Thursday, February 17, 2011

“You Are Short Of Breath Because You Are Overweight”

Another "gem" from My OB Said WHAT?!?"

“You are short of breath because you are overweight.”Doctor to a mother a few days after birth. One week later she was treated for pulmonary embolisms.

This is a particularly frustrating example of weight bias in medicine.  This was a woman who had recently had a cesarean, and had a documented family history of blood clots, and the doctor still dismissed her shortness of breath ─ a classic symptom of a blood clot that has traveled to the lungs (pulmonary embolism) ─ as being due to her weight alone. 

Because, you know, nothing else could possibly be wrong with a fat person except fatness.

So obviously, the main lesson here is that doctors need to stop blaming fatness for everything and be alert to the possibility of other complications when a symptom presents.

But another cautionary side note to this tale is how important it is to lower the cesarean rate in women of size.

One reason that the high cesarean rate in women of size is so dangerous is the risk of blood clots like these.  Blood clots are a rare but extremely serious complication of any kind of surgery; do enough surgery, and the rate of life-threatening blood clots like these will rise significantly. 

Remember, pregnancy increases the risks of blood clots in women of all sizes already, and "obesity" increases your risks for blood clots a bit more on top of that.  Then add into that major surgery ─ and cesarean rates of nearly 50% (or more) in some hospitals for "obese" women ─ and blood clots afterwards will be seen more and more often.

Mind, it's still a fairly rare occurrence, but it can ─ and does ─ kill.  Yet it's one risk doctors can proactively prevent much of the time by making sure that only truly needed cesareans are done in women of size, and when a cesarean is truly indicated, by considering the pros and cons of a blood thinner in that situation.

[Side note: If you are a person of size and have surgery planned, you should discuss the pros and cons of blood thinners with your surgeon ahead of time, especially if you have a clotting disorder or any family history of blood clots, strokes, or heart attacks.  It's not always a clear-cut decision; there are benefits and risks to the use of blood thinners.  However, you might want to discuss ahead of time the pros and cons of them for your particular situation.]

Furthermore, doctors should have a high index of suspicion for possible pulmonary embolism in an "obese" woman who has just had a cesarean, let alone one with a family history of blood clots.
This mother told her doctor about her symptoms a few days after the birth, and despite her recent cesarean, her size, and her family history of blood clots, the doctor dismissed her symptoms and told her the problem was because she was overweight.  She was sent home.

She lived with that blood clot for more than a week and is lucky she didn't die.  She was fortunate that she was seen by 2 visiting nurses postpartum, who recognized a strong possibility of a blood clot to the lungs and sent her to a hospital.   The emergency room took it seriously, did the testing needed to diagnose a pulmonary embolism, and got her to intensive care right away.

From her acccount, things were a bit touch-and-go for a while, but she did survive.  However, she was separated from her newborn baby for two weeks (any mother who has been separated from her newborn for any amount of time knows just how heartbreaking that is!) and had to stop breastfeeding.  This doctor's dismissal of her symptoms cost her a lot, emotionally and physically. 

(Fortunately, she was able to re-establish breastfeeding eventually, but many times breastfeeding doesn't survive a separation like that.)

This is yet another example of the common problem of doctors missing serious health problems in fat people because they are so busy blaming every health complaint on fatness. As if nothing else could ever be wrong!


Kirsten said...

Unfortunately you can sue for medical malpractice over what MIGHT have happened. Only over what actually happned.

Which is why this doctor, this MEDICAL PROFESSIONAL, will be allowed to continue to do this to women who are in fact heavier than he would like them to be.

**shakes head in disbelief**

Janeen said...

This was one of the reasons why I was VERY concerned about having a repeat cesarean (and one reason I fought it SO hard and one reason I was VERY concerned with staying in South Korea, a country that is not AT ALL used to dealing with plus sized women). I have a younger sister (who was NOT overweight at all) who had issues with clotting, had a clot in her colon due to the birth control pill, lost a baby at 28 weeks possibly due to a clot and had that followed by two miscarriages and took baby aspirin during her entire final pregnancy. I have a father who had a stroke. And I have a half sister (from the father's side) who had a heart attack. My concern with dying, I felt was quite reasonable and thus it annoyed me VERY MUCH how much the providers went on and on and on about how my baby could die. HELLO! What about me?! And I did bring up the clotting thing and I was basically blown off. What was more of a concern was how my obesity was going to kill my baby.

I have been VERY unimpressed by OBs once the baby is delivered. It seems like once it's all over with, they feel free to show their true colors. I'll never go back to an OB, especially not after what I went through at the six week post partum check up.

Tami said...

Just wanted to let you know, I had baby #5 on Feb 1. When I was pg with baby #4 my midwife dumped me at 37 weeks due to concerns over the baby's size--she came out at 41 weeks a measly 9 lbs, no problems with the birth whatsoever. Well baby #5 was a different story. New midwife, great pregnancy, except baby was perfectly happy and did not want to meet the world. We finally convinced him to come out at 42 weeks with quite a bit of prodding--he weighed 11 lbs 13 oz! As I review the birth story I see several points at which an OB would have called a c/s, so I thank God I was at home with a patient midwife instead. We had no complications, but it was an unusual labor in terms of timing, and with my "history" (VBAC, big babies, and weighing 250 lbs at the time I went into labor) it's easy to see where the docs would have insisted that a vaginal birth was impossible. But obviously it was possible, because I only pushed for 7 minutes with my nearly-12 lb baby boy. He came out with a perfectly round head too, obviously had plenty of room. So take THAT doc who insisted on c/s for CPD with the 8 lb 12 oz baby. And the mw who refused to attend my next birth after I had birthed a 10 lb 10 oz baby. We can do amazing things!

Lori said...

Please also take a look at Peri/PostPartumCardiomyopathy. I was planning a homebirth with my 5th baby in February 2007...with the same midwives who had been in my livingroom half in the Aquadoula with my husband and I as my #4 swam up into the world... just 18 month prior. My 5th pregnancy was healthy until my 8th month when my whole family caught and spread around the Norwalk virus. AWFUL. That did pass and we all felt better until 2 weeks before our "due date". I began feeling short of breath and nauseated, exhausted and just altogether rotten, with no resolution. I could not keep food down all the time. No fever just gross feeling. I told my midwives, repeatedly, that I felt awful and noticed protein in my urine. No biggie they said. You are not eating and drinking like you should, they said. Well no kidding, I reminded them, I cannot keep much down. They questioned my comitment to my homebirth. They were snarky and rude. They blamed my husband, they blamed me, blamed my 4 babies...long story short: I walked into the ER on my baby's "due date" having been unable to keep anything down for 3 full days. After all the dust settled and my daughter was born 5 hours after I staggered in the door, I was found to have severe eclampsia, a blood clot in my lung and a form of cardiomyopathy that only happens to pregnant or recently delivered mamas. I was told I was extremely lucky to have survived. My EF was 24% and I was hospitalized for a month. I fought to keep my newborn with me at all times. My nurses were so startled to see someone so adamant about bonding that they turned away doctor after doctor who was trying to have my littlest one sent home on a bottle. Everything they put into my system was triple checked to make sure it was compatible with breastfeeding. My mother-in-law came to the hospital almost everyday and then my husband stayed every night to make sure someone was with me and my baby 24/7. My mother was at my home raising my 4 other kids. She stayed for 5 months to make sure I was able to handle life after getting out of the hospital. My midwives were UGLY about the whole thing. They questioned every diagnosis, questioned my even having the gall to go to the ER, they were horrid and made a terrifying situation 100 times more awful with their smarminess. My main Point? SOB during pregnancy can mean decreased heart function. Do not let a smarmy medical professional or dismissive midwife make you feel so bad about yourself that you stop asking for help. DO Ask about PPCM. Be vigilant. Do not ignore these symptoms. It could mean the life of your baby, and your own.