Tales From the Crib: The Pregnancy 20lb

Monday, July 17, 2006

The Pregnancy 20lb

I am currently pregnant with #2 and recently had my first visit with a new doc...
I searched for this new dr. because there are so many HORRIBLE ones in this city and I really wanted to have a great experience this time around. With #1 my hospital stay was horrendous, and in my opinion consisted of; torture, coersion, and basically the lose of any right I had previously enjoyed. (My birth story...another time.)

So determination lead me to the internet and friends to find out the BEST place to give birth in all of NYC. This search has lead me to St. Luke's Roosevelt Hospital. A place that welcomes shortened stays, private rooms and respect of your personal choices (I hope). My desire to give birth at this hospital also is what lead me to this Dr. Due to insurance constraints I couldn't find ONE midwife that was covered by my plan and whom delivered at Roosevelt that was still in practice, so I went with an actual M.D. who supported midwife "methods" whatever that means.

My first meeting with her was great except she couldn't be any older than I am, which is a little creepy and seems like I'm having a friend check out all my "parts"... yikes.
The part that I really am writing about and taking forever to explain is what she referred to as the "prefered weight gain." This is currently being held at 20lbs.

Now I know what you are all thinking (cause i got an EAR full at playgroup the next day). 20 lbs!! Is this woman insane?
I gained 35 for my first and really have never met a single person to only gain 20 lbs for any pregnancy.
Now my dr. (I trust) isn't going to be overly strict and paddle me if I go over by a pound. She will only "alert me" if she feels there is a problem.
So now the debate is; am I crazy? Do i find another doc that will allow me to eat, or continue with "my friend" and possibly cause myself some mental and physical damage. (not that I would starve myself. COME ON PEOPLE I'm not stupid!)
And sadly I have come up with a justification, and that is that for my age and height, I technically was about 7-10lbs over weight to begin with. So that added that to my 20lbs I've been given permission to add puts me close to what I had with #1 right?
Ok, I think you're right...I AM insane.

23 Comments:

It seems that there are shifting winds historically with the recommended weight gain. I'd like to see some scientific evidence on this, but never have. My thought is this:

--going hungry because you don't want to gain too much weight is borderline neglect of your baby
--eating indiscriminantly is stupid because you will eventually have to work hard to lose that weight
--a little recreational eating in the face of all of the discomforts of pregnancy is to be expected :)
posted by Julie M. Smith at 7/17/2006 06:13:00 PM
I see no problem with her telling you the ideal. That's what doctors do. Just keep eating right and exercising and don't worry about your weight gain. What is she going to do? Kick you out?

By the way--I don't know anything about her practice, but I have found that many preofessionals that work with lower income (and less educated) people tend to give advice more as threats because they are not used to patient compliance. Could it be that most of her patients start out less healthy than yourself, and she just didn't adjust in her mind what to say to you?

If you really want to give birth there, I say stick with her for now.
posted by ESOdhiambo at 7/17/2006 06:16:00 PM
First I have to comment on your insurance not covering any midwifes. My insurance also did not cover any midwifes when I was pregnant with my second baby. I was devestated. I had such a great experience with my midwife at St. Luke's Roosevelt Hospital with my first, I just didn't want to accept anything else.

I had almost resigned myself to choosing a dr. when someone told me I needed to ask my insurance for an "out-of-network exception" because I wanted to "give birth at St. Luke's Roosevelt Hospital under the care of a midwife" (which scenario they did not provide in-network). I don't know what insurance loophole this fell under, but it totally worked. I had to call and bug a few times, but it all went through beautifully. So if you really want to change to a midwife, you could try.

When it come to weight gain, 20lbs does seem unrealistic. I only gained 20 with my first but it was only because I was basically cut off from all forms of sugar during the pregnancy. I will say that it made it a lot easier post-pregnancy to get back into shape though!

Do what you feel comfortable with. Maybe stay with her for a few months and then if you still feel weird, find someone else. With my first, I changed from a dr to a midwife at 5 months because I just wasn't feeling good about my decision. It was stressful to make the change so late, but it was worth it.
posted by This is Carrie at 7/17/2006 06:31:00 PM
I had a friend who was overweight when she became pregnant with her second baby - not obese, but definitely overweight. Under the care of her doctor she actually didn't gain any weight during her pregnancy until maybe the end she gained a few pounds. The baby was perfectly healthy. I was shocked, but it seemed to work, and she really wasn't doing any extreme dieting or anything. I would never suggest pregnancy as a weight loss program, or to do something like that without the supervision of a doctor, but it seems like it can work.
posted by Gina at 7/17/2006 07:35:00 PM
I had gained about 30 pounds with my first child when my dr. told me to lay off of the chocolate sundaes...and I looked at him like "What?!?" I hadn't eaten ANY chocolate and hardly any sugar in those 8 months because it made me sick.

I think dr.'s are terrified of gestational diabetes in women because obesity IS an epidemic. And that just adds more complications that just aren't needed or wanted.

But 20 pounds? I mean, seriously? That just sounds crazy to me. I don't know ANY woman that gained less than 20 pounds --oh, I guess there's my friend who was like tracy m (just sick, sick, sick) and my overweight aunt (morbidly obese).

I would go carrie's way and try to get a midwife. I that doesn't work, stick it out with this dr. but don't allow her to let you feel like you aren't doing this the "right" way --perhaps this will be the only hang-up, and if that's the case, it might not be so bad...
posted by Cheryl at 7/17/2006 08:06:00 PM
Why don't you confront her on the issue? Tell her it stresses you out and that you live a healthy lifestyle and won't be gaining 100 lbs or anything outrageous. If she seems unreasonable, find another doctor.

I agree with you. I think it's a Manhattan thing...I really do. I had a really strict doctor with #1. The office was in Midtown and I dreaded my appts because if I gained more than X each month, I would get a "reminder." It really put a damper on the experience and I regret not confronting her/ finding a new doctor. I ended up gaining 30 lbs that pregnancy (although the baby was 7 weeks premature)....I have no idea how much I gained with #2 who went full term... probably about the same...although I was carrying an extra 10 lbs to start off with....but was I MUCH less stressed through the pregnancy.
posted by Jen at 7/17/2006 08:07:00 PM
ksl - I agree with Jen that you should say something about your concerns to your DR at your next appointment. I mean, that's one of the MOST important things with the DR who is going to deliver your baby ---- can you communicate openly with them, share your concerns, etc? Regardless of the number on the scale it is important to know that your DR will listen to you and that you feel comfortable.

The DR who delivered DS was a MAJOR stickler about weight which I didn't realize until I'd been with him for about 5 months. He also didn't have the best bedside manner so needless to say I had a few very stressful DR appts. I always dreaded getting weighed. I mean, it's hard enough to let our bodies change when we are pregnant, can't a DR be sensitive about that? I will say though, that it helped me stay on top of my weight gain (which I am now grateful for post-baby).

I do think a lot of DRs probably see many patients who use pregnancy as an excuse to eat WHATEVER they want and end up gaining well over 40 lbs. Maybe that's why they mention it. Their intentions are good. And as pregnant women we are DEFINITELY sensitive about our weight. But talk to your DR and if you feel you can't approach her, then I suggest you switch. Carrie's idea sounds good, too, since it seems you really want a midwife.
posted by Beth at 7/17/2006 08:59:00 PM
OK, moment of truth - I gained ALOT of weight with both of my babies. With DS I gained 45 pounds. Yep. And I wasn't big at all to begin with. It was steady weight gain, spread evenly over 9 months but when I look back on it, I was completely irresponsible with chocolate milkshakes from Mr. Softee and loaded baked potatoes. I had a Manhattan dr. who never gave me a hard time. Maybe it helped that she'd known me for 5 years and knew that this was my pregnant body - I don't know. It took 5 months to lose the weight and I had to work at it.

With DD, I was much more careful with what and how I ate and except for a 3 week crazy binge at the very end of my pregnancy (In & Out and Taco Bell were constants) I seemed to be on track.

I still gained 45 pounds when it was all over.

This time my dr. was in the Bay Area and again, never gave me grief about my weight gain - totally fine. With this pregnancy it took 1 year to totally lose the weight.

So, yes it is always better not to gain 45 pounds (or more) if you can help it because it's harder on your body and much harder to lose the weight. But I've learned that my body when left to its own devices will gain FAR more than 20 pounds. And I'm OK with that.

As long as it all comes off :)
posted by chloe at 7/17/2006 09:21:00 PM
And I agree with Jen - I would talk to your dr. about her weight gain theories. It's your money, your time and YOUR pregnancy. She is working for YOU. Pregnancy is hard enough under the best of circumstances so if she isn't working for you the way you'd like, find someone new.
posted by chloe at 7/17/2006 09:22:00 PM
ksl, if you go with a midwife, they will never make you get on the scale (at least my manhattan ones didn't if I didn't want to)
And, pain meds is ALWAYS an option, they will just help you through it if you don't want them. At St. Lukes you start in the birthing center, and then if you want meds, you go upstairs. Carrie did this process right? And it was easy yeah?
And when I had a midwife in MD, I was hooked up to all the meds, and they did not bat an eye or make me feel guilty or anything.
posted by Kage at 7/18/2006 04:58:00 AM
First off, I hate "What to Expect When You're Expecting", especially their food and diet recommendations. ICK! That said, I was pretty aware of what I was eating when pregnant, didn't go all out but definitely gave in to some of my cravings, and I think gained close to 40 with Max, which took me over a year to get rid of, but then again I wasn't working at it. And my doctor (same practice as Chloe) never lectured me about my weight gain. There was one month where I gained quite a bit (8 lbs I think?) and she mentioned that I probably didn't want to do that every month, but since I hadn't been and didn't continue to, that was the end of that.

So, long-winded answer made short, talk to your doctor. And if you don't like her attitude, find another one. Even if you can't find a midwife, you could certainly find another OBGYN that delivers at your hospital of choice and is a better match for you as a caregiver.
posted by marian at 7/18/2006 05:52:00 AM
Do try for a midwife if possible. I was weighed monthly, but no one ever told me to adjust my eating, the weight was just monitered.

And do change Dr.s if you still don't like this one after a few appointments. You need support.
posted by ESOdhiambo at 7/18/2006 07:17:00 AM
So you won't like this. I gain 25 lbs for my first daughter and on my second I gained 13. I think she did something to my metabolism though because I don't have hyperthyroidism, but I had lost 23 lbs by the 6 week check-up, compared to what I was right before I had her. I would say that I probably had some unhealthy eating habits but it was more that the junk I craved wasn't in the house and we only have one car so I wasn't able to go by Del Taco at my whim, so I wouldn't always eat right when I was hungry because everything in the house made me nauseous. I ate the same but more often. Also the baby will never be neglected by your body, it will take from you, hence why some people loss weight instead of the baby never growing. To date, a year later, I am 18 lbs lighter than when I got pregnant, I think nursing helps a lot too. (my husband and I wanted to have our kids two years apart and in a few months is when we should start trying but I'm worried for three reasons. We have a two bedroom town home that is rather small, so we don't have room for a third child, I am just scared of having a third child, I only have two arms, then I worry that two things will happen. I will gain a lot of weight and feel unattractive after I have a third child, or I will not gain a lot of weight, like my second, and become even skinner. I'm already 120 lbs and I don't want to waste away to nothing.)
posted by Lacey at 7/18/2006 09:25:00 AM
As a woman who puked her guts out with her pregnancies, all I can say is Eat, Baby, EAT! Who cares about the stupid weight requirements. Your body will tell you what you need, and if you can eat it, go for it.

I wouldn't change your DR. over this one, though. There are other things that are more important than weight gain, and if she is with you on those things, then stick with her. If not, well, start shopping.
posted by Heather O. at 7/18/2006 10:52:00 AM
So are me and Chloe and maybe Marian the only ones that gained any real weight? 44 lbs. with DD and 45 with DS and I went two weeks early with him, so I would have hit 50 I am sure. I am a small person so to go from 105 to 150 was the coolest thing that has ever happened to me. I was fascinated! 9 months to they day oddly enough, I got back to 105 after DD. Not quite there at 8 months after DS, but with both of them, I didn't do anything to try to lose it. I just started a month ago to get serious about this post baby weight. It is amazing what you can do for yourself when you actually try.

I was never told by my doctors to watch what I was doing, and if anyone should have been, that would have been me. I ate like CRAP with both and they are both as healthy as can be! Bottom line if she makes a big deal out of your weight gain, dump her. It is so not worth the stress! Enjoy this time and eat what your body wants, there is a reason it wants it. I am a big believer in that. Even if it is cookie dough for breakfast!
posted by Kelly at 7/18/2006 01:10:00 PM
I used to eat cookie dough for breakfast all the time. I wasn't pregnant though.
posted by Anonymous at 7/18/2006 01:48:00 PM
I gained about 45 pounds with my pregnancy because I felt like barfing any time my stomach was empty and could only stand certain foods. I craved eggs and salty meats and never wanted sweets like I usually do. My doc gave me a bit of a warning, saying it might make the baby too big -- whatever! He was only 6 1/2 pounds and I had a c-section anyway.

breastfeeding and just trying to be somewhat healthy helped me get back to my normal weight, but I'm still all blubbery!
posted by Legendary Pink Dot at 7/18/2006 04:20:00 PM
Have no fear Z, I too am with the 45 lb club. First one was only 25 and then it's been 45 for the last 3!!! I too eat whatever in the crap I want and LOVE every minute of it. I've gotten back to my happy 125 after each, but it's gotten harder with each one. 170 lbs is a lot of me :) I truly believe that unless it's needed for a medical reason........eat whatever you want when you're prego. You will most likely have SOMETHING to lose after the baby so enjoy getting it there! I think 20 lbs is VERY unrealistic........way too much stress to even attempt it.
posted by Anonymous at 7/18/2006 04:39:00 PM
so Z happened to leave Tales open on the desktop, I was intrigued by the headline and read some of the comments that were posted and felt compelled to throw my 2 cents in, especially after reading Z's post, though I am not surprised that she said what she said, “to eat whatever you want,” because she does preg or no-preg (it served as a daily source of contention early on during our first pregnancy, and a topic I didn’t dare bring up during the second, and everything turn out alright as it seems it always does for Z making me look like I don’t know what I am talking about.)

Weight gain is a big deal during pregnancy and I applaud physicians who address the issue early on and are up front. There are Ideal parameters and scales that those in medicine use for various classifications to help measure, characterize and follow. Ideal is the key word, and fortunately none of us are Ideal, Average or Normal, that is why these parameters are used as a baseline and are flexible and not necessarily absolute (for a large part parameters are really based on statistical analysis and most variables depend on what there specificity and sensitivity are regarding it’s associated application and use). Nutrition is a crucial factor in ensuring the health of the mother and the fetus during pregnancy, thus advocating prenatal vitamins because everyone's diet varies. 20 pounds is an Ideal number for weight gain, normal weight gain is roughly 25-35 pounds for the entire pregnancy with a goal of a 40 pound weight gain for underweight women and a 15 pound gain for overweight women (not saying your overweight ksl). During the first trimester you should gain an average of 0.7 pounds a week, and from 20 weeks on approximately 1 pound per week. Weight gain is excessive when it is greater than 5 pounds a month and inadequate when it is less than 1/2 pound a week or less than 2 pounds a month. This is preventive medicine at its core; avoid complications associated with a malnourished fetus and gestational diabetes. Gestational diabetes has some direct risks associated with it that possibly could have been avoided if proper weight gain and nutritional diet was maintained during the pregnancy. Most notable complications associated with the fetus are large heads (macrosomia), shoulder dystocia (difficulty delivering vaginally due to an enlarged shoulder girdle getting stuck during passage through the pelvis-most leading to an emergent C-section) and subsequent fracture of the fetal clavicle and perinatal mortality in 2-5% cases, and congenital defects; and one of the maternal complications is the future risk of becoming Diabetic (30-50% of GD have impaired glucose intolerance later in life). In my humble opinion, diabetes is the NUMBER ONE disease that you do not want to get later in life, trust me.

My main point for even posting, besides educating, is that there are times our Doctors tell us things we don’t want to hear, frank as it sometimes can be, that doesn’t mean that he/she is being insensitive. I think we walk on thin ice if we shop around until we find a doctor who tells us what we want to hear (one of the main reasons I didn’t go into primary care.) chloe recommended communicating your concerns with your MD, excellent idea, it will allow them to teach you what she really meant by saying 20 pounds is the ideal weight. Sometimes physicians need to be more careful in throwing out abstract information to out patients, ideal or not, without following it up with substance, but don’t doctor shop because of it…
posted by Anonymous at 7/18/2006 07:44:00 PM
Just to clarify for everyone, D is Zinone's Dr. husband.

Thanks for that medical insight. Reading it, I can totally hear your voice spouting all the medical terms and percentages. I miss hearing all that crap from you! :)

I bet you now become an avid lurker just to check up on all of us!
posted by This is Carrie at 7/18/2006 08:27:00 PM
Well, with my first pregnancy, my doctor advised me to watch how much I gained and even suggested eating the diet prescribed to GD patients. I followed the diet for a good month and gained about 3 pounds...but the second the doctor told me that I didn't need to be so strict, I fell off the wagon. It was great to eat whatever I wanted, especially when I was on bedrest for 8 weeks (candy, doughnuts, etc). But the 40 lbs I gained, not so great (BTW, the doctor never said anything). And unlike most others, I just barely lost all the weight plus an additional 15 lbs (my DD is 21 months). Let me tell you, for me in my mid 30s, losing the weight was very difficult and hard - i.e. Weight Watchers and working out hard 6 days a week.

Now I am prego with my second. I am definitely watching what I eat but not depriving myself - more portion control and making sure I eat small meals every 3 hours (per doctor's orders). My goal this pregnancy is 25 lbs (if I go over, oh well but I am watching and working out more this time).

As D said, my doctor advised me that the risk of GD plus having a big baby are high for most that gain too much weight (I had a 6 lb baby that was 6 weeks early). Also having a huge baby puts your baby at risk for developing diabetes also. I didn't mind the doctor being upfront about the weight gain issue and I wish he would have said something when I was gaining too much. Just my 2 cents....
posted by Elise at 7/18/2006 08:31:00 PM
I smiled big when I saw you here D!!! Miss you and all that Ross knowledge! Sounds like stuff I've heard OVER and OVER before from B....priceless :)
posted by Anonymous at 7/18/2006 08:42:00 PM
Hi D! Oh, you're totally going to read this blog from now on! And like Carrie, I can hear your voice speaking your post.

Seriously though, thanks for the insight from a dr's perspective. You're welcome to lurk in on us anytime :)
posted by chloe at 7/18/2006 09:49:00 PM

Monday, July 17, 2006

The Pregnancy 20lb

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