I love riding my scooter. My dad rides a motorcycle and I always loved riding with him. A few years ago, I gave up my car (by “give up”, I mean totaled, and refused to replace). I’m not a terribly good driver, and it is much harder to get distracted on my scooter. I chose a scooter partially because I have a tendency to wear skirts every day; I’m not much of a lady most of the time, but straddling a motorcycle in a skirt is a bit beyond my comfort level. This leads to an interesting world in which some motorcycle riders acknowledge me as two-wheeled kin, and some don’t. I love seeing motorcyclists and scooterists on the road. To me, its a party where we all try not to get killed by drivers. And I always give a head nod or wave, either way. It isn’t always returned. I’m sure there is an argument to be made that a scooter can’t always go as fast, is a cop-out, and other reasons that motor cyclists might not openly recognize me. And that’s fine. While it is nice to see a head nod, wave, or two fingers flashed over a handlebar, the absence of recognition doesn’t make me go home and cry at night.
As I rode along a few miles from home, I was thinking about how this correlates to the birth community. Some see it as an adversarial system, where OB-GYNs just want money for c-sections and their evenings free, and labor and delivery nurses are either overworked and surly or saints, midwives are angels, but home-birth midwives might be irresponsible, and doulas take over the roles that friends and families should fill and just annoy the nurses. And of course, they all have trouble working together.
I remember when I first chose to start down the path to become a midwife, I chatted with a labor and delivery nurse one night at a friend’s house. I told her I was really glad to hear what she did, and asked her some questions about her experiences. Eventually, she asked me what my plans were. When I told her I wanted to be a midwife, she laid into me saying that any time a woman had a midwife they always ended up in her care with interventions. My decision was foolish, and harmful. I was shocked at the vehemence. I never ran into her after that night, so I never had the chance to understand the experiences that lead to her frustration with midwives and home births.
Her line of reasoning didn’t make sense, from multiple angles. There are many midwives who work in hospitals, and there is plenty of evidence showing that home births and birth center births are effective for many women.
I don’t think either view has much merit. In birth, no one has a direct ride to the front of the class. Each position has strengths and weaknesses. Every care provider picked their occupation to help pregnant and laboring mothers. OB-GYNs have a level of skill that is required for more complicated cases. Midwives have skills to lead uncomplicated cases safely through pregnancy and birth. Nurses provide care and valuable monitoring and liaising with a hospital. Home birth midwives fulfill a community need for supervision and guidance, even in the simplest of cases. Doulas provide one-on-one support, hands-on assistance, and useful education. They can all work together, within their own scope of practice, to create a community that supports parents at every level.
And maybe we can all go for a ride afterwards.
Today I start the Health at Every Size® fascilitator training, and I am super excited about it. I’ll spend a week learning how to best teach people in my community (that means you!) about the concepts of HAES. Until then, here is an overview.
The HAES concept doesn’t erase that people of different size may face different health concerns. It does acknowledge that long term weight loss is nearly impossible, and we need to address health concerns with people where they are, not when they reach an ideal body. There are people who lose significant amounts of weight and keep it off, but that is a very, very small minority of people; different studies show no more than 2-5% of dieters are able to keep off significant amounts of weight for five years. There is no weight loss method that has a decent success rate (which explains why nobody publicizes their results). Weight loss attempts usually lead to regain, and often lead to weight gain above and beyond the loss. This weight cycling is more damaging than just being fat. In a culture where people often start trying to lose weight in childhood, it means that they are weight cycling again and again and again.
The obesity epidemic panic also does a disservice to thin folks. Culturally, we assume that thin people are healthy, and don’t talk about how being inactive can impact their health, or that thin people need to be screened for the diseases and conditions that we associate with obesity, like high blood pressure, heart disease, and diabetes. When we teach assumptions about what kind of people get these diseases, we harm those outside of that demographic by reducing their awareness of their own personal risks. These assumptions are also found in health care providers, reducing the quality of care that both fat and thin people recieve.
Better than focusing on weight, what we can do is focus on health. While changing eating habits and exercising may not impact weight, they clearly impact health. If we focus on changing eating habits, and creating opportunities for enjoyable movement, we see that regardless of weight, health markers improve. This means lipid levels, blood pressure, resting and exercising pulse rate, blood sugar levels, blood insulin levels- all markers of physical health. This is an approach that works for thin and fat people.
A big part of this approach is self-acceptance. There is a lot of stress associated with thinking that you’re failing at losing weight. That stress, combined with other life stresses, snowball into a lot of the diseases we currently consider ‘weight-related’*.
Many people have dieted and exercised in ways that have moved them out of touch with their bodies. I have dieted and exercised in ways that got me way out of touch with my body. But understanding what your body needs doesn’t go away entirely, it just gets shouted over so much it is hard to hear.
HAES promotes intuitive eating, the idea that when you remove foods from being off-limits, and pay attention to how foods make you feel, you will make far more healthy choices than when we are stuck in a good food/bad food dieting denial loop. I know what foods make me feel good, what foods don’t, and when I want a little ice cream, I don’t finish off the carton because I’m afraid of my diet tomorrow, and that I’ll never again remember what it tastes like.
HAES also promotes enjoyable activity. Find something you like doing, because movement, however you define it, benefits health. Physical activity, whether difficult or easy, improves mood, sleep, and all the other health markers talked about earlier.
*See Robert Sapolsky’s book, Why Zebras Don’t Get Ulcers.