Preggie Pals
Plus Size Pregnancy

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[00:00:00]

[Theme Music]

Ray P. Kamali : Being plus size and pregnant in today's world can be difficult. But despite the scary medical statistics, overweight moms to be are having healthy pregnancies and happy babies everyday. So what's the truth behind being plus size and pregnant? Are you really more at risk? I'm Doctor Ray P. Kamali, an ON/GYN affiliated with Sharp Chula Vista Medical Center, and this is Preggie Pals, episode 35.

[Theme Music/Intro]

Sunny Gault : Welcome to Preggie Pals, broadcasting from the Birth Education Center of San Diego. I'm your host, Sunny Gault. Are you a member of the Preggie Pals Club? Our members have access to all of our archived episodes, plus bonus material after each show, and special giveaways and discounts. To sign up, visit our website, PreggiePals.com. Alright, so let's meet our panelists. Stephanie, kick us off.

Stephanie Saalfeld : Hi! I'm Stephanie Saalfeld. I am 29, I'm a gemologist, and I am currently pregnant with my first child, a baby girl. And we're having a hospital birth.

Elisa Suter : And I'm Elisa Suter, I am a wedding planner, I'm 32. And I'm pregnant with my first child who is also a daughter. And we are also planning a hospital birth.

Sunny Gault : And I think that's new for our listeners, because you didn't know what you were having last time.

Elisa Suter : Exactly, we found out on Thanksgiving with our families. That was exciting.

Sunny Gault : That's wonderful, well congratulations!

Elisa Suter : Thank you!

[Theme Music] [Featured Segment: Pregnancy Tips for the Clueless Chick]

Sunny Gault : Before we begin today's episode, here is Jennifer Durbin, with some Pregnancy Tips for the Clueless Chick.

Jennifer Durbin : Hi! I'm Jennifer Durbin, the author of Pregnancy Tips for the Clueless Chick, and mother of two wonderful little boys. I'd love to share with you my secrets for surviving the 10 to 25 minute feedings you shall have every two to three hours the first few weeks of your baby's life. Whether you're breastfeeding or bottle, be prepared to spend hours after hours glued to the couch, feeding the baby. With my must-have nursing basket, you'll have everything you need to survive and even enjoy all of that time. So grab a cute little basket, and add these ten must-haves. Number 1 – a stop watch app for timing the length of each feeding and the time between feedings, because it's so easy to lose track of time. 2 – a water bottle and snack for yourself, because you can get very thirsty and hungry while nursing. 3 – any prescription medication that you're taking during your recovery. 4 – a suction machine for nose drops, because it's easier to suction baby's nose while she's eating. 5 – hand sanitizer and your favorite hand lotion, because you can't be too germ-free in the first few weeks, and your poor over washed hands need extra attention. 6 – gas drops or gripe water if your baby has reflux or painful gas. 7 – nipple cream to apply after each feeding. 8 – a birth cloth for the inevitable spit ups and spills. 9 – your phone, to catch up on phone calls and check email. And 10 – a good book or the remote, so that you can do a little something for yourself while nursing. So sit back relaxed and enjoy the quiet time with your little one, and don't forget to pump from time to time, so that your partner can experience the joy of feeding time as well. For more great tips, visit CluelessChick.com.

[Theme Music]

[00:03:59]

Sunny Gault : Alright, today's topic was suggested by you, the listeners: how does pregnancy differ for plus sized women? Our expert today is Dr. Ray P. Kamali, an OB/GYN affiliated with Sharp Chula Vista Medical Center, where he's also the chairman of the Department of Obstetrics and Gynecology. Dr. Kamali, welcome to Preggie Pals!

Ray P. Kamali : Thanks for having me!

Sunny Gault : Sure, absolutely! At what point is a woman considered obese, and how is that measured?

Ray P. Kamali : We use the terms “overweight” and “obese” in our conversations on a daily basis, but the most clinically relevant definition of obesity and overweight comes from a number called body mass index (BMI) and that's calculated by taking a patient's weight in kilograms and dividing that by their height in meter squared. Most people don't know their weight in kilograms, so if you don't want to do all the math, you can just do an internet search for how to calculate your BMI and there are multiple websites that you can use, you have to put in your weight and height in pounds and feet and it will calculate it for you.

Sunny Gault : OK. And how accurate is BMI in calculating someone's overall health? Figuring out if they are healthy persons?

Ray P. Kamali : BMI is an estimation of a patient's average body fat, but it's not a perfect science, so usually a clinician will look at your health and the total picture, and hopefully in a preconception visit, if you are able to see the doctor before you are pregnant, they will take everything into consideration. But BMI is just part of that picture.

Sunny Gault : Now, Dr. Kamali, I know that BMI is very useful, but is it possible for somebody to have a high BMI and still be healthy?

Ray P. Kamali : Absolutely. BMI is just part of the picture, so we take that into consideration, but we look at the person's general health picture, pre-gestational health, we assess them for diabetes, for high blood pressure, and overall health. Again, BMI is just part of it, but yes, absolutely, we have many patients that have high BMI that do significantly better than normal BMI patients, so that is just part of it.

Sunny Gault : Why does weight matter in pregnancy? We put a lot of focus on weight, even if we come into a pregnancy having average BMI, we think about the weight we are going to gain, but why, overall, if we know we're going to gain weight, why does it really matter? We're gaining weight no matter what.

Ray P. Kamali : Your pre-gestational or pre-pregnancy weight determines the risks or some adverse outcome that you may face during your pregnancy, so if you are overweight or obese, you have slightly increased risk of developing some medical problems or complications during your pregnancy, and also in your postpartum period. As the BMI increases, the risk of those adverse outcomes increase. So it is important to determine the BMI and weight, just so that we can look for those possible complications or adverse outcomes, and also try to reduce and manage the risks.

Sunny Gault : Could we go into a couple of those risks?

Stephanie Saalfeld : And it would be nice to hear how much of an increased risk, 'cause I think that a lot of times, being overweight or obese, women hear, “Oh my gush, you have this huge risk”, and really, the vast majority of women who are overweight or obese are actually able to have healthy pregnancies and help the babies.

Ray P. Kamali : Absolutely. We can actually just break down those risks initially for pre-conception or trying to conceive, and then the risks during pregnancy, during labor, and then the postpartum risks and also risks to the baby. Again, as you mentioned, sometimes we talk about risks but you don't put a real number to it, it's kind of difficult to assess or understand exactly what the risks are. So let's start off with risks of having difficulty conceiving or what we call “subfertility” or sometimes “infertility”. Our patients with higher BMI, and mostly obese patients, but sometimes overweight patients – and just for the purpose of our conversation, we should define overweight and obesity; we talked about BMI and how to calculate it, we basically look at the patient's BMI. Patients with a BMI of 18 to 25 have a normal BMI, and that's the international Institute of Medicine and World Health Organization definition. So 18 to 25 is considered to be normal, between 25 to just under 30 is considered to be overweight, and over 30 is considered to be obese. We basically look at our patient's BMI and we put them in that class, overweight or obese, and that helps us determine the risks. But risks of miscarriage with our obese patients with BMI over 30 is increased by 2-fold, and sometimes patients that are obese also have difficulty of getting pregnant, and that comes from the fact that patients that are obese have higher chance of developing polycystic ovarial syndrome, which is having problem ovulating, and that would obviously pose a difficulty getting pregnant, and weight loss can help you ovulate and get pregnant.

Stephanie Saalfeld : Do you have any actual numbers, percentages? 'Cause you said it increases 2-fold, but what is the actual percentage for regular infertility? It might be a lot smaller than it sounds, 'cause it sounds really scary, “Oh my gush, I have twice as much probability of actually having a miscarriage”. Can you go into that a little bit?

Ray P. Kamali : Sure. Risk of miscarriage is pretty high in general population, there's an estimation that one in three pregnancies end up in early miscarriage. Sometimes people don't have a diagnosis miscarriage, because they are a week or two late for their period, and then they have a period and never take a pregnancy test, so they don't know they were pregnant and they miscarried. But increasing that by 2-fold, sometimes it increases your risk somewhere around 40 or 50%. That's just in obese patients, patients with BMIs of over 30. Now we are going to go to the actual pregnancy complications, those are basically complications that a mom is diagnosed with or faces during their pregnancy. One of the more serious ones is diabetes. A patient may develop gestational diabetes during their pregnancy, any pregnant women has a chance of developing diabetes, and patients with higher BMI have a slightly elevated chance of developing gestational diabetes. In the general population, the risk of developing gestational diabetes is somewhere in 2 to 6% range. With obesity, that goes between 6 to 12%, so it is elevated by 2-fold. But a person may also have diabetes before they actually conceive and become pregnant.

One of the things that we see a patient for the first time – a lot of patients, whether they are obese or normal weight, see the doctor for the first time when they're pregnant. So they had a healthy life, they haven't had any medical issues, and they haven't seen a doctor. A lot of times we see a patient for the first time when they are pregnant, so what we sometimes do is screen patients for diabetes in the first trimester, in the first visit, to see if they have pre-gestational diabetes. So if a patient does have elevated sugar or elevated glucose levels, before 20 weeks, they're considered to be pre-gestational diabetic, meaning that they had diabetes before they actually got pregnant. With gestational diabetes or pre-gestational diabetes, there are some increased risks of developing other complications, some of those we were talking about in the green room, or the waiting room, was macrosomia, having a larger baby – and sometimes larger babies pose some difficulty with labor, and we'll talk about that in a little bit. Sometimes placentiferous insufficiency causing a slightly increased risk of stillbirth, and sometimes smaller babies. Aside from the diabetes, there is also an increased risk of developing pregnancy associated hypertension, that's a special type of high blood pressure that people develop in pregnancy, and the risk is increased by one and a half times, so putting that in real numbers, the risk of a woman in normal population to develop pregnancy induced high blood pressure is about 10%, and with obesity and being overweight, that's increased to somewhere around 15 to 20%. And that's just basically developing high blood pressure during pregnancy, and sometimes that can be more complicated, sometimes you can develop preeclampsia, which is when the blood pressure starts affecting some of the other organs, like the kidneys, liver, the brain and sometimes the baby.

Then there is other things like developing bladder infections, it's been found that patients that are overweight and obese have 4-fold increase in risk developing these, but that is easily managed by checking and treating. Risk of having post-term deliveries – you don't want to go over 40 weeks, but sometimes you can go over 40 weeks. If there is an actual risk of pre-term deliveries, and there is no real increased risk of a pre-term deliveries, but sometimes with the complications, blood pressure or diabetes, you may need to deliver a baby earlier, so sometimes we deliver those babies a little bit earlier, because of the complications of pregnancy, but the actual obesity is not a real risk for pre-term deliveries.

Stephanie Saalfeld : So basically, there are definitely risks, but I think it's good for people to actually hear that there is a really good statistical chance that you'll be just fine.

Ray P. Kamali : Absolutely.

Stephanie Saalfeld : And I think that, from the perspective of someone who does fall into that high BMI category, not crazy high BMI category, but higher BMI category, a lot of times we hear constantly from our doctors, our nurses, etc., and I had shared some things with you outside, that, “Oh, you have to be extremely vigilant and you're definitely going to get gestational diabetes” - all these things, and I think that it's really important for women who are in that higher BMI category to just be aware that yes, there is an increased risk, but it's not dire, you're not definitely going to get that.

Ray P. Kamali : Absolutely, I'm glad you mention this, because the focus of this discussion and this talk is to increase the awareness, and just to look out for other risks, but really what we want to do is, by mentioning these risks, is to be able to manage and to diagnose these conditions better by encouraging patients to come and see their doctor, hopefully pre-conception, before they get pregnant, and just evaluate their medical risk, their medical conditions before they get pregnant, and also during their pregnancy, to come in early, because sometimes patients are just scared of going to the doctor and being told all those things, so they just avoid doctors. We just want to encourage patients to come in early, get tested so we can look out for those things and through various counseling we can help patients have a healthy pregnancy. But absolutely, we have most of our patients that fall in overweight and higher BMI category do great and have healthy pregnancies, and at the end, that's what we're after. Just quickly, I wanted to also touch on some – again, we're not trying to scare patients, but some possible complications during labor and then also possible prenatal complications. There is a slightly elevated risk of having longer labors, that's just something that they found by looking at patients that fall into the higher BMI category and the length of the labors, risk of having a difficult epidural or epidural that doesn't completely function or work well, meaning that the patient may have some discomfort, and also slightly higher C-section rates in the patients that are in the BMI over 30 category. And after the delivery, there is a risk of a longer hospital stay, sometimes that is because the patients end up with C-sections and have to stay in the hospital longer, but also sometimes because there are complications like increased risk of infection, specially in presence of diabetes, and increased risk of bleeding and sometimes if a patient also had a larger baby, a macrosomia baby, sometimes they have more trauma to their cranium, and sometimes they stay in the hospital slightly longer. So those are some risks of both labor and postpartum.

Stephanie Saalfeld : Now Dr. Kamali, I do have a question about what you just said, I know that there's an increased risk of C-section and an increased risk of longer labor, and I've read a lot of statistics that say that higher BMI women get induced earlier, often times, or have much higher rates of induction, in fact, I read one study that said that the rate of induction for normal rate women was 27%, around 27%, and the rate of induction for obese women was over 50. I'm wondering if you could maybe explain to us why that might be, and I know that there are certainly reasons why certain women might be induced, but it seems like it's an extremely high number.

Ray P. Kamali : There are multiple factors, one is, as I mentioned, sometimes medical complications may make it necessary to induce the patient, for example if they develop preeclampsia or sever preeclampsia at certain gestational ages, we recommend the delivery, the baby is better off being delivered than staying in an environment with higher blood pressure. Sometimes with diabetes we may notice that the baby is not growing appropriately and sometimes we induce. There are certain medical conditions that necessitate induction and those are basically more important. And then we also talked about an increased risk of patients going over 42 weeks, and sometimes we actually do wait up to 43 weeks, if a patient is well dated, and that also kind of touches on the importance of early prenatal care, if your dates are accurate you may not really be postdated, you may have an accurate due date. If you do have an accurate due date and you are passed 43 weeks, or sometimes 42 weeks, we do induce a labor, because there is an increased risk of stillbirth and other complications for post-term pregnancies. So sometimes that is the reason we induce patients. The risks of C-section for macrosomia babies also, as we mentioned, higher BMI patients have higher risk of having large pre-gestational age or macrosomia babies, and sometimes those babies can't be delivered by women because they are just larger and that necessitates the C-section. There are multiple factors associated with induction and C-section, but absolutely, if we can avoid an induction, especially on a patient with the first baby, and the cervix is not right dilated, we prefer to wait.

Stephanie Saalfeld : So how can all these risks be reduced – obviously, you are not going to ask a pregnant woman to lose weight – so with all these risks, what can a woman do to try and avoid all these risks?

Ray P. Kamali : That's a great question. Once a patient walks into our office and they are pregnant, as you mentioned, we can't ask them to go on a diet, but we want them to go on a healthy diet, meaning not to lose weight, but to consume the appropriate amount of calories so that they don't gain an excess amount of weight during their pregnancy, and also to educate them about the right type of calories or carbohydrates and avoiding empty food, stuff like sodas, chocolate deserts, sugar...

Sunny Gault : …All the good stuff.

Ray P. Kamali : Exactly. And then also sometimes we are able to refer them to a nutritionist or dietitian that can help them, because what we do is sometimes talk to these patients and some patients are very well informed and they have tried various different things, and some people just don't have any idea about what is good and what isn't good. So we try to engage their knowledge and also just refer them to nutritionists and dietitians, and to stress the importance of prenatal care and closer supervision. Sometimes, with diabetics and high blood pressure and other complications, we start monitoring the mom by educating about fetal kick counts, and also counting the baby's movements every night, just to make sure that the baby is moving and active, and then also somewhere around 32 or 34 weeks, we sometimes start doing a little bit more intense monitoring, by doing what's called a NST, Non-Stress Test, by having the mom coming to the hospital, to the office, and we just monitor the baby's activity and heart rate and sometimes the contraptions also, just to see if the baby is doing well, and we can also assess various things, like growth and fluid index. And so we just monitor these moms a little closer than normal weight moms, just to make sure that they have a positive outcome and a healthy baby.

Sunny Gault : Yeah, I had to do some of that actually with my second pregnancy, I had gestational diabetes, but it was something that wasn't the test that you take at 24 weeks or something like that, that was inconclusive, I didn't have all the markers, but borderline gestational diabetes. And then they said, “Oh, guess what, you have to come back and take this three hour test again”, and then I did that and that was over. So most of the time when you are initially marked as having borderline gestational diabetes it usually falls into gestational diabetes later, so I remember you were talking about the non-stress test, and that was something that I had to do. But it was kind of nice on one end, it was a commitment, but at the same time it was nice to see the baby more often and hear his heartbeat, and go through that whole thing.

Stephanie Saalfeld : But also in gestational diabetes BMI is not the only risk factor, in fact one of my friends was quite underweight and had gestational diabetes.

Sunny Gault : Yeah, absolutely.

Ray P. Kamali : Diet, genetics...

Sunny Gault : Yeah, I learned that when I went to my first class for gestational diabetes. I was like, “Wow, there are whole different types of people here!”, I wasn't sure what to expect. When we come back, we'll talk about ways plus-sized moms can discuss their health with their medical provider. We'll be right back.

[Theme Music]

[00:24:49]

Sunny Gault : OK, we're back, today we're talking about plus-sized pregnancy. Dr. Ray Kamali is an OB/GYN and he is joining us now, here in our studio, to tell us a little bit more about it. So Dr. Kamali, what advice do you have for plus-sized moms who's medical providers aren't as sensitive to their situation?

Ray P. Kamali : It's an interesting question, I personally didn't know that this existed, and last night also I was looking at some blogs in preparation for this, and it seems to be a big problem, there are a lot of patients complaining about their health care providers, because sometimes the provider tries to educate the patients, but sometimes they are scaring them or they are not being sensitive to the patients. I guess the first step would be to try to actually talk to your provider and make them aware of it, sometimes in some practices there are other providers and practitioners, so you can switch to the other provider, or sometimes you can also ask your friends or family members who have had babies or who were pregnant to see if they liked their OB/GYN or provider, or nurse practitioner, and if they're happy with their care, you can also switch to another provider, because it is difficult, there is no real directory that says, “these are physicians that are sensitive to overweight”, it's just kind of like shopping for anything else, and shopping for doctors is also very difficult, even when you're not pregnant, sometimes you walk in and you may love your doctor and you may not, you just have to be able to bond and be able to relate to your doctor and vice-versa.

Elisa Suter : Why do you think that is though, that some doctors are not as sensitive as they should be? I'm just thinking, from an outsider's point of view, that you're trained to try to make people “healthy”, and you're trying to fix something that you think is broken, is that what we're seeing?

Ray P. Kamali : Absolutely, and having this conversation today about all the risks, and the medical school for a number of years were just drilled about all the risks of obesity or overweight and hiper-pressure and diabetes and various different disease, you always look at the risk factor, being overweight is a risk factor for a lot of various conditions, so people are just automatically trained to think that, “You're overweight, you're obese, you just need to loose some weight and you'll be fine”. It's a lot more complicated than that, and we also realize that we need to be able to offer solutions and you can't just ask a patient to go lose some weight and you'll be better.

Elisa Suter : Especially once you're pregnant.

Ray P. Kamali : Absolutely.

Elisa Suter : Can I share my little story? And this is very short. I was talking to my midwife about the idea of not doing the gestational diabetes drink, and actually just pricking my finger, because I usually have low blood sugar, and wanted to make sure that I wasn't sick for three or four days after taking that horrible nasty sugar drink. And I suggested to her that this is what I want to do, and she turned to me and said, “Well, I don't understand how someone can get to your size without liking sugar”.

Sunny Gault : Oh my God!

Elisa Suter : And my husband, who is very very small, turned to me and he had eyes about the size of saucers, because he knows that he eats at least three or four times as much sugar per day as I do. And I usually have a very good diet, I exercise a lot, been very healthy all the way to my pregnancy and before, and it was such a slap in the face that someone would assume that I had terrible eating habits and that I was just a slough, because I happen to have a higher BMI. And I think that a lot of people get this from a lot of medical providers. You get this assumption that you're just lazy and you're not doing anything right. You aren't listening to me because of course, you wouldn't know if you were eating badly, because you're fat. And I think that it's important for people, for overweight women, to think about, “OK, do I actually want to be with this medical provider who's insulting me?” I mean yes, obviously, you want to make sure that you are eating healthy and that you're exercising and that you're doing all these things, but if there's a constant harping on you, “You need to watch those carbs!”, or whatever it is, which I've heard as well, you kind of go, “OK, well, why are they harping on me? Just because I'm a little bit bigger naturally?” There are a lot of other factors to weight.

Ray P. Kamali : Some great news about the diabetes test, I just read a study about jelly beans, so you can do that, with ten jelly beans, instead of that nasty drink, so you can actually enjoy your diabetes test.

Elisa Suter : That's nice, that's nice, I wish that they would have given me that option.

Sunny Gault : I don't think those words have ever been in the same sentence.

Elisa Suter : Are there specific challenges for health care providers with plus-sized pregnancy? So we're talking about it from the plus-sized person's perspective, but how about health care providers?

Ray P. Kamali : Well, there's a lot of education involved, again, like I said, we have some patients that are completely uneducated about they eat or drink, and also patients that are completely educated and are exercising and they know about their pregnancy and the risks. So part of the challenge is trying to educate your patients. But other challenges is non-compliance, sometimes we have patients that have struggled with their weight throughout their pregnancy and the last thing they want to hear from us is that we are going to refer them to a nutritionist or dietician, or that they need to eat better or eat healthy...

Sunny Gault : …”One more thing I got to do while I'm pregnant, whatever”

Ray P. Kamali : Absolutely.

Elisa Suter : Is there anything logistical as far as the equipment you would be using? Or anything like that that would be affected?

Ray P. Kamali : That's also interesting, 'cause last night, when I was going through some of the blogs, I read a blog, a website, which came from a patient's perspective walking into an office. They said that when you first walk in into an office you look and sometimes the chairs are not accommodating to higher BMI patients so right away you already feel like, “I got to stand up, 'cause I can't sit in any of these chairs”, and other patients are looking at you, “Why is this person standing”, and also sometimes the receptionist, and how their attitude is towards you, and going in to weight, the scale go up to a certain amount, is the platform kind of small to fit on to, and then the blood pressure cuff, if they don't have a larger blood pressure cuff, and then the size of the table, and then also those horrible gallons that we always give our patients, the one size fits all, but sometimes it's difficult for people to fit in, it doesn't cover them. So there is a lot of things, actually, reading that opened my eyes too, because we just go into a patient's room, we don't think about these things. But definitely, there are these things that patients notice.

Elisa Suter : That blood pressure cuff thing actually happened to me. For years I was getting diagnosed as having high blood pressure, and I kept saying, “Why do I have high blood pressure? This makes no sense”, and they finally used a larger cuff on me, and I'm right on the borderline, I actually measured my arm and different blood pressure cuffs have different circumferences, but generally speaking, you can find the number online, how big your arm should be. And I was actually measured with a regular size versus large size, and at one of my prenatal appointments they accidentally measured me with the regular size cuff, and then five minutes later realized it and said, “Oh, wait, let's measure with a large cuff”, and the difference was over 30 points. They would have been putting me on high pressure medication. And it wasn't that much tighter, it didn't feel that much tighter, it wasn't something that I would have been commented on prior to actually been measured with the large cuff, but I think it was 147, and that was scary to me, I was like, “Oh my gush, what happened?”

Sunny Gault : Yeah, if your blood pressure wasn't that high it was high after.

Elisa Suter : Yeah, I thought it was 1-10 over 17.

Sunny Gault : I want to touch on the emotional side of things, and Elisa, I'm going to toss this over to you. I think it's good for providers to hear conversations about this, and as well for other plus-sized women to now that they are not alone. So what are some of the things emotionally with your pregnancy that you've gone through that might be helpful to share?

Elisa Suter : I think that it's important for plus-sized moms to get educated. Because I know that when I was first looking at getting pregnant, and was first pregnant, you read all these books, then you read all these studies, and you read all these statistics, and a lot of statistics are, as I said, presented in such a way that you have a 4-fold risk of developing neural defects, while the actual risk for anyone else is well under 1 percent. So actually a 4-fold risk is still under 1 percent. And I think that once I started to do my own research, educate myself, it started to be less than a stressful thing. I think that it's really important for every mom to not be stressed out, not to let herself get to that point where she is just dealing with so much stress and anxiety and depression and whatever it is that she is dealing with. I think that it's very important for plus-sized moms in general – moms in general, but plus-sized moms in particular – to really get educated about the actual things that are going on and what you can do to make things better. Instead of beating yourself off for eating that delicious cookie, you go for a walk. Which can actually help reduce stress and make you healthier and stronger for when you're giving birth. And I think that at first I had a lot of anxiety, and once I started to do a lot of research for myself and realize that I actually was pretty healthy, despite my BMI, and really start looking at what I could do and what I needed to do, it made me a lot less anxious. I also think that going to a doctor that's not going to belittle you or make you feel upset, it really makes a difference, and I think that that's one of the biggest things that I have seen online.

If you start looking for a lot of plus-sized pregnancy things, there are a lot of doctors out there that just don't get it, and don't understand that people can be healthy and people can deliver healthily. And I think it's important for plus-sized moms to have a good relationship with their doctor. Because you don't want to feel bullied, you don't want to feel shamed, you shouldn't feel guilty for being your size, it's OK to be a different size than “normal”, as long as you are being as healthy as you can for you and your baby. I think that's the important thing. So I think that being educated and really having good relationship with the doctor and having good support in general are really important. Because I know that once I started to really think about things in a different way, rather than worrying about all the risks, and feeling like there was no way for me to be healthy, then I realized that there are a lot of ways for me to be healthy. And there are a lot of moms who have a BMI over 30, or over 25, or whatever, who have perfectly happy pregnancies, and I think that it's definitely something to focus on, it's good for moms to focus on being healthy and happy.

Sunny Gault : Alright, well thank you Dr. Kamali for being here today on Preggie Pals. For more information about Dr. Kamali, you can visit the episode page on our website.

[Theme Music] [Featured Segments: Maternity Fashion Trends]

[00:38:06]

Sunny Gault : Before we wrap today's show, here's some maternity fashion trends, from Christine Stubindack of Borrow for your Bump.

Christine Stubindack : Hello Preggie Pals, I am Christine Stubindack, maternity fashionist expert and founder of Borrow for your Bump, where you can buy or rent maternity clothes for a monthly rate. Today we are going to talk about the perfect weekend getaway looks for moms to be. For cooler weather, back to school, football games and fun weekend outings, this is the perfect chance to enjoy new looks by combining outfits already in your closet in a new style that would work with your growing bump. For a city tour or even day errands, we love the look of a dark top with bright crops. Color blocking is still a hot trend this fall, and it brings bright and light to your already glowing face. Add a silk scarf and some colorful footwear. The country getaway is a relaxing escape, and your wardrobe should say so. Try a sheet cotton or even denim blouse. For the bottom, add a half silk or shorts and tear it with some comfort shoes. Bring along an oversized scarf which can double for breezy nights. If you are lucky enough to experience an island escape during these months, you will love a simple dress or anything in the fun part. Trade your cool heels for flipflops, and don't forget the sunscreen. Every expecting mom deserves a spa session. You should choose a white sweater with a breathable cotton, some bright shorts from silk, that will help you relax. Don't forget your oversize shade to protect your fresh new face. Road trips are fun any time of year. For an American classic look, try some skinny milliary cargo pants, some basic sneakers and, if it will help, a hat. Whatever your getaway, find more styles at BorrowforyourBump.com. Enter the promo code “PreggiePals” to save 20% off for your entire order. Thanks for listening to today's tips on how we can escape, and be sure to listen to Preggie Pals for more great pregnancy tips.

[Theme Music]

Sunny Gault : That wraps up our show for today. For members of the Preggie Pals Club, this conversation continues as we explore what it's like for plus-sized moms who are looking for maternity clothes. How does that work? Thanks for listening to Preggie Pals, your pregnancy, your way.

[Disclaimer]

This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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