Episode 16: Fat and Pregnant with Michelle Mayefske

Episode Summary
In this episode of Fat and Fertile, I sit down with Michelle, who shares her transformative journey from navigating societal expectations to embracing body positivity. Michelle opens up about the necessity of setting boundaries, particularly in medical scenarios, to safeguard one's well-being. Her insights into finding size-inclusive care and advocating for oneself during fertility treatments are truly empowering. We explore how she shifted from challenging experiences with body image and disordered eating to become an advocate and doula for plus-size individuals, supporting them in having positive pregnancy and birth experiences. I hope her story inspires you to stand firm in your choices and seek supportive healthcare that aligns with your needs.

What to Expect from the Podcast

We dive deep into how to establish care boundaries in healthcare settings, especially for those undergoing fertility treatments. Michelle's stories highlight the significance of finding size-inclusive providers and becoming informed advocates for ourselves. From addressing weight stigma in maternity care to understanding health risks without fear, this episode is a guide for anyone seeking to reclaim their pregnancy and birth experiences with confidence and autonomy.

Highlights:

• Setting Boundaries in Medical Situations

• Navigating Fertility Treatments with Confidence

• Understanding Health Risks in a Supportive Way

• Embracing Body Positivity and Self-Advocacy

Links and Resources

• Michelle's book, Fat and Pregnant

• Nicola’s book, Fat and Fertile

• Fat Person's Guide to Getting Pregnant

• Join Nicola on substack

• Michelle’s Instagram

Get Involved
Nicola would love to hear from you! If this episode resonates, share your story, ask a question, or leave a review.

Support the Podcast
If you’re enjoying Fat and Fertile, please share this episode on social or leave a review! Every share helps make this info more accessible to everyone who needs it.

Follow Me on Instagram: Join me here for fat-positive fertility tips, updates, and encouragement.

👉 Explore all these resources here and take your first step toward parenthood without stigma or shame. I’m cheering you on every step of the way!

• Episode transcript available here ⟶

  Thank you so much for being here with me, Michel. I cannot imagine a better person than to be my very first podcast guest than you. So thank you so much for coming and being here with me today. Yeah, absolutely. Thank you for having me. So I thought first it would be awesome if you could tell us a little bit about how you got into the work that you do around fat pregnancy and yeah, what led you to start being the incredible fat advocate that you are today? Thanks so much. So I definitely did not plan to get to this point. Like so many people, I went to university for something totally unrelated to birth and pregnancy, and I'm originally from Wisconsin in the United States, and I had a very wonderful childhood, a very supportive family in so many ways. But like so many people, there was this very large layer of anti fat bias that was just running through my entire life. And to be perfectly honest, I never questioned it. So. Up until maybe, maybe six years ago. So before I even got into the world of body positivity fat liberation, I was navigating pregnancies well, being very unhappy with my body and how I looked. And I definitely learned from a very young age what was expected of me. And I was expected to be small. And I have two sisters who we are just built very, very different, same parents. But I would have always been the bigger of the girls. And my older sister is, let's see, 16 months older than me. And it was made very obvious as we were young girls kind of navigating elementary school and getting into middle school, that we were the same, that we were wearing the same size clothing, or that I was surpassing her size. So I was very self-conscious of the fact that then at some point, we started shopping in different departments where she was still in the girls and the teenage department, and I had migrated to the women's department, and I grew up in a household where my mother was always saying negative things about her body. So I learned very quickly what the expectation was. And. I just I continued with that and I was on so many, like so many fat people today. I tried all different diets and my weight fluctuated all the time. And during my first pregnancy, essentially prior to that, I'd had some pretty intense disordered eating behaviors, and I definitely would have said I had anorexia for a number of years. So when I got pregnant and finally gave myself permission to eat, I ate all the things. So I had what is sometimes called rebounding, where as soon as you give yourself permission to eat, you just eat everything in anything. So that was my first experience through pregnancy. I did not have a great birth. I was a very young mom, so I had him, my son, just before I turned 17, and I didn't really question anything within maternity care. And because I started off non plus size because I had that eating disorder, but then throughout the pregnancy because I was gaining weight, gaining weight, gaining weight, eventually I crossed that line where now I was plus size and nothing was said to me during that pregnancy. I think the biggest concern for them was the fact that I was young. My weight was never mentioned. And then there was a pretty big gap between my first and my second. I met my met a man who would become my husband. And at that point, like still struggling with so many body image issues and struggling with what I looked like and still dieting all the time. And, you know, there were times when my husband and I were were actively doing this together. So when I got pregnant for the second time, I was I was larger. I was definitely within the plus size range. I mean, if we're talking about like how plus size, I would say was probably let's see, Nicola, can you help me. Is it mid mid mid fat. Yeah. That's kind of on that fat spectrum. Yeah I'm the fat spectrum I was definitely mid fat and or large fat. So like us size I was probably not that it's super relevant but just giving people some context as I was probably. Of size 20, maybe 22 US. So I was aware of what the BMI was and I found myself pregnant, very happily pregnant, trying to navigate a maternity system in Ireland because I had moved. And one of the first things that was said to me when I contacted a midwife for a home birth was, you know, I rang her and had kind of built up this. I had built up what I was going to say to her, because I assumed it was probably going to be an awkward conversation. I had looked at the different guidelines for folks with a higher BMI, and I saw that it was one of the things that could actually take away that choice for me. I could be told that I couldn't have a home birth in the Irish system. And sure enough, I called this midwife and I specifically said, like, hey, this is something I really, really want to do. I'm really passionate about birthing at home because between my pregnancies, I had learned so many different things about birth in general and how it could be different and it could be positive. So I said this to her and also said, but you know, I am afraid because I am a larger person, that I won't be able to have this home birth. And she asked what I weighed and she asked what my height was. And her response says was, wow, you are big. I'm so sorry I won't be able to take you on as a client. And. Like it still stuns me to that day that somebody would think that would be an appropriate thing to say to someone when they're calling you and clearly sounding vulnerable and looking for support. And that phone call really just shut me down to the entire idea of home birth, which is really unfortunate. So thankfully that birth was more positive. I did hire a doula, and it was that pregnancy and that birth that really kind of launched me into the world of pregnancy and birth. I became hugely interested in why are we told this story about what pregnancy and birth can be? And I compare this all the time to diet culture, because diet culture tells us and shapes our beliefs. Like this is what your body should look like. This is how you should move your body. This is how you should feed your body. These. This is how you should. This is how you should operate within the world. And our modern maternity system does the exact same thing, right? It's just it's it tells you what you should eat during pregnancy, how you should move your body during pregnancy. It tells you all the different tests you should have. It tells you what vitamins you should take, what medication you should take, and then when it's time to birth your baby. There is definitely this idea that you should be handing over that entire experience to the experts. And this is also comparable to diet culture because if you're a fat person, you are told don't trust your body. You clearly don't know how to make quote unquote good decisions. You should rely on these dieting experts because they know what's better for you. And then we get into pregnancy and birth and we're told the exact same thing. Don't trust your body. It doesn't know what to do. You don't know how to make decisions. Trust these experts because they know what's best for you. So but I didn't I didn't make that connection at the time. I definitely have now, but but that was me dipping my toe into like, wait, maybe some of the stuff that we're told and that we don't question is really screwed up. And that was 11 years ago when more and more people were having like, high intervention births that were leading to birth trauma. And from that moment forward, I said, like, I, I don't know how I'm going to do it. But it was during that postnatal period with my second child that I was like, I need to get involved in this world. Whether it's volunteering, activism, I really need to be supporting people during pregnancy and not telling them what to do, but just helping them realise that this is their experience and they deserve autonomy during pregnancy and the birth process. And some people will choose exactly what's recommended for them. And that's totally cool and that's fine. But there are also many, many people who don't even realise they have options. So I continued on having babies. I had my third baby. That was my first home birth, I had my fourth baby and during my fourth pregnancy I really, really struggled with body image and eating. I definitely would have fallen back into old habits of disordered eating and excessive movement. That did not feel good, but I was doing it out of this pure fear of I don't want to gain too much weight during this pregnancy. And I gave birth to him, like, and all of my pregnancies, every single one. There was never any problems and I was technically considered a plus size person, a fat person, through every pregnancy. So I never had any issues. And it was after that fourth pregnancy I was really struggling because I did gain weight during that pregnancy and I was on this mission. Postpartum to not gain any more weight. It was like this could be the worst. This is the worst thing that could happen to me is if I gained weight now and again, I started falling into these really disordered eating habits where I was cutting out entire food groups. Intermittent fasting was something that was on my radar, and it was taking up so much of my time. I really cannot emphasize how much of that fourth postpartum period was me worrying about food, how much I was eating, how many calories I was taking in, how much I was moving, how many calories I was burning, watching the clock. Because then I started doing intermittent fasting and the worry that comes along with that. And I look back and it makes me very sad. but it's so all encompassing. Like, if you're focused on that, you're missing out on your children, right? Like on being present with them. And that is just I'm sure it's a story. So many people who have had babies before can relate to because the pressure, the pressure that we put on folks who are women, who have been conditioned to be women, like to lose weight or to maintain weight. Postpartum is massive. It's huge. Right? And you need to be doing that while also being a good parent. Right? There's also this pressure to be like super mom or super parent where you have your shit together. 20 47I did not have my shit together. I had no shit together. I was very much, I was very much. This is also my. This was. This was a time when I was so focused on my body and what I was eating, that I do look back and I'm like, oh, if I had just allowed myself to live and enjoy life in the body, I had what it would have looked so different. And so up until this point, I was really a huge advocate for pregnancy and birth. I trained as a doula during my fourth pregnancy and childbirth educator, so I was really passionate about that world. but I had not in any way, shape or form done any work on me as a human being and as a fat person. And that only came onto my radar maybe when I was 8 or 9 months postpartum with my fourth. So this would have been in 2018, and I was just getting back into working. And now I'm self-employed as a doula. I'm I had we had moved. So I was learning more about the area and the hospitals in my area, and I wanted some support with my business. So I joined this group for Women in Business. It was a wonderful group and I came across this woman named Jen. She was working on her business in Canada and she had recently trained as an intuitive eating counselor. So this is when. Of my entire world. Like, like totally shifted in the most random way. Like, I was not looking for this. It wasn't a family member or friend. It was like some random woman named Jen who was starting her business in Canada. And I started working with her, and I started learning about, like back then everybody was talking about body positivity. I wasn't seeing body neutrality, respect, acceptance, anything like that, any of those alternatives. So then I read Body Positive Power by Megan Jane Crabb, and I started looking at all the other books about these topics, and I the relief, the relief. I honestly, it sounds so cliche, but it was like getting my life back because I was able to stop the obsessive thoughts about food and my body. And it's not like a light bulb suddenly went off and my whole world shifted and I was good to go. No, this was definitely like an excavation process where I was unearthing and working through different beliefs about my body and about. Like movement, like even going for a walk or going to the gym. Not because you want to burn calories, but because it was time. For myself as a mom of four, it was like, okay, this is a time for me to enjoy. This is a time for me to move my body, stretch my body, because I had been trapped under a breastfeeding baby. There are so many other reasons to move your body other than burning calories or weight loss. So I had a lot of a lot a series of light bulb moments with Jen, and I'm so thankful to her because I was one of the first people she worked with. You know, so that was really wonderful. And essentially that's what launched me into body liberation and the work that I do now. So now I absolutely will support anybody during pregnancy and birth. But I have this huge area of passion, specifically supporting people who identify as plus size during pregnancy and helping them navigate a maternity system that often is not very kind to fat folks. So that's that's what I do now. And I, I offer trainings for birth professionals who are looking to learn how to be more size inclusive for their own clients. So that's another area. So that's what I'm doing now. I am so happy that you are doing this work. It makes me so unbelievably happy, because it means that when I work with folks and when they get pregnant, I have a wonderful, incredible person that I know I can then refer them onto so that they can continue to have a supportive and positive experience through pregnancy. Now, one of the the biggest topics that kind of crosses over in our world is pregnancy risk. Because for so many fat people, the idea of risk in pregnancy is one of the reasons why they put off trying to get pregnant in the first place, but it's also one of the reasons why access to care is often denied because of this big, scary risk that we have in our culture around the idea of fat people getting pregnant. So I would love for you to tell me in your kind of your worlds and your experience, like, what is the biggest myth that we have around fat people getting pregnant and the risks that are associated with that? If I had to. So number one, this is a big topic, but if I had to summarize it, it would basically be this belief that fat folks are a ticking time bomb. Ready for just any explosive complication. Oh yeah. Like and a lot of times that's how it's spoken about like, oh there are all these complications and there are all of these risks because of your size. And it ends there. They don't go into more depth about like precisely what complications are you talking about firstly. And secondly, how likely am I actually to have those develop. And what are those complications mean. Right. Like if you tell me that I would say the big three that I usually chat about are gestational diabetes, pre-eclampsia and gestational hypertension also known as high blood pressure. And but I but most of the time there is that oh like there's so many more risks and complications. There's no details given. But when people land into my inbox, it usually is these three topics. It may also include like, oh, you're at a higher risk of developing a blood clot, or you're at a higher risk of having a postpartum hemorrhage or you're at higher risk of having a stillbirth. So what I will say is, yes, the research does show that for all of these things that I just mentioned, fat folks are more likely to experience all of them. And I can go into detail about the exact numbers. So number one, yes, that is true. However, this is a big however, we really don't know if these risks are increased because of somebody's size or because of the treatment that they receive because of their size. So for example, chronic stress literally makes everything worse. You're more you're like everything, every single condition on the planet. You're more likely to develop it. And if you do develop it, it's more likely to be severe simply because you are chronically stressed. So if people have whether they have needed to have support with fertility or not. The harsh truth is that the vast majority of fat folks have had negative experiences prior to their pregnancy. You know, they've gone to their GP and with a headache or an ear infection and they're told you just need to lose weight. Or they're constantly being told that they should have weight loss surgery or, you know, eat less, move more. And some of these experiences are. More severe. Some of them aren't. But the reality is, is your average fat person who becomes pregnant already has some kind of baggage of accumulated trauma along the way. So there's and we do know this, that fat folks are more likely to experience stress in their life. And a lot of times when I talk about this, it's like it's me throwing out these questions, which can be really frustrating. But the reason I'm throwing out these questions is because we don't actually know. There's no research into these topics because because anti fat bias is so systemic within our world. There, the vast majority of researchers and those who fund research don't actually want to pay for something that could improve the quality of life for fat folks. They're not worried about that. That's not that's not something they're interested in. So for many of these topics, we just don't have the research. But what I would argue is if fat folks already have this baggage of stress and potentially trauma that they're bringing into pregnancy, of course they're more likely to develop gestational diabetes. Of course they're more likely to develop pre-eclampsia. And it has nothing to do with their weight. And it has everything to do with the fact that they have been treated poorly by the medical system to begin. Absolutely. And when that's framed, you know, you go into your first midwife appointment and it's framed as, okay, here's all the literature that you need about all of these increased risks. You know, you're in this scary conversation. Of course their blood pressure is going to increase. Of course these things are going to exacerbate already that baggage that they're coming with. It is not a supportive environment generally for fat folks going into that maternal health care system. You're absolutely right. So how can we reframe how we talk about this kind of quote unquote high risk label? If you could change the system, if you could educate all of the doctors midwives out there, how would you like to reframe this conversation around, quote unquote, this high risk label? The first thing I would do is stop generalizing. I don't think that is helpful at all to I don't think it's helpful at all to be really general or to only give relative risks, which I can go into, which only add to fear and anxiety, potentially stress that somebody might already be feeling. And so many people that I work with, some of them. Are at a point where they have found fat liberation or body neutrality. There, there. And I think it's great if you're already there, because then you're already you're already starting to reframe some of these things yourself. But if somebody does go into that experience feeling guilty or feeling shame about being fat and pregnant, they are very much more likely to accept whatever information is given to them and not question it. And again, diet culture has has done the maternity system a big favor in that regard because people have already gone through years of not trusting their bodies and not trusting themselves. So I think it actually primes people for a maternity system that wants to make all the decisions for you. That's so true. So I encourage people to take a step back. And if they have a provider who's making really generalized statements to then get into the nitty gritty of it and go, okay, well if you're saying I'm at higher, I have a higher likelihood of developing these complications. Let's talk specifically about what those are. So the first thing I encourage people to do, whether they're they're pregnant or they're a provider, is to start looking at the difference between relative risk and absolute risk. So relative risk is when when we're looking at research it's comparing one group of people to another. And when we're looking at research related to pregnancy, a lot of times this is comparing different BMI categories, which is already problematic. BMI is trash. So it's or this is already problematic. But this is what we have. Yeah. So it would be very normal for a provider to say you are three times more likely or five times more likely to develop gestational diabetes. But what's missing from that is five times more likely. Of what number exactly. Am I going from 1% to 5% or 6% to 30%. There's no it's not specific. So instead of using relative risk which also can make things sound pretty scary right. If somebody says you're five times more likely to developing this, that can feel like, okay, whoa, that must be a very elevated number. And am I guaranteed to get it right. So that can be scary. So I encourage people to like take a step back and look at what the actual number is. And again actual or absolute risk as it's often called. This is much more specific. So this is being given the actual statistical likelihood. And again this is based on the different BMI categories. But at least you can go in and have a better idea of what you're actually dealing with here. So it's not comparing one group to another. So this is a really good like I use this example all the time. So if you've ever heard me speak then you you probably know this. But relative risk for example gestational diabetes which so many people are. For starters, I think there's a huge stigma associated with gestational diabetes that is just so unnecessary. You can develop gestational diabetes and have a totally wonderful pregnancy and birth, and most people can control their blood sugars with some changes in eating and physical activity. And there's loads of folks like registered dietitians who have a weight neutral practice who can help people if they're diagnosed for this. So that's what I want to say, for starters. And so a lot of times people are told relative risk, oh, you're 3 or 4 or five times more likely to develop gestational diabetes. That sounds scary. But here are the actual numbers. So the BMI group, the quote unquote normal BMI group of 25 to 30 has a 6.74% chance of developing gestational diabetes, folks who have a BMI over 40. Are 20% likely to develop. So this is three times more. But I also encourage people to look at how this information is presented to them. So first let's stop looking at relative risk. Let's start looking at the absolute risk. And secondly you're 20% likely to develop. Gestational diabetes also means that you're 80% likely to not develop gestational diabetes. Absolutely. And what's also usually missing from this conversation is that there are actually some things that you can do to potentially reduce the likelihood of developing gestational diabetes. So things like doing some exercise, I usually don't use exercise because I think it's so attached to weight loss, but some movement that gets your heart pumping. Right. So yoga can also be really great for helping regulate blood sugar levels. But the research is saying 3 to 4 times a week get your heart pumping something that you actually like if possible, and reducing stress. So even working with somebody or reading the books, listening to the podcast. So when you do get into that room with your provider you already know the information. Right. So you're, you're less likely to be activated by something when you know these numbers already. Yeah. And you know all the information then, right? Like you can make fully informed decisions when you have the information available to you, which you can't when it's just this big unknown. Right? Exactly, exactly. So do you mind if I quickly run over the next two? Yeah. I'd love for you. I think it's really powerful. Awesome. So pre-eclampsia the again, the 25 to 30 BMI group is 6.4% and a BMI over 40 is 16.3%. So two and a half times more likely. But again, there are the same things reducing stress and getting in some movement. Just minding yourself. You're more likely to not develop these conditions and gestational hypertension. The likelihood of this is even lower. So it goes from 5.6% to 12.7%. So again, a provider could say you're two and a half times more likely to develop this hypertension. Reality is this 12.7%. You're you're actually less likely to not develop these then develop them. So and the reality is is there is no condition. During pregnancy or postpartum that only affects people of size. Every single thing, everything anybody can experience. So I really encourage people to and. I really dislike that we have to do this level of advocacy. This is a lot of work. You shouldn't have to know the research. You shouldn't have to know these numbers. You should be able to walk into your provider's office and for them to share this information. And if you ask them, well, what's the absolute risk? Even if that provider doesn't have it memorized, like I've been doing this work now for over five years, I don't even have these stats memorized. I have them sitting in front of me. Even if your provider had if they had a PDF or they could actually like, can you, can you imagine? I know that they have in their drawer where they could take it out and hand it to you so you can have a read of it and know the actual numbers, but not the amazing. Right. Like it's, it's see, like it would be monumental. And it's literally them just having a piece of paper so you could see what they actually are. You know, the little references of the research if you want to go and and read more, you can. But I am a huge believer that these complications can happen to anybody. And even if you were to develop one of these conditions. That has no impact on your ability to be an autonomous human being for you to ask questions. For you to get those answers and for you to prepare for whatever type of birth you're hoping for. And yes, difficult things do come up. Your voice should always be at the center of the decision making. And sometimes we have to make tough choices. You will feel so much better about making those tough choices. If you feel like you were respected, like you were heard, and like your voice mattered in these different scenarios. So this is a lot of what I do is just letting people know what these conditions actually are, what the numbers actually are. So if they do come up, they're not this big scary thing. Yes. And they're also not your fault, right? Like if you get gestational diabetes, that is not because of anything you have or have not done during pre-pregnancy pregnancy. Like these things happen to folks in all bodies who have all different lifestyle choices, and it is just one of the things that you should be supported with and cared for during your pregnancy 100%, 100%. And we shouldn't be stigmatizing folks that develop these different conditions, no matter what their body size is. And, you know, unfortunately, people are experiencing this weight stigma, stigmatizing care during their pregnancy. And that can only make these conditions. More severe. Oh, absolutely. And I love the way that, you know, I think language is really important. I talk about this a lot in fertility care. But when we're talking about the word risk, like even the word risk feels like high risk. That label feels scary. So I loved when you were talking about it. You were using words like likelihood, chance, like even just higher risk rather than high risk, like reframing it with different use of that language, I think is really powerful and really important. So there's lots that providers, doctors, midwives can do when they're talking about these, these chances of these complications coming up that can help reassure and support people rather than fear mongering and scaring people when they're talking about them. Absolutely. And it took me a while to get to that point where I was no longer using the word risk as much, because it's just everywhere. Anytime you look in maternity care and even there's no way to avoid risk, because oftentimes people are either labeled as low risk or high risk. There's no label within the system that completely removes the word risk. So that's where some of that reframing can absolutely come in. And I always tell people to if they're looking for a provider and they're asking around, one of the best things you can do is talk to somebody who's already in the birth world, reach out to a doula, reach out to a childbirth educator. If you are specifically looking for someone who would be more weight neutral, for example. It takes birth workers time. Like it's taken me years to figure out what professionals in my area are more likely to be respectful and provide. I will never say unbiased care because I think that's impossible. We all have biases that we are trying to work through, but what provider are they more likely to have a positive experience with? And most of the time that is by people that I have worked with. So I do so many things now I'm a yoga teacher, I'm a doula, I do all these things, so I might even have a plus sized person in my yoga class who I've never worked with before, and she just follows my work and she's like, hey, I just want to let you know that I was working with this consultant and I had a really great experience with them, and they automatically right go onto my list of possible possible size inclusive person. So that's one of the biggest things that people can do. And if you ask someone because of my BMI, do you label me as high risk? It is very easy for somebody to say no. But unfortunately you have to vet that answer. So. And I'm seeing this more and more where people are told, no, no, no, you're not high risk because of your weight. But then when they start to look at all the recommended tests and things, yeah, it's like this off the charts, really high monitoring, highly managed experience. And it's like, well, if you're not high risk, why are you being treated like your high risk? And why are all of these different tests being recommended, like they would for somebody who was having a more complicated pregnancy? So that's just something else to be aware of and kind of look out for. Yeah. So if you could give somebody who is either kind of worried about the high risk, like they're not pregnant yet, or they are just kind of starting out on that pregnancy journey and thinking about this. What's like your top 1 or 2 tips for like having a good conversation about these risks? The first thing I would say is to become educated yourself. Yeah. Become educated yourself. Know the research. Know the specific numbers. See if so. That's the first thing. Is that education piece yourself, which again, I don't think we should have to be doing. But unfortunately that's where we are. And then secondly get really comfortable with setting boundaries. Boundaries. Yes. And language. Oh man. This is like I say this all the time. But I have to openly admit I am a people pleaser. I hate creating waves. Like if I could avoid confrontation that's the only time you're going to see me run is what I'm trying to run away from some confrontation because it makes me so uncomfortable and you have to get comfortable with it. No, no, no, you don't have to get comfortable with it. You have to accept that it is usually a necessary part of care, especially as a fat person. You don't have to be comfortable with it. You don't have to like it. But. It is necessary. Yeah. And private setting. That's it. And and if you've gone through any sort of fertility journey where you're accessing care or support, chances are you already have some experience in this area because you have had to set boundaries. But I would start small and start setting boundaries with family and friends. Now I say small, this is still hard and testing it out, right? Testing out, setting boundaries with different people in your life in regards to talking about your body or talking about your weight. And if you can try to find that size inclusive provider, have a chat with a family friend, or even join a community. So I know you have a community. I also have a fat positive space for folks on Facebook. Yeah, but like reach out to other people in your area and see what provider might be a better choice for you, and then get ready to set those boundaries when you are with that provider. So if you are educated, you already know all the information about the research and the likelihood when that provider brings up risks, which most of them will. You can smile and nod. That might be your self-care practice is you let them say it all. Get it out of their system. And I do think it's important to know that there is an increased likelihood of these things. So let them say what they need to say. And then you can set that boundary of I'm happy we've had this conversation. Thank you so much for telling me these risks. I really would like if this was the last time that that we talked about that. I don't want my care revolving around my weight. If you're already in that appointment, you could then say, like, as you might have already noticed, I'm choosing not to be weighed during this pregnancy and you can explain yourself. You don't have to, but getting comfortable with setting those boundaries and being consistent, yes, it's okay to set them, but you've got to uphold them. That's you have to. Yeah, this this is it's all hard. It's all hard in my opinion. Absolutely. But you know, then you have that second appointment with them and they start you that first visit. You've already told them, you know, I don't want my pregnancy revolving around my weight. Second appointment comes up and now they're bringing something up about your BMI or because of your size. I think we should do this and that might be fine. But if they keep going on or now they're talking about all the risks again, or, you know, they're they start giving dieting advice because that's also super common. Unfortunately, you can then refer back to. Yeah, I just I just want to remind you that the last time I was here, these are the things that are important to me. And it's really easy for us to have this conversation because we're totally in this space. it is much harder when you have to work with somebody face to face, and maybe you're working with a provider. It's it's amazing if you can find a provider who is size inclusive, you might still have to set some of these boundaries. It's much harder when you're working with somebody who just is not on the same page and may openly criticize you because of your size, so those are other things to look out for. Are some of those weight stigmatizing comments and things that may come up, which you may have no choice but to stay with that provider. Unfortunately, it's you know, I used to say much more in the past, like, oh, just find another provider. That is a totally privileged. Yeah. It's not always that simple, right? With insurance, with geography, there's so many factors at play. 100%. So yeah, get educated. Learn about boundaries. Practice those boundaries. You're much more likely to have a positive experience if you are really tuning in and finding what's important to you. And yeah, advocating for the care that you deserve. Absolutely. I love that so much. So Michelle, tell us how people can find you. Tell us where they can find your fat, positive community. I would love for people to come and find your work and, access more of the goodness that you have to offer for the world. Thank you so much. So firstly, my website is fat and pregnant. Com I'm also on Facebook and Instagram under the same name, Fat and Pregnant. For folks that are looking for more fat positive community, there is exactly that fat, positive and pregnant on Facebook. There's loads of different parents from all over the world. Some folks are trying to conceive, some are pregnant, some are new parents. And that's a great space to learn. Like, hey, where can I find a size friendly provider? But equally like, where can I find maternity clothes or what nursing pillow is going to work for me? Or what rocking chair might work for me, or baby carrier, etc. and a really great way to learn about advocacy and learn about all the different research and the different risks, etc.. Is my book Fat and Pregnant? Okay, it is amazing book. Yeah, check out Fat Birth and there's also. So the first section is all about how to create this positive experience for yourself and work with professionals. And the second half is loads of stories from people who have had those empowering experiences. And it absolutely is something that you can have. You can have a wonderful experience. And yeah, those are all the places people can find me. Yay! I love sending your books to clients. It's amazing when people get pregnant. It's like, this is the perfect gift to send them. but thank you so much for being here with me, and thank you so much for the work that you do for the world. I appreciate you so much and I am so glad that you are doing this. Thank you. Thank you so much for having me. You're welcome. Take care.