What You Look Like on the Outside is Only Half the Story!

Kate vs Kim

What were your expectations about how you would look while pregnant? Maybe you were hoping that you’d look like Kate whose picture gets plastered on the front of magazine covers in the checkout aisle with a tiny arrow pointing out her adorable little “baby bump.” Maybe you really look more like Kim and now you’re feeling frustrated because your baby bump is neither little nor adorable! I can’t believe that I actually have something in common with Kim Kardashian, but apparently I do! We both “carry big.”

If you’re not careful, this can lead you down a path of negative thinking about your body just by virtue of how you carry the baby that’s inside of you. I want to talk about your amazing body – no matter what size it is – because what you look like on the outside does not tell the full story of all that is going on in the inside.

It’s important to change your negative thinking about this sooner than later. Stop agonizing about how “fat” you’re getting and instead start appreciating all that your body is doing to accommodate your growing and developing baby. Hopefully, this will lessen your anxiety about how you look, and more importantly, lessen your fears about not being able to give birth to “a really big baby.” These fears are only heightened when you listen to the misinformed opinions of others who make predictions of the size of your baby based on how you look on the outside! You might start to consider an induction to avoid giving birth to a baby you’re afraid won’t fit.

A thorough search of the ACOG Guidelines (American Congress of Obstetricians and Gynecologists), found no mention of suspected large baby as a medical indication for induction. In fact, in their paper “Safe Prevention of the Primary Cesarean Delivery” they state:

Suspected Fetal Macrosomia (Suspected Big Baby)
Cesarean delivery to avoid potential birth trauma should be limited to estimated fetal weights of at least 5,000 g (over 11 pounds) in women without diabetes and at least 4,500 g (9.9 pounds) in women with diabetes. The prevalence of birth weight of 5,000 g or more is rare, and patients should be counseled that estimates of fetal weight, particularly late in gestation, are imprecise.

If women are of normal weight pre-pregnant, the suggested range for gaining weight during pregnancy is 25-35 lbs. For underweight women, the range is slightly more, 28-40 lbs, and for women who are overweight or obese the range is less,15-25 lbs and 11-20 lbs, respectively. Many women gain outside this weight range – and I like to use myself to illustrate this point.

My husband is a testicular cancer survivor, diagnosed only 6 months after we were married. After 18 months of chemotherapy, surgeries and other treatments, we weren’t convinced we could even get pregnant. I was just finishing the gig of being his full-time caregiver when I was surprised to find out that I was pregnant! There was no established exercise regimen – at all. I ate well and eventually I did a little bit of pre-natal Yoga and some swimming, but nothing strenuous. Over the course of my first pregnancy, despite being considered normal weight going in, I gained 45 lbs.

With my second pregnancy, I was chasing after my 2 year old. Now, if you’ve ever spent a couple of hours with a toddler than you know that it’s quite the cardio workout! Again despite normal weight going in, I still ended up gaining 45 lbs.

Before getting pregnant with my 3rd child, I’d been seeing a personal trainer. After becoming pregnant, I continued to work out at the gym three times a week until I was about seven months into my pregnancy. And… I gained 45 lbs.

With my fourth and final baby, I had completed a couple of half-marathons, and had discovered Boot Camp classes! I continued to work out in my Boot Camp class three times a week until I was 36 weeks along. Guess how much weight I ended up gaining? Yep, 45 lbs!

Apparently, no matter what kind of exercise program I’m doing while pregnant, my body thinks it has to gain about 45 pounds in order to give birth to a healthy baby. But even though I was 10 years older with my 4th baby, my pregnancy, birth and recovery were all easier than any I’d had before! Why? Because I was in much better shape than I’d been with the other three. (Disclaimer: This does not mean you should start taking a Boot Camp class while pregnant! And if you haven’t yet had any exercise during this pregnancy, don’t beat yourself up about it. Walking, swimming and pre-natal Yoga are fantastic ways to prepare for the birth of this baby and all of them can be started at any point in your pregnancy. These simple and joint-gentle exercises help you build up stamina for the hard work of labor ahead – and they’ll also make you feel good now.)

So, if they’re not interested in embarrassing you every time you step on the scale at your clinic visits, why does your provider insist upon weighing you? Because they need to track your weight gain from visit to visit. If you have a significant jump in weight, or you gain very little or no weight at all, these could be indicators for your provider to check on your baby’s development. For example, if you end up not gaining enough weight, you could end up with a baby that has a very low birthweight. If you end up gaining more than what is recommended, you could be at higher risk of having high blood pressure or gestational diabetes. It is important to be mindful of your weight gain.

But I think what surprises women more than how much weight they gain, is how they actually look during pregnancy. If you’re a woman who has a longer torso in comparison to the rest of your body, then you might be able to sneak that baby up and inside of you for most of your pregnancy. You really are one of those women who has a tiny baby bump! But believe it or not, there’s a downside to this. People ask if your baby is okay, or if they’re developing properly because you “look too small to be carrying a healthy baby!” Or they just don’t believe you when you say you’re pregnant!

I had the opposite problem with all of my pregnancies. Maybe you’re like me and my BFF, Kim. I have less than a couple of finger widths between my hips and ribs. There’s very little room for my baby to hide and there’s nowhere for my baby to go but out. People always asked me, “Are you carrying twins?” or “You have how much time left?!” And while fielding these questions is annoying, those of us who “carry big” run the extra risk of buying into the idea that our babies are huge and there’s no way we’ll be able to deliver them vaginally.

You need to stop that train of thought – now. Inside of you, there are many things at work not visible to the eye that should provide a sense of relief and a solid belief that you can give birth to the baby inside of you – no matter what you look like on the outside.

When you were first seen by your provider and they performed that lengthy and uncomfortable pelvic exam, one of the things they were trying to determine is whether there were any concerns about the size and shape of your pelvic structure. If any anomalies were discovered (which would be rare) a Cesarean birth would have already been discussed. It’s safe to assume that your pelvis is just fine size and shape-wise.

But if you still find yourself catching your reflection in the mirror thinking – “How can I possibly deliver a baby this big?” or secretly measuring your partner’s head while they’re sleeping, then remember what’s happening inside your body that will help you give birth to whatever size baby you’re carrying.

There’s a hormone coursing through your bloodstream during pregnancy called relaxin. Relaxin, which is 10x more prevalent in pregnancy, has many properties, but is especially helpful for birth. Relaxin has a softening and widening effect on your cervix and it also relaxes the ligaments in your pelvis creating some “give” for when your baby is passing through during birth. In addition, your baby’s skull is made up of five bony plates that mold together as the baby’s head passes through and out your birth canal. This allows for the smallest circumference of their head to be moving through the birth canal at any one time.

The combination of your pelvis being plenty big enough to birth a baby, the hormone relaxin on board to loosen the ligaments in your pubic symphysis, your baby’s ability to mold its head to fit the space, and the addition of positions in labor that provide even more space for all the twists and turns your baby needs to make on their way out – translates to most women being perfectly capable of giving birth to whatever size baby they have within.

Toward the end of your pregnancy, many people – including your provider – might try and tell you what size baby they think you’re carrying. They might do this by palpating your belly at a prenatal visit but at best, it’s only a guestimate. Some studies show that even when an ultrasound is used to estimate fetal size, the measurement can be off by a pound or more in either direction!

I know a woman from my classes who went through an induction for a suspected large baby, and after a cascade of interventions which ultimately lead to an unexpected Cesarean delivery, she gave birth to a 7 1/2 lb baby! Not exactly the 10+ pound baby her provider guessed it would be if she went to full-term.

Try not to compare your body with other pregnant bodies that you see in the world. Understand that your uterus can expand anywhere from 50-75x it’s original size to accommodate your growing and developing baby. And even though your uterus was considered a pelvic organ before you were pregnant, once the baby gets big enough it becomes an abdominal organ. Depending on how much space you have between your hips and ribs, that baby might have nowhere else to go but out.

Now is not the time to think of your changing body as getting “fat” – this is the time to celebrate all of the amazing things your body is doing to bring a healthy baby into this world. Celebrate those changes! Find some time to give your body and your self-image some much needed TLC.

And remember, whether you’re a “Kate” or a “Kim” what your body looks like from the outside means little compared to what it is capable of doing from the inside!

Did you have a hard time with your changing body while pregnant? Did you feel “too small” or “too big?” How did you handle the comments of others, from your friends, provider or even complete strangers? Did what you looked like on the outside actually translate to you having a “big baby?”

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4 thoughts on “What You Look Like on the Outside is Only Half the Story!

  1. Amen! (Relating to so much, including the pregnancy weight gain and short torso.) I am so glad you write, Barb. You are a wise, gracious, sane and loving voice in the midst of all the doubts and comparisons. This world needs your words. Love you, sister.

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