Size Bias in Maternity Care: Why Plus Size Pregnancy Deserves Size-Inclusive Prenatal Support

Let’s talk about something that doesn’t get nearly enough attention in maternity care: size bias.

If you’re navigating a plus size pregnancy, you’ve likely already felt the weight of the world’s opinions pressing in on your body. But when that pressure starts coming from the very providers you’re supposed to trust with your care? That’s when the damage can go deep.

Weight stigma in maternity care, also known as size bias, is real. It shows up in both subtle and more apparent ways. From offhand comments about your BMI to restricted access to certain birth interventions, many plus size women are treated differently simply because of their size. And it’s not just unfair, it’s dangerous.

The Impact of Size Bias on Pregnancy

As someone who’s worked closely with women across all body types, I’ve seen firsthand how weight stigma can affect pregnancy and birth outcomes. Providers sometimes make assumptions before even opening your chart. They might dismiss your concerns, jump to conclusions, or suggest interventions that aren’t evidence-based simply because you fall into a higher BMI category.

This bias can lead to:

• Increased stress

• Avoidance of prenatal visits

• Higher rates of postpartum depression and anxiety

• Mistrust in the provider-patient relationship

• Delayed care-seeking, which can impact both your health and your baby’s

  
  

And the crazy part... studies show that stigma itself can contribute to the very outcomes providers claim to be concerned about, like elevated BMI or health complications. It’s a vicious cycle, and it’s one we need to break.

What Size Bias Looks Like in Maternity Care

Size bias isn’t always someone saying something overtly cruel. Often, it’s more Subtle:

• Limited access to midwifery care because of BMI cutoffs

• Being told you "can’t" have a natural birth because of your size

• Extra pressure to induce labor early

• Automatic scheduling of cesareans based on assumptions, not medical necessity

• Dismissive attitudes when you express your preferences or ask questions

• Lack of knowledge/availability of necessary equipment, such as larger blood pressure cuffs.

• Extra testing, because they assume your body simply can't have a healthy pregnancy.

These experiences send a message: "Your body can’t be trusted." But I’m here to tell you, that message is false. Your body is strong. Your body is capable. And you deserve providers who see that too.

The Case for Size-Inclusive Prenatal Care

Size-inclusive care isn’t about ignoring health risks, it’s about addressing them without bias. It’s about looking at the whole person, not just the number on the scale.

A size-inclusive provider will:

• Respect your autonomy and listen to your goals

• Focus on your health habits, not just your weight

• Offer evidence-based guidance, not fear-based assumptions

• Support your choices in labor and birth

• Celebrate your body’s ability to grow and birth life

When you have that kind of care, it changes everything. You feel seen. You feel safe. You’re more likely to stay engaged with your prenatal visits, follow through on health recommendations, and walk into your birth experience with confidence instead of fear.

What You Can Do

If you’re currently pregnant and feeling the weight of size bias, here are some steps you can take:

1. Find a size-inclusive provider. Don’t be afraid to interview multiple OBs or midwives. Ask direct questions about how they care for people of all sizes.

2. Bring a support person or doula. Someone who can advocate for your wishes and back you up if you’re feeling dismissed. And make sure your doula/support person in size inclusive as well!

3. Request evidence. If a provider recommends a specific intervention "because of your size," ask for the research. You deserve to make informed choices.

4. Use your voice. Your questions, concerns, and preferences matter. You’re allowed to speak up,even if it’s uncomfortable.

5. Know your rights. You have the right to respectful, individualized care, regardless of your body size.

   
   

My Experience

I’ve sat beside many plus size mothers during their births. I’ve seen them labor powerfully, birth beautifully, and mother fiercely. I’ve also seen how much harder they’ve had to fight to be respected in their care.

I won’t pretend that the system changes overnight. But I will promise this: if you’re in a plus size pregnancy, you are not alone. You are worthy of respect. You deserve care that uplifts, not limits.

The Bottom Line

Size bias in maternity care is more than just hurt feelings. It’s a systemic issue that can affect outcomes, damage trust, and increase risk. But it doesn’t have to be this way.

With the right information, the right provider, and the right support team, you can have a birth experience that honors you and your body. Your body is not a problem to be solved. It’s the very vessel bringing new life into the world. And that, my friend, is something to celebrate.

If you're looking for a size-inclusive, evidence-based birth support team—someone who sees your strength and believes in your body—reach out. I'd be honored to walk this path with you.