Throughout both of my pregnancies, I was regularly reminded about the myriad risks my fat body could potentially pose not only to myself, but to my unborn children. I might develop high blood pressure for life unless I ensured I didn't gain any more weight (especially in the third trimester, one midwife said with a totally serious face). My kids might gravitate towards unhealthier foods, thus predisposing them to fatness, another noted. "'Obese' women are at an increased risk of miscarriage," a doctor sighed (though he was unable to tell me why, exactly). Nowhere in what often felt like an endless list of complications, however, was there any mention to the potential risks of getting an epidural when you're fat.
Out of all the foreseeable complications my midwives and obstetricians cited throughout my pregnancies, none actually panned out. I feel very lucky for this. Ultimately, almost every possibility they referenced was something any woman, of any size, can experience. Although I did contend with migraines, back aches, swollen feet, and insomnia (you know, the usual stuff most expectant women go through), my pregnancies were fairly straightforward.
What wasn't so straightforward was the set-up of my epidural when I went into labor with my eldest daughter. The dread on the anesthetist's face was instantly discernible as she eyed my body up and down. Through my intermittent groaning and screaming (I'd been laboring for over two days at this point), I could hear her whispering to the midwives about my size. She asked for my weight, and was unable to hide what seemed like plain disgust as someone muttered "not far from 300."
This wasn't the first time a medical professional gave off these vibes in my presence. It happens almost every time I step into a doctor's office, just as it does to so many visibly fat people who are instantly dehumanized even by those expected to care for them. This time was a little scarier than most, though, because the doctor in question was about to take an enormous needle (the extra-long one reserved for patients with a BMI over 30) to my spine.
For most of my daughter's first year of life, my body felt shattered. The first few weeks after we arrived home were the worst. I couldn't sit down with my back touching a chair without bursting into tears.
A preliminary anesthetic had numbed my back, so when it came time for the epidural, I could feel the needle going into my body. I just couldn't feel the pain.
I could, however, feel the anesthetist missing her mark. I could feel her struggling to get the epidural in correctly. I could feel her taking the needle in and out of my back nearly a dozen times before finally breathing a sigh of relief. "Well done," my head midwife told her.
"You're a difficult patient," the anesthetist told me in return, in what I can only describe as a tone of refrained shouting.
"While anesthesiologists have special training in identifying the landmarks of the back that guide the [epidural] process, these bony areas are harder to feel in heavier women," Dr. Adrienne D. Zertuche, an OB-GYN with Atlanta Women's Healthcare Specialists, tells Romper. "Studies have shown that anesthesiologists often have to make multiple attempts at epidurals/spinals before successfully placing them in obese women."
These multiple attempts can result in "advertent dural puncture (causing a severe headache over the next several days), failure of pain relief necessitating repeat epidural/spinal placement, and low blood pressure," Dr. Zertuche adds. Or, in my case, months of severe back pain.
For most of my daughter's first year of life, my body felt shattered. The first few weeks after we arrived home were the worst. I couldn't sit down with my back touching a chair without bursting into tears. I couldn't walk without it screaming at me to sit back down. I couldn't lie flat facing the ceiling, no matter how tired I may have been. I probably spent most of those early days on my chest, or on my side, or sat in a terribly uncomfortable position sans backrest.
This was a direct result of being repeatedly stabbed in the spinal region with a needle that looked as though it'd be fit for a horse.
Throughout that first year, even flat, simple walks became a challenge. Bending down was an instant way to throw my back out for the rest of the day. When I shared my concerns with my midwives in postnatal checkups, I was always gently (or not-so-gently) nudged in the direction of weight loss. "That'll take the pressure off your back," they'd say, ignoring the simple truth that this wasn't how I usually felt in my fat body. This was a direct result of being repeatedly stabbed in the spinal region with a needle that looked as though it'd be fit for a horse.
According to a panel of health writers on Baby Center, there is, indeed, "an increased chance that an epidural may be tricky to set up" if you are clinically categorized as "overweight" or "obese." However, "Once your epidural is set up, it should work as well for you as any other woman."
When I look back on that first labor, I don't wish that I hadn't gotten the epidural. In that moment, after experiencing that level of pain, the procedure brought the relief I needed. There were consequences in the aftermath, but it got me through what was, at the time, the most agonizing situation I had ever been in.
I do wish that the potential difficulties of putting in the epidural had been among the "risks" my doctors and midwives shared with me. They were all so focused on the "what ifs" of my fatness. On the conditions that I had no sign of developing. On the possibility of having babies so big that I could not have a vaginal delivery (even though all my growth scans showed my babies were actually kind of small). On the future ailments they assumed I'd develop, just as they were assuming so much about my lifestyle, diet, health status, and body.
According to Baby Center, "Many hospitals make sure, if your BMI is 30 or higher, that you have an appointment with a senior anesthetist before your due date." I certainly never had one, even though the risks of getting an epidural when you're fat are actually immediate, practical ones that bare considering.
Still, when the time came to deliver my second daughter, I actually wanted to get an epidural again. I wanted to get it because I could so vividly remember the pain of the contractions. I wanted to get it because I craved the pros, and I decided I'd be willing to deal with the cons if necessary.
My body had other plans, though, and I was in active labor for such a short amount of time that an anesthetist simply couldn't get to me before my baby did. We got through it, though. This time, my labor pains reached new, unprecedented heights that I could not have imagined. Without the epidural, however, my physical recovery was fast. I could not believe that I could walk unassisted only an hour after delivering. I could not believe it when, upon getting home, I could walk up and down the stairs without wincing.
I have since spoken with fellow plus-size mamas about their own experiences with epidurals, only to learn that many didn't have any complications at all. Some did, but then so did thin women. There are always risks to labor. There are always possible side effects to the pain management medications we choose. There are always things that can go wrong. That's why it's all so damn terrifying.
There is no shame in recognizing that you are facing potential risks that someone else you know isn't. Our bodies are unique like that. What we all deserve, however, is to have as much information as possible before making our birth plans.
In an ideal world, every medical professional would be perfectly trained to handle any situation. Every medical professional would treat every patient with the same compassion and care. Every medical professional would be able to discuss the risks you are facing before labor, or surgery of any kind, while reserving judgement. As this is not the world we live in, the best we can ask for it to know all the facts. We deserve to know the actual truths of our bodies and situations, rather than the assumptions.
After a very frustrating first birth experience, this Deaf mother wanted a change. Will the help of two Deaf doulas give the quality communication and birth experience this mom wants and deserves? Watch Episode Four of Romper's Doula Diaries, Season Two, below, and visit Bustle Digital Group's YouTube page for more episodes.