To locate a size-friendly midwife or obstetrician, ask other plus-size women you know for recommendations and then make appointments with a few clinicians just to chat. Vireday advises asking open-ended questions such as, "What are your concerns for me as a larger woman?" and "How will you help me have the best chance at a normal birth?" By listening carefully to the answers, you will gain valuable feedback on how the midwife or obstetrician views plus-size women and be able to pick a care provider whose personality and style best suit your needs.
"Because I was already 60 pounds above my ideal weight, I wondered whether or not I even needed to gain weight during pregnancy," confesses Mare Solomon, a recent first-time mom living in Toronto, Canada. "And then I talked to my OB. She explained that changes in a woman's body—increased blood volume, the placenta, and the weight of a growing baby—make adding extra pounds during pregnancy normal for every woman, no matter how much she weighed prepregnancy."
The Institute of Medicine (IOM) agrees, recommending overweight women gain between 15 to 25 pounds total during pregnancy (your provider can tell you the amount that's right for you). The IOM has found that plus-size women who stay within these weight-gain guidelines have the best chance for delivering a healthy birth weight baby and also reduce their risks for delivering by Cesarean section.
"The key to healthy pregnancy weight gain is to gradually add pounds," Dr. van der Ziel advises. The American Dietetic Association (ADD) calls for plus-size women to gain up to three pounds during the first trimester and then put on between one-half to three-quarters pound per week starting from the twelfth week of pregnancy.
Make Every Bite Count
"Eating a wide variety of nutritious foods can decrease your risk for certain health complications, give you more energy, replenish your body's supply of key vitamins and minerals, and make it easier to reach weight-gain goals," says Dr. van der Ziel. Excellent prenatal nutrition also ensures your baby receives the proteins, carbohydrates, fats, vitamins, and minerals necessary for optimal fetal growth and development.
Your challenge for the next nine months is to fill your diet with fruits and vegetables, whole grains, nuts, beans, and certain fats, fish, meats, and dairy products—foods that naturally pack powerful combinations of vital nutrients into every bite. "An occasional treat is OK as long as you make sure you are eating enough quality food," adds Vireday.