The Real Impact of Weight Bias in Pregnancy with Jen McLellan

Introduction and Welcome

Britta: Hello folks and welcome to Transformed by Birth, a podcast about the rite of passage of pregnancy, birth and new parenthood. I'm your host, Britta Bushnell, author, mythologist, childbirth educator and all around deep diver with a side of goofball. I'm so glad you're here. Today's episode addresses size bias in pregnancy, so grab your comfy beverage of choice, or take us along for a walk as we connect with Plus Size Birth founder and speaker Jen McLellan.

Britta: Before we begin, we start the way we always do by lighting a candle. If you want to join me, please do or just take a breath as I light mine. Today is a candle to honor and acknowledge pregnancy in bodies of all sizes. Pregnancy is a time of transformation and change. One aspect that's changing is our body's shape and size, as well as the way we feel in our body. These changes can bring about a ton of feelings, from shame to exquisite joy. How we feel and inhabit our own body is not a singular experience across the board, and expanding our understanding of how pregnancy and birth are experienced differently is critical to improving how it can be improved and navigated for everyone. And the experience of navigating pregnancy in a larger body comes with an extra layer of complexity that shouldn't exist, but does. Weight bias in healthcare is real. The assumptions about risk and negative messages, both subtle and overt, can make plus size parents feel like their bodies are problems to be managed, rather than beings of strength and capability. My guest today has spent years working to change that narrative and improve conditions for all bodies navigating pregnancy and birth.

Introducing Jen McLellan

Britta: Jen McLellan is a certified childbirth educator, published author and founder of Plus Size Birth, and host of the Plus Mommy Podcast. With over 8 million page views, Plus Size Birth has become the premier plus size pregnancy resource, trusted by parents and professionals alike. Her work has appeared in The New York Times, Glamour, and CNN, and she's spoken everywhere from the National Institutes of Health to TEDx Albuquerque. One aspect of what I love most about Jen's work is the transformation she facilitates, helping plus size parents shift from fear and self-doubt into trust, self-advocacy and confidence in their bodies. She helps people unlearn harmful messages about weight and pregnancy and reconnect with their own agency. And increasingly, she's training perinatal professionals to unpack their weight bias so they can offer more respectful, size-inclusive care. I can tell you, she has helped me do better too. Whether you're navigating pregnancy in a larger body yourself, supporting someone who is, or working as a perinatal professional who wants to provide more respectful and better care, this conversation offers both practical guidance and a necessary perspective shift. Also, full transparency — Jen is actually my Director of Operations here at Transformed by Birth, and Jen is a huge part of what makes this podcast and my work possible. Getting to work with her is one of my greatest joys. Okay, I'm gonna try not to tear up. I am so thrilled to share this conversation with you. Welcome, Jen. I'm so glad we're finally doing this together.

Jen: I am too. Thank you so much, Britta, for having me, and the feeling is absolutely mutual.

The Reality of Plus Size Pregnancy: BMI, History, and Why This Conversation Matters

Britta: So before we go too deep into our love fest, which I know we can do, I want to get really right into this conversation that is so important. I want you to share the reality of what plus size parents are facing, as well as what are some of the challenges and why is this conversation so important for us to have?

Jen: Yeah, let's do it. Let's dive in. I know when we think about plus size pregnancy, sometimes it can feel really abstract — like, what does that really mean? And when we think about it, it's really BMI, body mass index, that is still so used in our medical community to classify people into different categories of health. But we also know that that was created in the 1800s by a mathematician to find the ideal human.

Britta: Okay, wait, wait, wait. Let's just pause right there. A mathematician determining a measure for health.

Jen: But they were only looking at white men, Britta. So the BMI — yes, I know. So that's why when people see articles like "BMI is rooted in racism," and people are like, "No, it's not" — yes, it literally is. In the 1800s a mathematician was trying to find the ideal human, the ideal weight, only looking at white men. And now still to this day, we use BMI to categorize health. And when we look at how that impacts pregnancy, it's about 30% of people who can become pregnant who have a BMI over 30. So this isn't a small percentage. We need to be having this conversation far more often — and not only about pregnancy when it comes to BMI, but BMI restrictions limit access to different elective surgeries. I say "quote unquote elective," but like knee replacement, that can be debilitatingly painful for people — life insurance, health insurance, gender-affirming healthcare. This is a really important conversation to be having, so thanks for having it with me.

Britta: Oh, absolutely. And so there are some unique situations around childbirth, pregnancy, and postpartum that also fall under the umbrella of weight bias in healthcare. So can you unpack a little bit about what is the unique intersection of weight bias and perinatal care?

Weight Bias and Perinatal Care: Elevated Risks and Assumptions

Jen: Of course. So as we know, everyone going into pregnancy has risks, right? There's not one risk that only impacts people in larger bodies. But when we look statistically, there are elevated risks for pretty much everything if you exist in a larger body. We know that people in larger bodies can have higher rates of gestational diabetes — when maybe they went into pregnancy already having some blood sugar issues that may or may not have been identified — or high blood pressure issues. The problem and the concern is that a lot of studies that we have around high BMI in pregnancy — there aren't studies overall that look at low-risk healthy individuals with a higher BMI. So we can have people of all sizes that are low risk. But if you exist in a larger body, you're very often treated as high risk, just purely based upon your BMI. So what that means is sometimes not having access to the midwifery model of care, which we know reduces the Cesarean birth rate. And people in larger bodies — the greatest risk they face really is Cesarean birth. Very high statistics around Cesarean birth.

Britta: Can I ask how much of that is — can we look at and say that a provider sees somebody in a larger body and just thinks that this isn't going to work — putting that in air quotes — that a vaginal birth isn't going to work because of what they see? And that's where that bias comes in, making an assumption about the health and vitality and ability of the person in the body in front of them. Is there some of that? Is that accounting for some of it?

Jen: Absolutely. I started doing this work in 2011 following my own empowering experience, and I was screaming this from the rooftops. I remember making memes — before I think they were even called memes — about weight bias against people in larger bodies resulting in this astronomical Cesarean birth rate. But there were no studies specifically around weight bias in healthcare until 2020. 2020. And it was wonderful to interview some of the researchers that came out with this data basically confirming everything that I've been screaming for over a decade — not just me, so many people — and so many people who have lived experiences of weight bias. Being told on their first prenatal visit that you need to have a cesarean birth just because of your size. But not only that, Britta — and this is a very small percentage, doesn't happen often — but even people being told that they should have an abortion because of their size. And again, I think we have these sensationalized TV shows — My 600-Pound Life and all these other shows — and everyone, regardless of size, deserves dignified care. But I think that's where we start to think about what size someone in a larger body is during pregnancy, and where we start to have these things being said. But I've heard stories of people under 300 pounds being told this purely based upon what they look like and their BMI. And again, everyone deserves dignified, compassionate care. But this is a true, true issue that is impacting far more people than I think we realize.

Britta: What about one in three? Yeah, of the population that can become pregnant. So walk me through — what are some of the ways that weight bias shows up for somebody who is coming in? You were just saying there's the possibility that a provider immediately starts thinking of them as being somebody who needs to have a particular type of birth based on what they're seeing. And I imagine — you know, this podcast is about transformation, so it's not just about the external, but also the internal. I'd love you to help us — me and the listener — feel into the emotional toll, the emotional weathering that can start so early in a pregnancy journey from the examples you just gave. What is it that happens for some folks? What are the things you want providers to know about that they can change and improve — not just the physical sensation and journey of somebody in a larger body moving through birth, but the emotional and transformational aspects?

The Emotional Toll: Representation, Visibility, and Feeling Seen

Jen: I mean, let's go back even further. I'd love to share what I'd like to have providers hear, but especially for any listeners that aren't providers, or someone who doesn't even exist in a larger body — let's start at the beginning of what it is like to be pregnant in a larger body.

Britta: That's kind of where I was hoping we'd go.

Jen: You go online and there's not a lot of positive information, which is why I started my work all these years ago. I remember searching Google Images — pages and pages and pages trying to find an image of a body that looked like mine pregnant, and I couldn't find it. There weren't really positive resources from medical organizations. It's all focused on the risk. That has slightly changed, and I can share what the National Institutes of Health put out, but it's still to this day so much focus on these increased risks. And going into pregnancy thinking, oh, well, then I'm just going to have a high-risk pregnancy. And it's not just that assumption — it's a societal belief too. Because people, loved ones, will say, "Well, you know, you're going to get gestational diabetes. This is going to happen," or, "Should you even be pregnant?" So you're not seeing yourself represented, you're not feeling the support. You go on pregnancy apps and they say, "Oh, you should start showing." But for people who exist in larger bodies, quite often they show a little bit later. They feel movement a little bit later. It's just a little bit of a different journey, but their body is still growing an amazing human, doing incredible, transformational things. But you don't feel like you are represented, and that makes you feel like there's something different.

Britta: From an early place. And societally — we're not even talking about healthcare. We're talking about here is the standard of what you should be experiencing. Well, not for me, in the body that I'm in. So where is the variation? One of the things that I love to talk about is ranges of possibility, rather than hard-and-fast truisms that people offer as if they are true. And so you're saying that even that is showing up early in the process.

Jen: Oh yeah. I used to — I'm dating myself — I used to show a range of pregnancy magazine covers, right? And there's really no representation there. But there's no representation in many ways. And that's something else that we need to very clearly state, is that people go into pregnancy with multiple marginalizations. So someone can be in a larger body, and they can be Black, and they could be trans, and they have so many underlying marginalizations where the healthcare industry — we know statistically things happen, and harm happens, and poor outcomes happen. We even had recently, I'm pretty sure it was ACOG, come out with a statement saying that Black people with a high BMI are at a higher risk of stillbirth, and that racism can be an underlying cause of that. But this is only recently being stated. So we think it's really important, whenever we talk about plus size pregnancy, to also address multiple marginalizations.

Multiple Marginalizations and Cumulative Healthcare Trauma

Jen: And then that does cross over to healthcare — many people go into pregnancy with cumulative trauma in healthcare. Many people of size have spent their relationship with healthcare with only one thing focused on, and that's their size and their weight. And so I always encourage any perinatal professionals: while you're unpacking your weight bias, and you might be the most incredible size-friendly doula there is, there's often for many people a mistrust already the minute they see a provider or a doula or whoever it is, because there has been so much shame and harm. So that's another reason why it's so important that we're having this conversation and working through our own biases on many different levels.

Britta: Yeah. Okay, so keep going on — what are some of the things that somebody in a larger body might be experiencing as they move through their pregnancy?

Jen: Where can I find cute maternity clothes? Like, it's so difficult and so frustrating. Nursing bras, belly bands — all of that stuff is still, to this day, hard to find.

Britta: What about carriers?

Jen: Baby carriers? I mean, you've had the amazing Laura Brown on your show, and I have too. And so there are size-inclusive carriers that are wonderful now, but you don't know what you don't know. I remember when I was pregnant, going to a facility and squeezing my body into this area that really didn't fit, and I'm sure it was putting marks on my back, but I just wanted to feel like everyone else. And I think that's a real thing that people experience — like, I want to be pregnant too. I want people to come up to me, strangers, and ask to touch my body — and not so often, because people don't feel like they have that pregnancy experience that we see in movies. I know that once we realize that's not really the experience that people have — but for some of us, it's what we want. You want an obnoxious band on pants that keeps rolling down for your belly because everyone else has that. And then when it doesn't come in your size, it really starts to impact your self-esteem around pregnancy.

Jen: And then you go into the health space, and you can be treated differently, or be told you need to do this, you need to do this, without a really full explanation of what those risks might be. Why are we encouraging you to have a gestational diabetes test very early on in pregnancy? It's like, "Okay, you need to do this." And really, they're trying to see if you're already diabetic or pre-diabetic. But very often that isn't fully explained. And so then later on in pregnancy, when everyone's being tested for gestational diabetes, you're like, "Oh wait, I already passed that." They're like, "No, no, you need to take it now." So there's just a lot that is even evidence-based recommended where there isn't a full conversation — it's just like, "You need to do this." And I think that's pretty common for people of all sizes, but it's really frustrating and hard when it feels like you're being treated so differently.

Jen: And we know that there are studies that show this early testing for gestational diabetes isn't having the outcome of catching things earlier and helping with better outcomes as was assumed. We also know that it can take about 17 years before something is proven in studies to be evidence-based before it's implemented into medicine. And that can relate directly to labor — people in larger bodies, the first stage of labor is longer. We know it's statistically longer, and we've known this since about 2013. And we're just now having an extended period of time instead of saying "failure to progress, you need to have a cesarean birth" — we just need a little bit more time.

Relative Risk vs. Actual Risk: Reframing the Statistics

Britta: So there's clearly a lot of different ways that weight bias shows up in the pregnancy experience — from outside of a provider's office all the way into a provider's office. In mainstream media, in books, in Instagram accounts and all kinds of things. And I know that part of what your work does is look at some of the opportunities that pregnancy can offer for changing some of the messaging that we've ingested in our lives. There are harmful messages about weight and pregnancy and all of that that we need to unlearn. And you like to help folks do advocacy. Can you talk about some of the ways that you support that transition — that transformation, if I can use that word — from fear and self-doubt into what? What is it you like to help folks do instead of fear and self-doubt?

Jen: Normalizing the pregnancy experience, right? Like providing resources on where to find those obnoxious belly bands that fit your body. Working with brands — I've worked with some brands in the past on how to be size-inclusive. Really talking and breaking down what increased risk really means. For gestational diabetes, for example — and sorry listeners, if I get too heavy on statistics, but I think it's important to talk about relative risk versus actual risk. Let's unpack it. If we look at — Britta and I are not having babies anytime soon, but Britta is on the grandparent train and I'll get there at some point — but when we were younger and having babies, if we were just to have Britta and Jen standing side by side and looking at our risk, Britta's risk factors versus Jen's, that is called relative risk. And Britta's risk factors would be lower than mine statistically — about four to five times. I have an increased risk of gestational diabetes, existing in a larger body, than someone in a smaller body like Britta. And so relative risk is what we always hear in the news: "four times more likely, five times more likely," and it sounds terrifying. Like, oh my gosh, does that mean I have like a 40 to 50% increased risk more than Britta? No. It's looking at relative — just comparing one factor, one set of statistics, to the other. But when we look at the actual risk of someone in a larger body incurring gestational diabetes, it's about 17%.

Britta: Still quite low.

Jen: Yes, yes, yes. So what I teach and encourage is: let's flip the script. That means you've got about an 87% chance of not incurring gestational diabetes. And by the way, this number isn't fixed. We all go into pregnancy with different underlying factors. We also have studies to show things like nutrition and physical activity can reduce our risk even more. So I try to teach: let's empower people with evidence-based information. I'm not afraid of the evidence. I'm concerned about how it's presented and the pool of people that we're pulling these statistics from. When I spoke at the National Institutes of Health, they're like, "What studies do you want?" And that's when I said, I want lower-risk people in larger bodies, which overall is more likely to show the trajectory of pregnancy accurately. Because it is my fear — whenever ACOG, the American College of Obstetricians and Gynecologists, comes out with their committee opinion on higher-weight pregnancy, I'm always afraid that they are going to classify people as high risk. But currently they do not — a transfer of care is not necessary unless people do become high risk. But care providers set their own guidelines and safeguards, and so often people are labeled high risk from the very beginning —

Britta: Simply by existing in a larger body.

Jen: Because facilities can set their own guidelines and safeguards. So anyone listening — it's a good thing to ask in advance before showing up, especially at a birth center. It's very common for birth centers to have BMI restrictions.

Britta: And yet, here we are. You also just said that when you flip the script, there's an 87% chance you won't have gestational diabetes — for example — just as an example.

Jen: And when we look at stillbirth — stillbirth is something that we know for people of all sizes during pregnancy, the conversations around it almost encourage people to make choices that they didn't necessarily want to make, sometimes around induction. There's some fear-mongering there. But for people in larger bodies, they're told your risk is far greater, and that is terrifying.

Britta: Everybody — everybody I've ever worked with who is pregnant has that little seed in their fear belly that's like, oh, I hope this doesn't happen to me.

Jen: Of course, of course. Would you know that statistically, it's still under 1%?

Britta: And yet that seed can get watered and have the fear grow with conversations that are unhelpful.

The "Fat Vagina" Myth: Debunking a Harmful Theory

Jen: Yeah. And talk about unhelpful conversations — one of the most horrifying things I heard early on in my work was people being told their vagina was too fat to birth their baby.

Britta: Okay, well, we just took a hard right turn. Let's talk about that — so that a vagina can be too fat to birth a baby vaginally?

Jen: Yes. And I'm glad we can be candid here, because I called bullshit on that early on, and let's unpack it for a minute. Because if someone is told their vagina is too fat to birth their baby, it's not just that one conversation behind closed doors. It's how they feel walking out, how they feel not only about their ability to birth their baby, but their body in general, their intimacy with their partner from here on out, their self-esteem, and the way they teach their kids about self-esteem. Like, this is horrific. And I was just so upset by this. And I've heard — a handful of stories, it's not just one person — who have said this. And also, you can Google the "fat vagina theory." There have been articles about it. But I called bullshit on it, so I actually hired a researcher — the same researcher that Evidence Based Birth uses — to dig into this. Because I'm like, I gotta pay for this. I need to know that this is not true, because this really bothered me so much. And in fact, what we found is that yes, while the first stage of labor is longer for people in larger bodies — so that's why there was this assumption of, oh, it's taking too long, failure to progress, and then some care providers assuming because the vagina is too fat — oh my gosh, it's actually the second stage, pushing, that is shorter for people in larger bodies, statistically. So that negates this theory completely.

Jen: And I think of you, Britta, and all your work around mythology. And what I can see now — we're recording on video — are these beautiful, voluptuous figures pregnant that we've always had. Pregnancy has existed in a variety of sizes, skin colors, abilities throughout all of human history. People have always been getting pregnant. And so it's really speaking up against bias and encouraging people to ask questions early on in pregnancy, to ensure that they've done the very best they can to connect with a care team that isn't making assumptions based off of just a person's size. One way to do that is to ask, "Do you have any guidelines around what medical recommendations you're going to make and encourage me to do during pregnancy and birth? Let's talk about them." Because sometimes, yes, there are some recommendations — like, even that early gestational diabetes test isn't necessarily a red flag. But if someone says, "Oh, I'm going to recommend an induction because you have a BMI over 30" — well, if that's what you want, I fully support you having that induction. But if that's not what you want, then maybe that care provider isn't the right fit for you. And that really goes for everyone. But the difference is, when you go online and do research during pregnancy in a larger body, most of the stuff you're going to find is negative, and it's going to lead you to believe that, oh I guess, yeah, I should be having induction, or maybe even I should have a cesarean birth.

Self-Advocacy: Navigating Care as a Plus Size Parent

Britta: So, yeah. And yet I'm imagining that one of the things that's really challenging is navigating what are the real risks or added concerns versus discrimination or bias. How do you help folks move through and navigate that — especially in pregnancy — because you've also got all the added layers of concern as well as the added layers of newness. Because when you're navigating going to a gynecologist, in a body like mine and yours, it's like we've been doing that for years and years. So there's a certain familiarity, even if it's not necessarily always super fun, or we're facing bias in there. But you add in pregnancy — especially a first one — and the stakes feel like they go way up. How do you help people with effective self-advocacy and navigating those differences?

Jen: Like when you walk through the door of your medical facility — in the lobby, are there chairs without arms? Are there places where you can feel comfortable? When you're walked to the back and being weighed, if you don't feel comfortable being weighed or you want to stand backward on the scale that day, is that supported? When you go into the exam room, is there a place for you to sit comfortably and with dignity that isn't just on the exam table? And if you're sitting on the exam table, does your gown fit fully, or does it not? And then you're partially exposed. And when you are partially exposed, it's really hard to advocate for yourself.

Britta: And to feel dignified.

Jen: And to feel dignified. And when they bring out the blood pressure cuff — is it the cuff that fits your body? Now, everything that I've just talked about is really inexpensive to fix. That's what's so frustrating to me. I mean, we can talk about monitoring, and that can get really expensive. And there are monitors like the Monica Novii that's designed for people in larger bodies. But a blood pressure cuff — an adult thigh blood pressure cuff, which is what you often use for people with a much larger arm — is like 20 bucks. Probably even cheaper from a medical supply store.

Britta: So if a provider has some of these things, it can kind of be a nod toward — oh, somebody's paying attention.

Jen: And I have a whole language framework for professionals on talking to people in larger bodies. But how are you being talked to? What language is being used? Is everything revolved around your size? Are there assumptions being made? Because very quite often, I hear from people that they're not even just being tested for gestational diabetes early on and then when everyone is — but multiple times. And just this belief that they must have gestational diabetes tends to be the one that gets harped on the most. So people are being tested like three and four times.

Britta: Where folks in a smaller body are being tested once. Yeah. And it's almost like providers looking to see what they are sure is already there. That bias.

Jen: Unfortunately, we know statistically we've got about 50% of physicians that look at larger bodies as slow, ugly, non-compliant. And that non-compliant thing — I mean, they all bother me, "unattractive" — I don't like any of it. But the worst to me is "non-compliant," because if that gets put in a medical record — and also, we talked about the blood pressure cuff: the wrong-size blood pressure cuff being used, especially near the end of pregnancy. This is a thing that happens so often, not just in pregnancy, but then, "Oh no, you have very high blood pressure, we're so concerned," and then you're put on this trajectory that can lead to so many medical interventions that you didn't necessarily want. And then during pregnancy, being put on medication that you didn't necessarily need for a simple inaccurate reading.

Jen's Own Birth Story: From Fear to Empowerment

Britta: So you were inspired in this work because of your own birth journey. And I've heard you refer to your birth journey as really empowering. So here you are talking about all of these biases and roadblocks, and yet you came out of yours having a very different kind of experience. So what made a difference? What did you do, and what were you met with, that made the difference for you so that you could have such an empowering birth that you turned around and used it as inspiration for a whole library of work?

Jen: This is something radical. I hope everyone's listening. I was talked to and touched with compassion. I mean, that's what it comes down to. It makes me so frustrated sometimes — it's like the basis of what I teach is just be compassionate. Just meet people where they are with compassion and dignity. It was the first time in my adult life that I saw a care provider that helped me to believe that my body was healthy. And we talked about Health at Every Size, which is also evidence-based. And having those experiences made me want to go to water aerobics three times a week and try prenatal yoga, even though I was terrified — and then realized, damn, I'm like halfway upside down and my body's pretty amazing. But it really was the basis of just being met with compassion. I remember going online and telling my midwife, "Oh, I read I'm gonna have a big baby because I'm a big girl." And she's like, "That's what your hips are for. You can do this." It was just different. But I will say it didn't start off that way. I went to the same OB that I had gone to for normal visits, and it was a doula who said, "You want an unmedicated birth — have you heard of the midwifery model of care?" And my first response was, "I'm high risk." And she's like, "No, you aren't." So if I hadn't had someone to support me and help me realize that — and connected with that midwifery model — it was such a dramatic difference.

Britta: And not all OBs have weight bias —

Jen: And not all midwives don't. Absolutely. But it was just so different — not only how I was talked to, but how I was touched. And that radically changed for me how I realized I deserve to be treated differently in healthcare. Because I did. I had a completely healthy pregnancy and gave birth on my knees in a hospital and had the unmedicated birth I wanted. And I thought for so long I wanted an unmedicated birth because my mom did, and it's empowering and all these things — and yes, absolutely transformative is the word I use for my birth. But really what I realized, underlying all of that, was: I don't want to be immobile. I don't want people to have to hold up my big legs for me. I was so scared. I thought all about different labor positions and all that, but never really actually birthing my baby, because being that exposed and vulnerable was terrifying to me, because I've had awful things done to me and been touched in ways that weren't right by care providers. And that's where I talk about that cumulative trauma. And it is so important. And I think just knowing that — anyone listening who has gone through any trauma in healthcare, it doesn't need to be because of your size — you are worthy of so much better. And I learned that through my pregnancy and birth.

Breaking Cycles: Parenting, Diet Culture, and Body Image

Britta: Which is so inspiring and powerful to hear you speak about. And I've heard you also say — and you just sort of touched on it — that you actually felt remarkably capable. And that, to me, also is a through line around trauma as well as feeling capable. How we are treated matters for how we see ourselves, which can then also impact how we parent. Like, if we aren't being treated in a respectful way, can that lead to feeling doubt in our own capability, which can then lead to parenting full of doubt? It sounds like you did some work and upended that for yourself.

Jen: I mean, I still sometimes have parenting with doubt. Of course, absolutely.

Britta: I mean, come on, let's not be Pollyanna. We know parenting with doubt is a baseline existence in many ways — kids are, in part, meant to keep us humble.

Jen: Yeah. But it was the first time I saw Braden stand backwards on a scale at the pediatrician when he was really young that I realized that he was picking things up, and that I was teaching him things that I wish I would have known. And it's just something so small. And I also want to be clear that I still have biases. I exist in a large body. I teach about weight bias, and I still hold weight biases. We all hold biases. So this is continual work and continual unpacking that is so important. But I can't even fathom how I would be raising my child, especially around food, if it wasn't for unpacking how harmful diet culture has been my entire life. And it's the reason why I am the size I am today — so many failed diets, then regaining all the weight plus more, which we know statistically happens about 96% of the time when people only diet.

Britta: Now we've got to talk about the GLP-1 trend, because I would imagine that the prevalence of that is making some of this worse.

GLP-1 Medications and Weight Loss Surgery in Pregnancy

Jen: Yeah. And Britta, I too, first and foremost, believe in body autonomy. Your body, your choice. You do you. So I am not shaming anyone who is listening who is on one, or who has a loved one on one. But we don't have studies to show that it's safe during pregnancy or breastfeeding and chestfeeding. So yes, it's very common — when a person in a larger body goes for a preconception visit, to be recommended the GLP-1. And also, even weight loss surgery is what we used to talk about. But what isn't talked about is so many people experience a rapid weight gain the minute they get off of it — so people then lose a significant amount of weight right before pregnancy, but also have very malnourished bodies. So there's a lot more oversight that needs to be happening there. And then they're no longer on this medication, or even people who have had weight loss surgery, and then they start rapidly regaining weight during pregnancy and also postpartum. But no one talks about that. And then I am now hearing people being told on their six-week postpartum visit, "Hey, do you want that GLP-1 prescription?" — which, again, if they are breastfeeding or chestfeeding, we don't have studies to show that it's safe. And it just breaks my heart. Like, your body has been through so much. You've literally grown a human and birthed a human. And the priority should be on nurturing and nourishing your body, not jumping on a medication that's going to cause stomach issues, possibly, and all these other issues. Again, your body, your choice — it's just the way it's being pushed on people.

Britta: Yeah, that is very upsetting to me. And it's also discrediting the wisdom of our bodies. Like, I know for me — I was a yoga teacher when I was pregnant, and I existed in a very lean body. And when I became pregnant, I very quickly gained more weight than I've ever gained in my entire life. And it was not simply my baby. My body loaded it on. And I had self-doubt about that, and I had shame about that — what is happening, why is it doing this? And all kinds of things of that sort. And I needed every ounce that I added to my body for my feeding journey, my nursing journey with my children. But I didn't know that ahead of time. My body seemed to, though. And it's like — what about the wisdom of our bodies?

The Wisdom of the Body and Finding Joyful Movement

Jen: Well, I started moving my body in beautiful ways and doing water aerobics, and I was eating intuitively, which I didn't even know what that was. It's something we talk about today, but 15 years ago we didn't. But I was really trying to unpack diet culture, and I lost weight during pregnancy because I was nurturing my body in a way I hadn't before, because I felt supported by a care team that didn't make me feel shame around my body. And that's another thing — people are being told, "You have to lose weight," or "Don't gain any weight during pregnancy," when you exist in a larger body. And ACOG does have some restrictions on the weight gain recommendations. But to me, it's all about how do we frame these conversations — connecting people with nutritionists that are Health at Every Size aligned, and working with people to find movement in a way that's joyful. Because so often, existing in a larger body — it's like you're damned if you do and damned if you don't. You don't move your body, then "oh, you never exercise." You move your body, and people literally say horrible things to you as you're walking down the street. And up until recently, it was fucking hard to find clothes that would fit my body. I have huge boobs, and it was like impossible to find a sports bra that would really do a good job. And I'm glad that's changed, but it's just exhausting. It is so exhausting to sometimes just exist in a larger body, let alone be a parent, and know that you're being judged when you're at the grocery store and people are looking at your cart.

Jen: You just walk through the world a little differently. And it's when you connect with people that care — and something so small, like Britta, us working together, and me coming to your home and you saying — because I was so thrilled to stay at your home with you — "Hey, I've got this shower and the door doesn't quite go all the way, so I've got this other bathroom if that isn't comfortable for you." It was just one sentence, but it said so much more to me. You thought about, well, Jen's gonna want to bathe.

Britta: I thought you might want to shower at some point.

Jen: But having another plan in place. And your home has a lot of stairs, and I sometimes need to take a little break, and I never feel shame to do that. But still, even though I know that you see me and love me for who I am, I still got embarrassed when I needed to take a little break. And so I'm still always working through things as well.

What Size-Friendly Care Actually Looks Like

Jen: But at the end of the day, I define a size-friendly care provider as someone who provides compassionate, evidence-based care. And I laugh because it's so simple, and yet it's not. And I've actually had a recent awakening with my husband losing his vision, because to me it's like, oh, chairs without arms are so basic — you just want to make sure people of all sizes can sit comfortably. But I see how he walks through the world without the vision he once had, and I realized how ableist I am and the assumptions that I make. So I've had a lot more grace and compassion with doing this work, of — yeah, you don't know what you don't know until you know it. But at the end of the day, lead with curiosity, compassion, and kindness, and the world can be a much better place.

Jen: And we've seen a big shift since I started doing this work, which is beautiful. Hashtag plus size pregnancy — there are hundreds of thousands of photos now. And there are so many birth professionals that are now saying "I'm size-friendly" and others doing the work that I was doing. And it's so beautiful and so needed and so necessary. And yet it's still so difficult to find a pair of plus size maternity jeans — even 3X, let alone 4X.

Britta: Yeah. There's so much in that. And thinking about the multitude of ways that bringing compassion and curiosity to the world is part of what all of us need. My working with you definitely brought awareness. I think I mentioned at one point — I went to my dentist's office and I walked in and it was all narrow chairs with arms, and I was like, wow. And I don't know that I would have thought of that before. And I looked at all those chairs with arms, and I said something to the receptionist. I was like, "Hey, I'm just noticing..." Which just felt important in some ways. And as you're speaking about your awareness with your husband — I remember when I blew my knee out and was on crutches, just even what it was like to open a door to go into a doctor's office, and how existing in that way felt very different. And the ableism that is kind of inherent — that does overlap into your size-inclusive work — feels important for all of us to be looking at.

Jen: So many ways. And I also think of, Britta, when you and I were doing a little work retreat at a hotel, and you kind of saw how this group of businessmen sitting behind me pretty much just ignored my existence. And that's another thing — sometimes you exist in a larger body, you're almost so apparent that you become invisible, and people don't want to engage or acknowledge your existence. And that is another layer of this that is just so complex and hard and something that we don't talk about very often.

Jen: And you know, for a minute there, it felt like as a society, body positivity was the rage, and we were having more of these conversations. And now that has really stopped in many ways. And it's heartbreaking. Because I love the work that you do of just meeting people where they're at, whatever type of birth they want or plan they want, or however they identify. We just meet people where they're at with compassion and dignity. Like, should that have been that hard? But it might help everyone to look around a little bit more as we exist in the world. When you're scrolling on your phone while you're peeing — does everyone on Instagram look like you? And if so, explore some beautiful hashtags, diversify your feed. Not just with size, but with so many different layers. I think that's so incredibly important, and it makes you a stronger, better human in so many ways.

Resources: Plus Size Birth and the Plus Mommy Podcast

Britta: Yeah. And this is part of why Plus Size Birth and the Plus Mommy Podcast have become really trusted resources, because you are communicating this. And you not that long ago were at the center of a TEDx talk speaking about this as well. I think it's important for folks to know where there are resources and why it's important. So can you tell us a little bit about what you offer, where folks can find things that you have — I know you have offerings for different avenues. Share a little bit about that.

Jen: Yes. In typical Jen fashion, before I share my resources, I did mention earlier about the National Institutes of Health — I do want to mention that I was very honored to collaborate with them on the Pregnancy for Every Body initiative, which — by the way, it's a terrible name, because it's just about size and not many other existences. They realize that. But in and of itself, it was the first time that a big institution came out with positively framed information for providers and parents around plus size pregnancy. So I pushed back on a lot of the BMI stuff, and they said, "Jen, this is how it goes." I did my best. But unfortunately, it came out in November of 2019 —

Britta: So it got buried under a lot of other things.

Jen: Yes, but if you Google it, it'll pop up. And they recommend my work.

Britta: Let's put the link in the show notes.

Jen: Yes, let's do that. So that was a true honor to have that collaboration, because I cried when they asked me. Because it was the first time someone was really caring about the consumer perspective and not just looking at the risks. So I hope that's a takeaway too from all of this — the lived experience and how that impacts how people of size enter care.

Jen: But as far as my resources — on plussizbirth.com it goes two different ways: from parents to professionals. So for parents, literally anything you could ever need or want being plus size and pregnant is there, because I started it when my kid was only a few months old. I just felt called, because I was like, surely I'm not the first fat person to have a healthy pregnancy and a positive birth experience. But there weren't a lot of stories. So there are stories and photos and resources, from how to advocate for yourself to where to find clothes and all that good stuff. And a book — my Plus Size Pregnancy Guide on everything you could want to know about being plus size and pregnant, and how to find a size-friendly care team.

Jen: And then for professionals — my heart work has really started to lean that way, especially because I do so much speaking nationally on this topic. I created a course on how to be a size-inclusive professional. It's approved for nursing credit, so if you're a nurse, you can get continuing education units. And it really helps you to unpack bias, evaluate your tools and your facility, and goes into depth on that lived experience and all the medical facets surrounding pregnancy, birth, and postpartum in a larger body. So yeah, I clearly have a lot of passion, because it changed my whole life just to have care that centered me as a human and not a number on a scale. And I fight for that all the time now, for others and for myself. And the fight continues. And I've always said I look forward to the day when my work is no longer needed.

Britta: Yeah. And I know that seeing representations in social media and magazines and in the public sphere was a piece that you were really hungry for when you were pregnant — that you now offer. You have social media you want to speak to, because I also think that part of what your platform in social media offers is some community, some feeling of being less alone in a plus size pregnancy.

Jen: So yeah, thank you. Everything started as Plus Size Mommy Memoirs because it was 2011 — everything was different back then. But I launched in April of 2011, and by May, I knew that this wasn't just my story. I knew that it was so much bigger than me, and that's when I started Plus Size Birth. But this was back in the Facebook days — Instagram was being developed — so I have a huge community on Facebook, over 220,000. And they really shortened the name to Plus Mommy. So there are kind of two different facets of Jen. PlusSizeBirth.com is where you'll find everything that we've talked about. And then on social media, on Instagram especially — Plus Size Birth — I really try to share so many photos that people have generously donated of what it looks like to be pregnant in a larger body, celebrating those images. Because so many people would be like, "Oh, I wish I would have taken photos, but I never saw photos like this." So that's hugely important to me. And then there's Plus Mommy, which is kind of like hanging out with me, and we're besties, and I just talk about my lived experience. We go to the dermatologist together. We go to the dentist together, even though I'm terrified of the dentist. And we just live life. I share things like when someone parks way too close to me and I can't get in my car — what that feels like, and how it can be embarrassing to ask someone to move my car for me, but I'm going to do it because I've got to get home. It's like, I just share me, transparently. And I think it comes from starting a blog in the mommy blogger era — back then you just shared it all. And I love it. I love sharing with people, because it's honestly sometimes hard for me to show up myself. And so I feel like, if I can be like, "Hey guys, we're going to the dermatologist for a full body check, let's do this together," it helps me, and I hope I help others in the process.

Magic Wand: What Would You Change?

Britta: I love that, and I know it does help. So I have two questions. I know I normally end with just one, but I'm going to end with two. And one is — just enjoy a little fantasy with me. You know I like a little fairy tale, mythology vibe. So I'm kind of feeling like handing you a magic wand. If you could wave a magic wand and change something or improve something that really matters to you — what would it be? How would you want to use your magic wand for good? I know you're already doing it with your work and your offerings, and I think there's a thread in there of what it is that you're doing. Maybe it's about advocacy. Maybe it's about feeling good in your body at any size, or being respected. What feels really important to you?

Jen: That size-inclusive education was integrated into maternity education. Because I think that would really, really dramatically change how people are treated during pregnancy, and lower the Cesarean birth rate. And and maybe in some way help people to learn — like what I did in that moment of being treated with compassionate care — "Oh, I deserve this so much outside of this, and I deserve this in every aspect of my life." But I wish that this was something that was really integrated within our healthcare system. And not just maternity care, because so much harm is happening. And I know we're in cute fairy tale territory, but people are dying. People are dying because they're too afraid to access healthcare because they've been treated so horribly. And not all the equipment is designed for people in larger bodies. There's so much we could go into. But I would want the education to be implemented immediately. We got the statistics around maternity weight bias in 2020 — I don't want to wait 17 more years. We can't. We can't. There needs to be a huge shift, and the medical system really needs to take this seriously and stop causing so much harm.

Britta: Yeah. Because if it's integrated early, the downstream effects would really take off. And great change would happen, and God only knows what benefits would come that may not even be related directly to pregnancy. But just that — those knock-on effects of being felt respected, and valued, and like our bodies matter — the ripples of that could be immeasurable.

Closing: One Thing for New and Expectant Parents to Know

Britta: Okay. So my last question that I end every episode with — as you know — which is: what's one thing you feel passionately about that you want new or expectant parents to see, hear, feel, or know during this profound period of their lives?

Jen: I want you to know that you are worthy of the same healthcare and advocacy that you will fight for your children. All the time and work that you put into wanting to find the best pediatrician — you are worthy of that healthcare for yourself. Another thing I love to talk about is body love and body image — how do we love ourselves at any size? And a huge part of that to me is advocacy and advocating for yourself and your well-being. And you are worthy of it. So don't ever forget it.

Closing and Outro

Britta: Amen and a little woman to that. Yes. Oh, you are worthy. And Jen, you are worthy. You are such a gift to my life, to my business. My gratitude for you is so abundant and just overflowing, and I'm so grateful that you joined me today. Thank you so much. And thank you listeners for sharing this time with us. If something shared today impacted, supported, or moved you, please share this episode with a friend. I produce this podcast myself — with Jen's support, by the way — and your support makes it possible. To show a little love for the podcast and these conversations, please follow, rate, and review. If you'd like to continue the conversation, please join us on Instagram at Transformed by Birth. I look forward to being with you again on the next episode of Transformed by Birth. Now let's gather what we want to take away from this episode — with an inhale, and with an exhale, I'll blow out our candle. Until next time, bye friends.