Your weight before you get pregnant
First the good news. It is absolutely possible to be overweight and to have a healthy pregnancy.
Which really is good news, since between one in five and one in four pregnant women in the UK and Ireland are overweight or obese.
Which is not to say that being a healthy weight during pregnancy isn’t preferable to being overweight.
Women who maintain a healthy weight during pregnancy reduce their risk of miscarriage, gestational diabetes and preeclampsia.
But given the enormous anxiety that many women feel going into pregnancy, it’s important not to lose sight of that fact that, in this day and age, most women will have a healthy pregnancy and safe delivery, regardless of age, weight or lifestyle.
This is thanks in large part to advances in medical science that have made childbearing safer than it’s ever been.
Just a few generations ago a woman about to give birth was faced with the very real prospect of her own mortality.
Even a healthy woman could suffer haemorrhaging or develop infection post-partum, which in the days before antibiotics could soon turn deadly.
For the impoverished, undernourished and overworked women who made the up the bulk of expectant mothers in the rapidly industrializing Britain of the 1800s, pregnancy and childbirth was frequently an ordeal.
And in an age before reliable birth control, it was an ordeal that could also be pretty frequent.
Acceptance of germ theory lead to better hygienic measures during delivery towards the end of the nineteenth century. But maternal mortality rates really plummeted from the 1930s onwards, mostly in response to the availability of effective antibiotics.
We are now living in an era in which for most women in countries with developed healthcare systems, giving birth isn’t shadowed by the prospect of death.
Despite this, anxiety and stress is a feature of pregnancy for many women.
And some of this anxiety is actually a consequence of the fact that pregnancy is safer than it’s ever been.
Now that the blind action of bacteria has been all but banished as major cause of maternal mortality, we increasingly see women themselves as the guardians of their own pregnancy outcomes.
This is why doctors like Eva Osmond find it acceptable to brand overweight mothers as ‘criminal’.
And yet this sort of rhetoric does not improve health outcomes for women or their children.
The advances in maternal medicine of the last century took much of the terror out of childbirth, by giving doctors and midwives the tools to save the lives of pregnant and post-partum women in medical emergencies.
Having achieved so much in that regard, we have a situation in which much of maternal healthcare is now geared towards preventing those emergencies before they develop.
Being overweight or obese does make it more likely that a woman will experience complications during her pregnancy.
Every complication, however manageable, makes pregnancy more stressful, more frightening and more medically invasive than it otherwise would be.
It is important that women know these things going into a pregnancy, because they may influence the decisions she takes in navigating her own fertile life.
But rather than treating women who have embarked on higher-risk pregnancies as if they’re the irresponsible custodians of malfunctioning incubators, healthcare professionals must never lose sight of the fact that what every pregnancy has in common, is that it is only possible thanks to the body of the pregnant woman herself.
She’s not just ‘involved’ in the process; she is the process.
The next frontier in maternal health is not the battle between clever doctors and the fat, feckless, fetus-endangering women they have to treat. It’s a ceasefire.
Part of the ongoing effort to end hostilities between ten millennia of human history and women, who have been side-lined, defamed, controlled and demeaned as a consequence of the every-day miracle of which their bodies’ are capable.
If we care about the health of mothers and their children, we need to make sure that women have honest, up-to-date information about the issues that they might come against at all stages of pregnancy and the support to make informed decisions about how to handle those issues, if and when they arise.