Why We Need To Talk About Pregnancy Weight Gain

I make large babies. At my 36-week ultrasound for my first son, the tech appointed to peer inside my belly took one look and exclaimed, “Whoa.”

“What?” I said, alarmed.

“That is one big baby,” she said. “Have they talked to you about interventions?”

“No,” I snapped back. Don’t sugarcoat it for the first-timer or anything, lady, I thought bitterly. “My due date isn’t for another month.”

“Honey,” she said, more sympathetically, “you’re not going to term.”

My baby was born a week later, without interventions, huge and healthy at 8 pounds, 14 ounces. The midwife declared, with good humor, that he was the biggest 37-week baby she’d ever seen. He’s now the tallest kid in his preschool class.

Also contextually relevant to this story: I’m almost 6 feet tall. My husband is about 6 feet even. He played hockey. I look like I played basketball. (I was actually a competitive speller.) When we started dating in college, we did not fit comfortably in the university-assigned single bed together. We are strapping folk.

During my pregnancy with said giant firstborn child, I gained about 55 pounds. This was terrifying to me: because I have a history of eating disorders, and because every single baby-related website on the goddamn internet told me, over and over again, that a “normal” weight gain in a “healthy” pregnancy was about 25-35 pounds. With this range lodged in my brain, every checkup — particularly in the later stages of gestation — was laced with panic. Am I gaining too much weight? Will I ever lose it? Is delivering this baby going to kill me? Will I never poop right again?

It seems ridiculous to me, verging on irresponsible, to assign a single pregnancy weight gain target range to an infinite range of female bodies and experiences. Of course it’s medically necessary to track weight during pregnancy; not gaining weight can be dangerous to the developing fetus, and rapid weight increases can signal health risks like preeclampsia or gestational diabetes. But in a culture that constantly punishes women for gaining weight, is it really helpful to place strict, quantitative, uniform guidelines on what constitutes “too much” or “not enough” weight gain in pregnancy, without regard for individual context?

Any answer to this question relies upon a cold reassessment of our information sources. As I’ve told many a girlfriend freaking out over a late period, you cannot take a pregnancy test on Google — and you can’t diagnose a healthy pregnancy, either. While widely trafficked pregnancy-tracking sites like WebMD, BabyCenter, and TheBump can be helpful for reassuring oneself that heartburn is common and first-trimester nausea will probably go away, they’re also imperfect, and in some ways unreliable, sources. BabyCenter and TheBump offer message boards, for example, where preggos can anonymously throw questions out to the reproducing internet at large, and while they’re popular enough to suggest that some find them useful, it’s also easy to find reports of cyberbullying on both sites.

The funding sources of these websites make them worth taking with a glacial crag of salt, too. Sites like What to Expect earn money through affiliate links hawking pregnancy and baby products, meaning at least some of their “medical” information could be incentivized by advertisers. Even more dubiously, in 2013 JAMA published a study revealing that WebMD receives more money than any other medical communication company on record from pharmaceutical and device companies. Physician-researcher James Yeh, who studies how Big Pharma funding influences medical information, articulated WebMD’s “conflict of interest” to Vox in 2016: “Maybe they are trying to educate the clinician or the public, but at the same time there’s the marketing side: They are also trying to sell a drug.” This in-text sales pitch includes, let’s not forget, plenty of weight-loss drugs, sometimes with little hard data about those drugs’ actual effectiveness or side effects.

The medical establishment itself, too, is hardly faultless when it comes to diversely applicable and body-positive discussions of weight. Dr. Tirun Gopal, an OB-GYN who also practices ayurveda, acupuncture, and homeopathy at St. Luke’s Hospital in San Francisco points out that both the internet and certain medical devices fail to “take into account the culture, the race, the ethnicity” of a patient: “Unfortunately, all the numbers numbers built into the software” of an ultrasound machine only give “information that is applicable to a Caucasian”. In other words, as a result of setting white standards as the baseline for health, these devices provide an incomplete picture of greater maternal and fetal wellness; for instance, Dr. Gopal often fields anxiety from Asian mothers who fear, unnecessarily, that their babies are too small.

And even though gradual weight gain is a sign of health in pregnancy, the pregnant are rarely exempt from weight-related body-shaming: I know too many women who have left prenatal checkups in tears after being told they’re gaining weight too fast, too much, the wrong way. For women in ED recovery like me, even being made to face a scale regularly can be panic-inducing: I haven’t owned a scale in 15 years. Why? Because scales unfailingly make me feel terrible about myself, and because I’ve done a lot of hard work to find better indicators — strength, protein-rich snacks, regular exercise, eating when I’m hungry and stopping when I’m full — of health to guide me. (The National Eating Disorders Association also provides some good information on de-centering weight in prenatal care.)

In addition to the mostly justifiable medical surveillance pregnant women endure, there’s also the wholly unnecessary, yet relentless, amateur surveillance we encounter all around us. In the first two trimesters of my second pregnancy, various people told me that I “didn’t even look pregnant”, obviously meaning it as a compliment. My mother informed me, repeatedly, that I shouldn’t get my hopes up about delivering my second baby as early as my first, because I had been so much bigger last time. And now in my third trimester, if another person remarks “You’re so pregnant” to me, I might lose it. With these comments echoing in my head, so too have I surveilled myself, examining my body in the mirror, testing my clothes, trying to see if I was gaining weight at the same rate — or maybe, I hoped, a little slower? — as I had last time. Even as much as I’ve known, intellectually, that weight gain in pregnancy is healthy and desirable, the toxic messaging of a fatphobic culture dies hard.

It occurs to me how often, implicitly and explicitly, a woman is told never to be full. Full of food, full of confidence, full of sex, full of herself, full of a burgeoning self. Even when we have literally donated our bodies to the science of sustaining the human race for 10 months — an extraordinary and ubiquitous act of selflessness — we are constantly reminded, by institutions and individuals alike, that we had better not be too much. In her essay on Kim Kardashian’s “unruly” pregnancy and the cult of “cute celebrity pregnancy”, Anne Helen Petersen articulates the “contradictory messaging” pregnant women in our diet-obsessed culture are given: “you’re hot, but on the border of obscene; you’re perfect, but you’re huge; don’t feel bad about yourself, but your thin body is better.” I want to say enough and yet I know I will still struggle with it, will still surveill myself, will still feel imprisoned by images of my unpregnant body. Though it sounds absurd to put it so plainly, it’s still not easy to prioritize how I feel over what the scale says as a measurement of my value.

Our information age is sometimes still so far from the answers we need. You cannot take a pregnancy test on Google, and neither can you search for a healthy self-image there. There is no more an ideal pregnancy weight gain than there is an ideal baby. On my best days, when I feel as confident as I want to feel, as mature, authoritative, and healed, I can find the moxie to tell myself: I have as much a right to be full as I do to be hungry. You do too.