Ten years ago when Pamela Vireday* found out she was pregnant for the first time, she experienced conflicting emotions. She was thrilled, but she was also scared because, as a plus-sized woman, she wasn't sure how her size might impact her baby.

"Back then, I could find no information on what it meant to be plus sized and pregnant, and I was full of fear about what my size might mean for pregnancy and birth," says Vireday. " My doctor had very little information for me and was generally full of scare tactics. So while I was thrilled at the thought of being pregnant, I also felt like I was out on a limb, all by myself. I knew I couldn't have been the only fat woman in history to be pregnant, but it sure felt like it at times."

In fact, she wasn't the only one, as she found out very quickly when, in an effort to inform other women in her situation, she started Plus-Size Pregnancy Web site (www.plus-size-pregnancy.org). Vireday is quick to note that there are risks inherent in a plus-size pregnancy, but she also wants to show that many women of size do have healthy pregnancies and births.

Vireday now has four healthy children, ages 9, 7, 4 and 6 months, but it took some empowerment on her part to have positive pregnancy and birth experiences. The doctor who delivered her first two children felt that his obese patients needed extra intervention, which Vireday feels led to two unnecessary Cesarean sections. With her last two children, she found a size-friendly midwife and doula and experienced vaginal births in a positive, caring environment.

Dr. Paula Bernstein, co-author of Carrying a Little Extra: A Guide to Healthy Pregnancy for the Plus-Size Woman (Berkley Publishing Group, 2003), agrees that doctors need to be more sensitive in communicating necessary information to their heavy patients, but she also suggests that sensitivity on the part of the patient may play a role in how heavy women take the information.

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