Chat with Brette Sembre
Your Plus-size Pregnancy

Pregnancy

Hi. Welcome to our chat today at Pregnancy.org with author Brette Sembre! Brette is a plus-sized mom of two who felt it was time someone noticed the fact that half the pregnant women in this country are plus-sized! Brett, a pregnancy and parenting writer, collaborated with a Maternal-Fetal Medicine Specialist who is experienced in working with plus-size moms. Together they wrote Your Plus-Size Pregnancy: The Ultimate Guide for the Full-Figured Expectant Mom.

Besides being a former attorney and author of 20 non-fiction books, including Your Plus-Sized Pregnancy, she has also written a children's book. Brette is a contributing writer for ePregnancy print magazine and a contributing editor to amaZe magazine. She has written extensively about family and parenting. Her freelance work has appeared in over 140 publications, including Pregnancy, American Baby, Every Baby, Child and others. She is a member of the Association of Health Care Journalists (AHCJ) and the American Society of Journalists and Authors (ASJA).

Moderator: Thank you for joining us today Brette. Do you have a opening statement you would like to share with us before we open the question line?

Brette Sember: I'm a plus-size mom of two, author of Your Plus-Size Pregnancy and owner of www.YourPlusSizePregnancy.com. I'm not a doctor, but my co-author is, so obviously you should talk to your own doctor about medical questions. I'm looking forward to answering your questions today, so go ahead and ask!

Moderator: I have a question to start out with. What lead you to write this book?

Brette Sember: It's the book I wish I had had when I was pregnant. I just had so many questions that the other books didn't answer. I was lucky to have a great doctor who answered a lot of them.

*Annie*: Sounds like this is the book I wanted, too.

Brette Sember: But there was so much more I wanted to know -- and so much more I was worried about. Getting this book published really was a dream come true for me. It's really one of my babies!

~Angelia~: Its a wonderful book.

revama: How do you suggest dealing with family (parents, etc.) when they are judgemental and hurtful about being overweight and pregnant?

Brette Sember: First you've got to get to the point where you can love yourself. Then you need to stop listening to people who are not supportive. Tell them that they are not helping. Talk to the people who support you and always remember that only you can make you feel good about you.

revama: I'm happy with myself, they just nitpick everytime we go to see them or talk to them on the phone...I don't want to cut them off, but I don't want to feel bad everytime I talk to them either.

Brette Sember: I guess I would steer the conversation away from topics they can't handle. You decide who is going to influence you.

~Angelia~: Great suggestions. Brette, what are some ways to help build your self confidence?

Brette Sember: To build self-confidence, you have to think about the important work your body is doing. You need to appreciate the beauty in your body and you need to remember that you're doing something truly miraculous -- creating a new human!

chinablue: I am assuming the mention of over half of today's pregnancies are that of over sized woman is referring to Americans? That statement would not be an accurate one for Canadian woman.

Jules: Interesting, chinablue. Do you know the stats for Canadian women off the top of your head?

Brette Sember: I think I did read that Canadians are getting larger and the stats up there are approaching US stats.

*Annie*: My family is complete, but l would like to be able to help other moms and moms to be. Are there things that we can do as women to promote support for other women?

*Annie*: I agree on the clothes. It was like a nightmare to find anything remotely "business-like" for a normal budget.

Brette Sember: It's just awful -- the selection that is out there for pregnant and non-pregnant women. JCPenney is where I bought my one maternity suit.

chinablue: I think that a healthy body is what matters, does it not?

Brette Sember: It's all about being healthy and feeling good about yourself. It is absolutely possible to be plus-size, pregnant and healthy. The odds are that plus-size moms ARE going to have healthy babies.

chinablue: To promote obesity would not be a healthy way to promote a healthy pregnancy, would it?

sagebrush kid: You know, I agree in a way but on the other hand, if you are already pregnant and not at your "ideal" weight should you have to be ostrasized for 10 months?

Brette Sember: Absolutely not. I'm not suggesting we promote obesity. I'm suggesting we fous on being healthy and happy and doing everything we can to have healthy babies. Some women are larger. Period.

bunniemunch: I was overweight when I was pregnant each time, quite a bit so. What extra precuations should I take next time if I still havent managed to shift the extra weight? I know there are some risks involved.

Brette Sember: Talk openly with your doctor. If you want to lose weight before conceiving, then do so. Take your vitamins and consider taking extra folic acid to protect yourself and your baby. The best thing is to have a doctor or midwife you can talk to about your concerns. If you come into the conversation already armed with knowledge it will help.

sarasota: I realize that being overweight does bring risks to a pregnancy but aren't there other factors that can even things out -- like exercise, good nutrition, stuff like that?

Brette Sember: Yes! The thing is, being overweight does not mean you are doomed to have an unhealthy pregnancy. Nor does it mean you will have an unhealthy baby. Nutrition and exercise are key. So is getting good medical care, so you can get appropriate tests.

Most plus-size moms are going to have perfect pregnancies and babies. There has been so much written about the risks, that people forget that those are not the norm.

sarasota: Which tests in particular?

~Angelia~: Brette, any tips on finding a supportive provider?

Brette Sember: First ask other women you know. If you're going in blind, call the office and specifically ask if they are size-friendly. A woman on the boards on my web site just did this and she said it eased her mind.

sarasota: I never would have thought of that. Great idea.

Brette Sember: When you go to the doctor, look around. Do the nurses smile at you? Do they make a big deal out of weight? Does the doctor look you in the eye? Does the gown or blood pressure cuff fit?

~Angelia~: I would never have thought of asking the office about being size friendly. Great idea!

Jules: That's important on stuff like the gown and cuff as not fitting in the gown makes you feel stupid and a too small cuff doesn't read true.

Brette Sember: It is so important! If the receptionist doesn't know, schedule a consult with the doctor to get a feel. Blood pressure measurements are especially important and you can get a false high reading with an improperly fitting cuff.

The thing is -- weight should only be one factor in your care and any doctor who makes it the only issue is not the doctor for you. Your weight shouldn't be the focus of the doctor, but a healthy pregnancy!

sarasota: I agree. Now to be brave and confident enough to agree in public...

Brette Sember: Your weight shouldn't be your primary focus either. You can't and shouldn't lose weight while pregnant. It's not a good idea so your focus has to be on growing a healthy baby...That means eating healthy, nutrient dense, foods, exercising (and we should really talk about that separately if we get a chance), and making sure you feel good emotionally.

Romantic74: What amount of folic acid do you suggest for plus-size women? Should they take more than is normally suggested?

Brette Sember: You need to consult your own doctor on this. My co-author says to take 0.4 mg. The idea is that folic acid prevents neural tube defects and some doctors believe that larger women need more because it is absorbed by fat. Thus, plus-size moms might need more to get the same effect as smaller women. Neural tube defects are SO preventable. I'm TTC and I take a prenatal vitamin and an addition folic acid supplement. My doctor is ok with it, but every woman should discuss it with her own midwife or doctor.

Romantic74: I do the same, Brette. My doctor wasn't overly concerned, but she supported taking the additional supplement.

bunniemunch: I found that out the hard way.

Brette Sember: Bunniemunch, I am sorry to hear that. You should realize that if you had a problem in the past it was not your fault. We all do the best we can and every woman comes to pregnancy with her own risk factors.

bunniemunch: Thanks. I took 4mg plus prenatal for my next pregnancy. Do plus-sized women generally have a higher risk of complications during childbirth? Will keeping as active as possible help in any way to minimize problems? I can't pretend I was fit and it took an hour in the pushing stage.

Brette Sember: Being overweight increases your risk for a c-section but the thing is, there is new research which shows us that plus-size moms tend to have longer active labors. Many doctors pull the plug on vaginal birth too soon for plus-size moms. Laboring longer can sometimes do the trick.

bunniemunch: It did take me a whole day literally from being induced, and it was my first fullterm pregnancy but 4th actual one. My doctor was surprised I got to 39 weeks, let alone made no progress in dialation!

Brette Sember: As for other complications, larger moms do tend to have larger babies, which means it can be harder to get the baby out -- shoulder dystocia, etc.

~Angelia~: Does the research explain why plus sized moms have longer labors?

Brette Sember: The research doesn't say why, but I think (just my opinion) that it seems to take plus-size bodies a little longer to do things since breast milk also comes in much slower. Probably has something to do with hormones and body fat density or something.

BrigitteVermont: Brette, I found your new book on Plus-Size pregnancy to be an excellent resource! I wanted to ask if there is a greater risk of health complications for babies born to plus size moms.

Brette Sember: Shoulder dystocia is a concern in vaginal birth. The baby's blood sugar will also be monitored since that can be a factor. Really though, odds are you are going to have a healthy baby!

Romantic74: I'd love to hear your thoughts on exercise. I am TTC and trying to get healthy. I'm not dieting, but I am eating well and exercising about 45 minutes a day (walking, light jogging or swimming) and I am wondering if this is acceptable. In a perfect world will this help me have a healthier pregnancy?

Brette Sember: I think that is awesome! Yes, it will definitely help.

About exercise -- so many people think OMG I can't do aerobics or jog. What I say in the book is just get to a point where you move your body 30 minutes a day on average. Be active and do things that feel good. I love to walk and swim. It's not about high impact huffing and puffing, but instead about getting the blood moving. I find that exercise is really important for my mental health, too.

~Angelia~: While we are talking about exercise, do you have some safety tips?

Brette Sember:

• Work up gradually
• Don't jump in whole hog
• Do things that don't hurt
• Stay hydrated

Romantic74: I think this will be a question for my doctor, but generally, is it okay to continue jogging?

Brette Sember: Romantic, they now usually say there are no restrictions on exercise as long as you stay hydrated, don't exercise flat on your back and don't overdo. Do what is comfortable for you.

~Angelia~: Water, water, water...Jules pushes water a lot!

Brette Sember: Water is important in your pregnancy even when you're not exercising. It's the best beverage.

~Angelia~: What do I, as a plus-sized mom, need to know about nursing?

Brette Sember: The most important thing is not to give up! Studies show your milk will come in slower and a lot of moms give up. Get a nursing bra that fits. Drink water, water, water and see a lactation consultant. Don't get discouraged. I left the hospital with both babies after c-secs without my milk really in yet. Sometimes it just takes longer for a plus-sized mom's milk to come in. You've got to have really good support -- your partner and a good lactation consultant you can turn to because you can get discouraged (I think ALL women do).

~Angelia~: How long did it take for your milk to come in? How do you help improve supply?

Brette Sember: I would say my milk came fully in by about day 4 or 5 after the birth. To improve supply you have to nurse. And drink water. That makes it sound so easy, but it's a matter of being determined and not giving up. My son was given formula in the nursery at the hospital because they felt he was weak (he had fluid in his lungs). That was hard for me, but I went on to successfully nurse him for 15 months.

BrigitteVermont: I found the more the baby nursed, the quicker the milk came in.

~Angelia~: Oh great, Brette! That gives lots of hope for a happy nursing relationship.

*Annie*: Is it harder for the baby to get a good latch?

Brette Sember: Bigger breasts can make it harder for you to maneuver things around, but it should not impact the baby's latch. If you're having problems, you need a good lactation nurse who can get that baby on.

I was so embarrassed to have a strange women moving my breasts around, but she really knew what she was doing. It was all about getting that mouth on as far as possible so it wasn't just nipple play and was actual sucking that stimulated the milk,

Jules: Right. It isn't just time at the breast -- it is effective nursing that stimulates milk production.

bunniemunch: Does it take longer for plus-sized women to lose the baby weight?

Brette Sember: Some women I talked to had an easy time and others had a hard time. A key factor is how much you gain. If you don't gain a lot, then when you have the baby, you lose a lot of what you gained right there.

bunniemunch: Would nursing help the overweight lady slim down even further than what she weighed prepregnancy?

Brette Sember: Nursing helps some women lose weight. For me personally it didn't help. I was hungrier than when pregnant and I felt so inactive since I was always sitting and nursing. The key is that it took 9 months to gain it and it should take 9 months to lose it. You have to be patient with yourself and not expect too much.

bunniemunch: It can be easier for the overweight to grab the wrong food, at least it was for me.

Brette Sember: Yes and when you're sleep deprived, cooking healthy is the last thing on your mind!

Jules: ...and carbs and chocolate -- anything to boost serotinin levels is ON your mind!

bunniemunch: I tried to get cereal bars, something a little healthy and quick to grab -- in the one minute your baby lets you eat.

~Angelia~: When speaking of nursing they have recomended coloric intake. Does that stay the same for a plus-sized mom, or is it reduced?

Brette Sember: My co-author says it is the same -- the thing though is what basic calorie amount are you adding those calories to? If you're taking in 2500 calories a day or more, then you may not need to add that extra calories.

Jules: So again, it is the nutrient dense foods that you really need to be eating.

Stacy: Brette, what about recovery for birth, whether vaginal or section? How is that different for the plus mom, and what can I do to help speed recovery?

Brette Sember: Your recovery should not be longer, but if you had a c-sec you need to watch for wound care. Make sure that incision heals properly. It can be a problem because there is extra fat and tissue in the area. Keeping it dry is important. Air that area out. Uncover it. Wash it, pat it dry. Look for redness and infection.

Brette Sember: Remember it is going to heal and it is just temporary. If you make sure it looks right and wash it like they tell you, you'll be fine. Everyone is individual so you've got to take it easy for as long as necessary for you.

Moderator: Where did the hour go? Brette, this has been a great chat. In closing, do you have 3 tips for moms-to-be during a plus-size pregnancy? And please check out Brette's site, www.yourplussizepregnancy.com -- she has lots of information there!

Brette Sember: Thanks. 3 tips:

1. Find clothes that make you feel good about yourself.
2. If your doctor makes you feel bad, find another one. There are lots of great providers out there who will treat you well.
3. And finally, love yourself and your body. Pregnancy is such a brief time -- it goes by so quickly. Don't waste it hating your body or wishing you were something else.

Moderator: Thank you for joining us today, I really did enjoy this chat.

Brette Sember: You guys are awesome. Thanks!

Moderator: Have a great day, everyone.