Early in her pregnancy, Tara Sawyer was told the local hospital would not be able to accommodate her.
"Because of my higher BMI, you automatically have to go to Box Hill rather than Angliss Hospital," says the 29-year-old from Emerald/land of the Bunurong and Wurundjeri peoples in Victoria.
"Initially I was quite upset about that because I'm a teacher, I work full-time, and it meant all my appointments had to be an hour away, so I had to take a whole day off work to have an appointment.
"It led to stress in my job, which was not ideal."
Tara says she also felt ashamed to tell people why she had to travel to a different hospital.
"My husband and I talk about weight all the time, but even just to tell him I can't go to this hospital because I'm overweight, was quite embarrassing."
Recent research from Monash University has found reducing women's experiences of weight stigma should lead to better care and better pregnancy outcomes for larger-bodied women.
It shows larger-bodied women are sometimes automatically treated as high-risk, which the authors write is "problematic because it focuses on body size rather than health".
BMI is a method used to sort patients by weight into four categories from underweight to obese. Its appropriateness as a measure of healthy weight for individuals has long been contested.
For Tara, the redirection to a hospital further away ended up being a "blessing in disguise", thanks to a program dedicated to maternity care for women with a high BMI.
"It meant that I could opt to not be weighed at each appointment, not be told about my weight, or be told only if I wanted," Tara says.
We spoke to Tara about her pregnancy journey, and how, for the first time, her weight meant she received more care, rather than less.
These are her words.
Health concerns were dismissed throughout my life
I had been on a health journey for about 10 years prior to being pregnant, with what I assumed was an autoimmune disease.
I really struggled to get care early on. The default response from most doctors about my symptoms was to exercise more and lose weight.
I was aware of my weight, but struggled to lose any, and suspected whatever else condition I had was contributing to that.
I also have anxiety, and at one point I was having some internal bleeding investigated.
When they didn't find a cause, I had a specialist gastroenterologist tell me what it was probably just anxiety causing those symptoms.
After about three years of fighting to have my voice heard, I was finally referred to a rheumatologist who has taken my condition seriously.
I also found a fantastic GP who has listened to my fear of being dismissed because of my weight, and made sure unless my bloods indicated it was a problem, or I came in concerned about my weight, it would not be factored into my care and treatment.
It worked out for the best in my maternity care
I actually fall into the catchment of Angliss Hospital, but due to having a suspected autoimmune condition, borderline high hypertension, and a high BMI, I was told I had to present to Box Hill and receive care there.
I was quite frustrated and embarrassed I had to do that. But it did work out for the best.
I was told about the PEARL (Pregnancy Elevated BMI Antenatal Risk reduction and Lifestyle) program. It's run by this beautiful midwife Maddy (Madeline Hawke).
She was concerned about weight stigma with pregnancy and how many women deal with a lot of weight conversations in pregnancy that are not necessarily important to that pregnancy.
I saw Maddy and the same obstetrician throughout my pregnancy.
We didn't really discuss weight. At one point I raised concerns about how much I was putting on, but I was assured it was in the normal range for women with my BMI.
There was also an honest conversation about why it's sometimes recommended women with high BMI be induced, but it was presented to me as research and fact, rather than pressure or opinion to sway me one way or the other.
I kind of got the "royal treatment".
I met another woman in the program and she said to me, "It's like the first time that being overweight has been a positive in my life".
I felt the same way.
Advocating for myself hasn't always been easy
Despite the great care, I had such an awful pregnancy with pain and pre-natal depression.
It was a really hard time.
But I would give birth every day of the week. I loved it. It was such a positive experience.
The midwives and team were amazing.
I put that down to all the research I did. Familiarising myself with hospital policies on what I could and couldn't push back on. Having a thorough birth plan.
I learnt that I was always entitled to ask for a second opinion, and ask for a second doctor if I wasn't happy with my care.
It's your right to ask for that.
And I know it's really hard; as women we are seen as being rude and up-front when advocating for ourselves.
But pregnancy is one of the most vulnerable times in your life, you want to make sure the people in the room have your best interests at heart, and don't look down on you because of your weight.
