortable.
But far too often, women are stuck in bed during labor and birth with a fetal monitor and tubes all over the place and are no longer really able to move.
This needs to change---and nowhere moreso than for women of size.
Why It's Important To Stay Mobile in Labor
Watch a typical birth on TV reality shows and you'll see that most women who labor and birth in the hospital are stuck in bed. Although hospitals now allow more movement in early labor than they used to, by the time labor has progressed very far, most women are still flat on their back, semi-sitting on their behinds, or propped a little to one side. Very few are up and moving about. And even fewer push the baby out in any position other than semi-sitting with the knees pulled back or their feet in stirrups.
This reflects our modern medical culture's expectation that women should labor and birth reclining in bed, and this positioning is strongly encouraged by doctors because it is more convenient and comfortable for them to attend.
However, if you look at labor behavior in non-Western cultures, women tend to move around in labor a lot. They may labor standing, sitting, walking, dancing, leaning over, in water, or on all fours.
Some choose to give birth lying down in bed, it's true, but more often they birth upright in a standing, squatting or in a "supported squat" position (someone holding them in a semi-squat from above and behind).
Some women give birth leaning on a table or bed, or sitting on a special "birth stool" that keeps them semi-upright. Many homebirth midwives today have special birth stools that women can choose to use. Others create a birth stool-like position by having the dad sit on a chair, knees apart, and having the mother hook her legs over his knees.
Some women have a strong instinct to pull or push against something during labor, especially when pushing out the baby. They may give birth hanging onto a bar or dangling from a rope or a person's hands. This is not unlike the "supported squat" position mentioned above, only now the woman is supporting her own weight.
Some women find themselves pulled towards laboring or giving birth in asymmetric positions, such as walking up stairs, or standing/kneeling with one foot up and one foot down. Others "do the hula" and circle their hips a lot.
This lifts up one side of the pelvis and creates extra space for poorly-positioned babies to reposition and rotate more easily. If the baby has trouble negotiating its shoulders past the mother's pubic bone, some midwives think a kneeling lunge or the all-fours position is particularly helpful for resolving things.
Because it too helps create more space in the pelvis, many women are pulled towards laboring and birthing on all fours.
This is often helps lessen back labor, and may help turn a "sunnyside up" (posterior) baby to an easier position for birth. If the baby is large or its shoulders are a tight fit, this position may help them slip out more easily.
All of these positions are much more commonly seen in non-Western cultures, and also in non-technological approaches to birth here in the West.
Why do women birth in all these different positions? Cultural expectations play a part of course---but research shows that when Western women are given access to a room in which the bed is not the central feature and are encouraged to labor and birth as they feel most comfortable, most do not choose to birth lying down in bed either.
The reason that most women prefer to move around a lot in labor and birth is because it's physiologically sensible and logical. It helps them give birth more easily and more comfortably.
Their bodies intuitively tell them they need to move and so they do it. Even in high-tech medical model births where women are stuck in bed, many still try to move as much as they can, shifting in bed, rocking their bodies, turning to their sides, trying to arch their backs. In fact, women with an epidural may have better results pushing in a side-lying position than in stirrups because there is more mobility of the pelvis in this position. Yet it is often not even tried.
This is not to say that women should never give birth lying down or in the semi-sitting position. Actually there are times when lying down can help a baby get past the mother's pubic symphysis more easily, and of course, many women in the hospital do manage to give birth vaginally in the semi-sitting position despite its challenges.
It can be done--but most women, when given true freedom of movement, do not choose these positions for birth, and there are times when other positions probably facilitate birth much better than these. The point is that women should have the choice.
What Research Says and Why
Research shows that being more upright in labor shortens the first stage of labor (dilation of the cervix) and lessens the need for epidurals. Alternative positions may also help increase the pelvic space available for the baby
Gravity helps move the baby further down into the pelvis, putting more pressure directly on the cervix, which helps it dilate more quickly and evenly. Mobility also helps change the internal dimensions of the pelvis, creating a little extra room for a baby when needed. (This is a little like how, if your boot or your jeans are a bit tight, you wiggle back and forth to get into it anyhow.)
Lying on the back or in a semi-sitting position means that the tailbone basically gets pushed into the pelvic outlet, making the space available for the baby a little smaller. Because the woman is sitting on the bed, the bed prevents the tailbone from moving out of the way as the baby is coming out, and it compresses the pelvic outlet. When women give birth in more upright positions or on all fours, they often arch their back at the last moment, moving that tailbone out of the way and creating more space at the pelvic outlet instead of less.
Another concern with lying flat on your back or in a semi-sitting position is that it can compress the blood flow to the uterus, compromising baby's oxygen supply. In fact, doctors often warn women during pregnancy not to sleep or lie on their backs for too long---yet once the mother is in labor, suddenly this advice is no longer followed and women are left for hours in this position. Moving around freely keeps the weight of the baby and the uterus off of the blood supply to the uterus, and helps ensure a better continuous oxygen supply to the baby.
Movement is also the body's natural response to discomfort. Think about how people respond to pain in daily life. Animals in pain are often restless and move around a room. If you stub your toe, you hop about for a while until the throbbing subsides a bit. If you are too sick to move around a lot, you may rock back and forth to deal with the discomfort you are feeling, or shift position frequently.
Many women handle labor pain in the same way. Some relax deeply and become more motionless to handle labor pain, but many respond to labor pain by moving. They may shift position frequently, walk around the room, rotate their hips, push actively against the doorframe or wall, dangle from a squat bar or pull against someone's hands, or rock back and forth as they deal with the surges of labor contractions.
Being stuck in bed on your back makes it more difficult for your body to move in response to the pain and makes you more likely to need drugs for pain relief. Pain meds are not "bad" (and we can be glad they are an option when needed), but they do come with risks to the baby and the mother. It's much simpler and safer to reduce the need for pain medications by allowing the mother to move freely in response to her pain and her body's instincts, reserving the meds for when they are truly needed.
Furthermore, many women find that their bodies intuitively tell them how they "need" to move during labor and birth in order to best facilitate the descent and rotation of the baby through the pelvis. Many women feel the need to get up and move about, to go onto hands and knees, to lift one leg, or to arch their backs during labor. Often, well-meaning nurses discourage this kind of movement near the end of labor, seeing it as counter-productive to getting the baby out, when in fact it may be exactly what is needed to get the baby out. We simply need to respect women's instincts more.
This is not to say that mobility is absolutely forbidden in hospitals these days. There is progress from the past when many hospitals required women to lie flat for labor, using drugs and physical restraints in order to keep them immobilized. Many hospitals today recognize that movement in labor is beneficial and "allow" the mother to change positions, walk, use a birth ball, or even labor in water.
Many doctors will tell women that they can labor in whatever position they'd like---and the nurses will absolutely support that---BUT when it comes time to actually catch the baby, most doctors insist the woman be back in bed, semi-sitting, with her knees pulled back and her body curved into a "C" position.
Alas, this is only the best position for birth if you are the attending doctor. It allows the doctor to sit on a stool and catch the baby without discomfort. But it makes the mom essentially push the baby out "uphill," makes pushing both more painful and harder to deal with, and diminishes the pelvic space. How sad that the priority in hospitals today is on the comfort and convenience of the doctor, not the comfort, convenience, and health of the mother and baby.
The research on mobility during labor is summarized in the Healthy Birth Practice Paper: Walk, Move Around, and Change Positions Throughout Labor and its accompanying video:
When you walk or move around in labor, your uterus, a muscle, works more efficiently. Changing position frequently moves the bones of the pelvis to help the baby find the best fit, while upright positions use gravity to help bring the baby down the birth canal. The diameter of the pelvic inlet and outlet can increase as a woman moves around in labor....Ah, and that is the key.
Researchers who examined all of the published studies on movement in labor found that, when compared with policies restricting movement, policies that encourage women to walk, move around, or change position in labor may result in the following outcomes:
In fact, no woman who participated in any of the research studies said that she was more comfortable on her back than in other positions. No study has ever shown that walking in labor is harmful in healthy women with normal labors....
- less severe pain,
- less need for pain medications such as epidurals and narcotics,
- shorter labors,
- less continuous monitoring, and
- fewer cesarean surgeries
Walking, moving around, and changing positions make labor easier and safer...Lamaze International encourages you to plan to be active throughout labor, to practice labor and birth positions during pregnancy, and to choose a care provider and birth setting that provide many different options for using movement.
You must choose a birth setting and a care provider that not only "allows" but believes in the importance of mobility in labor and will do everything possible to help promote that.
Yes, "even" in women of size.
And therein lies the problem.
Mobility Restrictions Affect Women of Size Disproportionately
Even in hospitals that pay lip service to mobility in labor for other women, oftentimes "obese" women are not allowed the same freedoms.
In many hospitals, fat women are restricted to their beds--or if not outright restricted, strongly discouraged from moving about during labor. This is because of several erroneous beliefs or concerns about "obesity" and pregnancy.
Fear of Stroking Out
First, some care providers have the erroneous belief that all fat people have high blood pressure and are about to stroke out or have a heart attack at any moment. Even when a fat person's blood pressure is perfectly normal, care providers often believe that their high BP has simply yet to be unmasked and may well spike during the work of labor.
Because women with high blood pressure are typically kept relatively immobile in bed during labor, many doctors and nurses assume that fat women should be kept immobile in bed too, "just in case." But if the woman's blood pressure has been normal throughout pregnancy and is normal in early labor, chances are it will remain so, and keeping a woman of size immobile "just in case" is unnecessary and overkill.
Fetal Monitoring Issues
Another reason fat women tend to be kept immobilized is fetal monitoring issues. The baby of an "obese" woman is viewed as being at ultra-high risk for problems, so continuous electronic fetal monitoring (EFM) is often seen as obligatory in them, even in spontaneous labor with no drugs or pain meds (when EFM is usually not mandatory). This fear of problems for the baby is largely exaggerated, as the vast majority of babies of fat women do just fine--but in this litigious society, doctors tend to err on the side of interventions, even though continuous fetal monitoring has not been shown to improve outcomes.
Although theoretically, EFM should permit the woman to move around somewhat during labor, in practice it often means that the woman must lie still in bed in order to get an uninterrupted reading. Because women of size have extra adipose tissue that makes getting reliable EFM more difficult, they often have to keep extra still to get a reading.
Although telemetry (wireless) monitoring is available, it is usually not offered to women of size. Furthermore, because external EFM can be more difficult in women of size, an internal fetal monitor is often encouraged or even made mandatory for "obese" women in many hospitals. An internal monitor requires that the mother's waters be broken and a small electrode screwed into the baby's scalp. These wires go up into the mother's vagina, further restricting her ability to move around, and many women are told that once their water is broken, they are no longer allowed out of bed.
So external and internal fetal monitoring often are a big part of why women of size tend to have less access to full mobility during labor.
Fears of Falls and Worker's Comp Claims
Other reasons for restricting movement in women of size are fears about them falling, the strain on healthcare workers who might have to move them or help support their weight, and the financial burden of workers comp claims that might be filed as a result.
Although falls like this are quite uncommon in labor, the concern that a healthcare worker might injure themselves having to help a fat person is a common concern and has often been used to justify denying a woman of size access to waterbirth, to birth centers, and to movement during labor.
Barbara Harper, director of Waterbirth International, addresses the issue of denying fat women access to waterbirth based soley on BMI and fears of worker's comp claims. She says:
Stereotypes about Strength and Mobility Levels
When I teach the professional Waterbirth Credentialing workshop, I do address waterbirth BMI restriction policies and insist that hospitals treat each woman individually...I implore them to look at pre-pregnancy activity levels.
I have been successful in having the BMI policies removed from some hospital protocols, but not in others.
There is no available scientific evidence one way or the other, with the exception that we did a search in both the US and the UK to find workers compensation cases for back injuries in labor and delivery settings. There were some, but none related to water.
Holding the leg of a 300 pound woman while she is pushing is much harder than helping her in and out of the bath.
Many birth attendants also don't believe that fat women are strong enough or flexible enough to be mobile in labor. They don't encourage mobility because they've been programmed to believe that all fat people are unfit, weak, and sedentary, so why bother trying?
Unfortunately, these unconscious stereotypes about fatness also discourage medical staff from suggesting mobility and change of position options to their fat patients, most of whom could handle them just fine. Many fat women are far more flexible and fit than is commonly believed.
All of these factors combine to keep fat women in bed, on their back or semi-sitting, and strongly discouraged from moving around at all. Yet this may be the group that can most benefit from mobility in labor in many ways.
Why Mobility in Labor May Be Even More Important in Women of Size
No one has ever really studied mobility in labor in an "obese" population, so it's difficult to conclusively prove that mobility is important in this group. However, if it is helpful in women of average size, there is no reason to believe it wouldn't also be helpful in women of size.
Anecdotally, "obese" women who have had access to full freedom of movement during labor and birth usually report having fewer cesareans and fewer other problems compared to their previous births in which movement was restricted. (This was certainly true for me and a number of women of size I know from ICAN.)
Now, that's only anecdata at this point, but many women of size and their birth attendants find they achieve better results when they move freely and use non-traditional birthing positions. Waterbirth in particular seems to be VERY helpful to many women of size because the water buoyancy makes it easier for them to shift positions and maintain them with less stress.
One thing that many doctors worry about in fat women is the dubious concept of "soft tissue dystocia." Basically, this means that they worry that extra adipose tissue "down there" will make it harder for a baby to fit through easily. Many (in all seriousness) blame the higher cesarean rate in "obese" women on soft tissue dystocia (or "fat vaginas" as some doctors call it).
Ironically, almost no research has been done on "soft tissue dystocia" to see if it really is a valid concern or not, but doctors everywhere have been trained to believe it with every ounce of their being. A minor detail like lack of proof makes no difference. (I seriously doubt its validity as a real factor for fat women, but that's a whole 'nuther post.)
But let's pretend for a moment that soft tissue dystocia might be real, and that a fat vagina might reduce the pelvic space available to push the baby out. IF that were true (and that's a big IF), then mobility in labor would be even more important for "obese" women because it could open up the pelvic dimensions and give their babies a little more room to get out. It might make the difference between a cesarean and a vaginal birth, or a shoulder dystocia and a normal spontaneous vaginal birth. Every centimeter counts and mobility in labor can help add a little extra room that might make a difference.
And yet, fat women are the ones least likely to be given access to full mobility in labor. Ironic how the logic is so inconsistently applied, isn't it?
If you are pregnant, the most critical issue is to find a care provider and a birth setting that is supportive of you moving around as needed, whatever your size, and which will encourage you to labor spontaneously as much as possible (which will help you retain the ability to move freely).
Major red flags would be facilities that require or strongly encourage"obese" women to have constant EFM (especially mandatory internal monitoring), have BMI limits on access to waterbirth or other "alternative" modalities, or who assume that you will be induced and/or "need" an epidural because of your size. These are not birth settings where you will be encouraged to be as mobile as possible, and you are likely to have a higher risk for a cesarean under these conditions.
However, some hospitals and birth centers (and even homebirth midwives) talk a good game but
it's only lip service. In the end, some don't really support full mobility or spontaneous labor for fat women either. These have to be a little more carefully vetted because they can be wolves in sheep's clothing, pretending to be something they are not.
Tour the hospital and birth center and see just how many woman in labor are out walking the halls, ask how many use the tubs to labor in water, and how many have full mobility not only in labor but to actually push the baby out too. Ask your care provider what the weirdest position is that he/she has ever caught a baby in, and how often women in his/her care give birth in any position other than semi-sitting. Ask to interview former clients and see whether they felt they were encouraged to be truly mobile in labor.
If you observe carefully and ask a few open-ended but pointed questions, you'll be able to find the providers who truly support mobility and spontaneous labor instead of the ones who just give lip service to it. That won't guarantee you a better birth, of course, but it's a good step on the journey towards it.
Graphics from Wikimedia Commons or excerpted from www.transitiontoparenthood.com/ttp/foreducators/arthome.htm. (Many thanks to Janelle Durham for making these latter illustrations and information available freely!)