You probably have a lot of questions about your pregnancy. The most important thing you can do is find a health care provider who is size-friendly and who treats you with respect, compassion and dignity. There are special issues that come up in plus-size pregnancies and you want to make sure you have a health care provider who is familiar with them and is comfortable working with plus-size patients.

Call and ask the receptionist if the provider is size friendly. Set up an initial consultation and evaluate him or her for yourself. Make sure the office has large sized blood pressure cuffs, exam gowns that fit, and weigh-in procedures that make you feel comfortable. If your provider scolds you, treats you like a child, insults you or acts insensitively, go somewhere else.

You can choose to work with a doctor or midwife, whatever feels more comfortable for you. The most important thing is to find a provider who makes you feel good. You should think of your health care provider as a partner in your care. You need to have mutual respect and sharing of information. This means you should be honest with your provider and expect him or her to be honest with you. Your goal is to work together towards the goal of a healthy baby. Respect your provider’s advice and opinions, but know that you are the only one who can make decisions about your health care.

5 Important Questions You Should Ask Your Health Care Provider

• Is your office size friendly? Working with a health care provider who is not size friendly is a recipe for disaster. Not only will you feel uncomfortable the entire time you are there (shrinking from the nurse’s disapproving look as she weighs you or cringing as she huffs off to find the “big” blood pressure cuff), but you’re also likely to feel intimidated and unable to ask the questions you need to and have the conversations that will allow you and your health care provider to work as a team.
  
• How much weight should I gain? Experts recommend that most plus-size women gain 15 to 20 pounds during pregnancy, but each woman’s situation is different so it’s important to talk about weight gain with your health care provider. It can be difficult to talk about weight and face the fact that it will be monitored at each visit, but having a healthy pregnancy is your priority.
  
• Should I take more folic acid? Plus-size women are at a higher risk of having a baby with birth defects, including neural tube defects. Folic acid prevents neural tube defects, but research shows that even taking the recommended dose may not fully protect plus-size moms. Some experts believe plus-size moms may need a higher dose in order for it to be effective.
  
• What is your opinion about epidurals and C-sections? There are some experts who believe plus-size women should get early epidurals because they are more likely to have C-sections and having the epidural line in place makes it very easy to go right into surgery. This reasoning assumes a plus-size woman probably cannot have a normal vaginal delivery (which is not true) and also takes away the option of having natural childbirth. It’s important to talk to your health care provider about epidurals, C-sections, and your preferences.
  
• How long should I wait for my milk to come in? Plus-size moms often find that it takes longer for their milk to come in. Studies show that if you can wait for it to come in, you can successfully breastfeed. It is difficult to do this without the complete support of both your health care provider and your child’s health care provider, so start asking questions about this now and start to put a plan into place that will allow you to successfully breastfeed if that is something you want.
  

Tips to Make Your Health Care Provider Visits More Pleasant

• Ask for a Larger Blood Pressure Cuff Most offices have at least two sizes of BP cuffs. Not only is the larger size more comfortable, but using a cuff that is too small can give a false high reading. Ask the nurse if she can make a note on your chart to always use this cuff, without you having to ask each time.
  
• Ask for FemSpec FemSpec is an inflatable speculum that is more comfortable to insert than a regular speculum. Some plus-size moms have vaginal walls that are collapsed inward, so a regular speculum can be uncomfortable, particularly during pregnancy.
  
• Apply Heat Before a Blood Draw If you have fleshy arms, finding a vein can be difficult for the phlebotomist. Applying heat to the inside of your elbow or forearm by running warm water over it or holding a warm coffee cup against it will make the veins easier to find and make your stick less prickly. Plus-size moms do not need different sized needles!
  
• Be Direct Many women find that it helps them to be direct with the doctor or midwife about their weight. If you have questions or concerns, or are afraid of being lectured, go in and say, "We both know I'm overweight. What can I do to make sure I have a healthy pregnancy?"
  
• Express Your Dissatisfaction If you ever feel that anyone in the office treats you negatively because your size, speak up. Tell your main provider. If you don't let them know there is a problem, they can't fix it. It's also important to remember we all have bad days, and you shouldn't assume someone is rude because of your shape.
  
• Ask About Vaginal Ultrasounds If you need an ultrasound early in your pregnancy, a vaginal ultrasound usually is the best method. However, because plus-size women have adipose tissue (fat) in their abdomen, a normal ultrasound may not be as effective later in pregnancy. If you continue to have problems with ultrasounds, ask them to just schedule a vaginal one so you don't have to drink and hold all that water for no reason.