What Not to Say to a Pregnant Woman

Everyone knows what not to say to a woman who might be pregnant: "When are you due?"

But once a woman is most certainly pregnant, no one knows what not to say.

"It's just unbelievable that people are just so willing to say anything, and what that anything is -- it's literally anything," says Jodi Rubin, a psychologist in New York who's more than seven months pregnant.

Take the people who've commented on the growth of Rubin's thighs and the roundness of her face. Or the security guard who asked Rachel Turow, a lawyer in the District of Columbia, how she got pregnant. Then there's the Starbucks barista who told Kristen Wilson, a software consultant in Arlington, Virginia, that she was getting fat when she ordered two snack boxes instead of one.

Even the most innocent questions can be complicated for some women to answer. Vicki Salamon, a public schoolteacher in the District of Columbia, for example, is now pregnant after three miscarriages. "When people ask me, 'Is this your first?' I can either decide to share because it's important for people to understand this isn't my first pregnancy and that [miscarriage] is very common ... or I just say, 'Yup, my first,' because I'm thinking about my first take-home baby," she says. Indeed, studies indicate that up to 25 percent of all pregnancies end in miscarriage, according to the American Pregnancy Association.

Of course, most remarks directed toward pregnant women are well-intentioned, and plenty of pregnant women are happy to indulge the curious. "I think it's an amazing thing to watch someone's body grow and change and create a new life -- and everybody's body does it differently," Rubin says. "In a way, it begs for comments."

But some comments are unwelcome, ill-informed or just plain rude. The trick, Rubin says, is to let the pregnant woman initiate the potentially sensitive aspects of the conversation herself. Here's what not to say the next time you encounter a mom-to-be:

1. Anything about her shape or size.

"You're huge!" "Are you sure you're not having twins?" and "You're so much bigger than the last time I saw you!" are all comments that can make many pregnant women cringe. Though rarely meant maliciously, Rubin sees such remarks as a form of "fat-shaming," a type of discrimination which has been shown to have a more dire impact of physical and mental health than racism or sexism. "It doesn't go away during pregnancy, and it actually seems to escalate," she says.

Comments about how small a woman's belly is aren't much better -- Rubin likens them to fat-shaming's equally unhealthy opposite, skinny-shaming. Plus, they can make a woman question her baby's development, says Rubin, who specializes in treating women with eating disorders. "There's nothing to be gained by talking about anybody's size," she says. "That to me just feels like there's judgment attached to it." Instead, Rubin suggests, say, "You look beautiful," "You're glowing" or "How are you feeling?"

Remarking on the shape of a woman's belly or weight distribution -- and how they predict the baby's gender -- is usually unhelpful, too. Those projections are also unfounded, says Shelly Holmstrom, an OB-GYN in Tampa, Florida, and associate professor at the University of South Florida's Morsani College of Medicine. "People carry so differently, and it depends on different things," including muscle tone, whether the woman has had a child before and the shape of her pelvis, she says. "I don't know of any scientific study that's ever shown how people carry determines gender."

Also misguided are cracks that a woman looks about ready to "pop," "burst" or "explode." In reality, a pregnant woman is not a balloon, a pipe or a ticking time bomb.
"Their skin's not going to pop open and [the baby's] not going to pop out of their belly and it's not going to fall out of their vagina," Holmstrom says. Even rapid labors take at least several hours before the contractions are strong enough and the cervix is sufficiently dilated to initiate a birth. "Your cervix is going to hold that baby in until it's ready to come out," she says. "Babies don't fall out."

2. Anything about how much or what she's eating.

When Holmstrom was pregnant, even fellow OB-GYNs sometimes criticized her food and drink choices. "I think people really try to be well-meaning and well-intentioned, but it comes off as making you feel guilty," she says.

Holmstrom's experience is common: According to qualitative research in the journal BMC Pregnancy and Childbirth that analyzed posts on online parenting forums, pregnant women frequently reported experiencing guilt and blame related to their weight and nutrition. One woman, for example, said that co-workers commented on everything she ate -- down to the celery sticks and apples.

The truth is that most pregnant women are acutely aware of the latest guidelines on nutrition and weight gain that indicate, for example, that "eating for two" doesn't really mean doubling your portions. Women who are overweight or obese before pregnancy -- and thus advised to gain only 15 to 25 pounds and 10 to 20, respectively, compared to the 25 to 35 suggested weight gain among normal weight women -- can face particular stigma from the public and health care professionals when pregnant, research suggests.

"No woman should be made to feel guilty about her weight when pregnant, she should be guided and supported," wrote one commenter in the 2014 BMC Pregnancy and Childbirth study. "It's a tough enough time without going through it with a side order of guilt."

3. Birth horror stories.

It's normal for pregnant women to feel some anxiety about the birth of their child and life after birth -- "hopefully in a healthy, planning way," Holmstrom says -- but when well-meaning parents spill details about a birth gone wrong, that anxiety can become unhealthy for mom- and baby-to-be. Research out this month in the Archives of Gynecology and Obstetrics, for example, found that the more a pregnant woman fears childbirth, the more likely she is to have an emergency C-section or a birth that involves medical instruments like a vacuum. She's also more likely to rate her birth experience negatively.

"You think, 'oh it's just one story,' but it's compiled by the hundreds" of horror stories that the pregnant woman is reading online and hearing from others, says Allison McGill, president of the nonprofit Lazarus Ministries in the District of Columbia who dealt with anxiety during her pregnancy. Such anecdotes also tend to mask the fact that every birth experience is different, Holmstrom says. Instead, McGill suggests, "encourage the woman with some of the more joyful stories."

By that same token, offering your perspective on how a woman gives birth or how she should raise her child is unwelcome, says Wilson, the Arlington consultant, who was told twice that having a caesarean delivery would cause her to "miss out on the experience of becoming a mother."

Quite untrue, says Rachna Vanjani, an OB-GYN in Boston. "'Becoming a mother' has everything to do with you caring for your child to the best of your ability and having a delivery -- whether it be a cesarean section or vaginal delivery -- that is the safest for you and your baby," she says. "The most important outcome is having a healthy baby and healthy mom at the end of the day."