Supporting Body Image While TTC, as well as During Pregnancy, and Postpartum
Body image can be challenging for anyone trying to get pregnant, going through pregnancy, or postpartum. There are so many societal expectations on one’s body- and those can feel significant during your reproductive years. Those who have experienced, or are currently experiencing an eating disorder may struggle with body images in more significant or new ways.
Whether you have struggled with an eating disorder, or just notice some body image concerns during this time- this article is here to provide you with some additional information as well as some helpful tips to support your physical and mental health during this time.
How Disordered Eating Impacts Fertility
What is an eating disorder?
Disordered eating is defined as having an unhealthy relationship with food, weight or body image.
The most common types of eating disorders are:
Anorexia
Bulimia
Binge Eating Disorder (BED)
Other Specified Feeding or Eating Disorder (OFSED), which is diagnosed when your symptoms do not exactly match the other types of eating disorder.
It is common to miss the early signs and symptoms of an eating disorder. Some symptoms experienced in the beginning stages of an eating disorder can include:
spending a lot of time worrying about your weight and body shape
avoiding socializing when food is involved
not eating a lot
deliberately making yourself sick
exercising too much
having very strict habits or routines around food
changes in your mood.
Realizing you need help can be extremely challenging but it opens the door for increased positive support by those around you. Whether that is your primary care provider, or family and friends. Talk to your General Provider. You can take a partner, family member or friend with you if it helps.
Eating disorders and pregnancy
Some women find their symptoms actually improve while they are pregnant but come back or get worse after they've had the baby.
The two most common types of eating disorders, anorexia and bulimia most commonly emerge during adolescence or young adulthood. These eating disorders not only have an effect on one’s physical health, but during the reproductive years, can have a significant impact on fertility and pregnancy.
Eating disorders affect fertility by reducing your chances of conceiving. Most women with anorexia do not have menstrual cycles, and approximately 50% of women struggling with bulimia do not have regular menstrual cycles.
The absence of menstruation is caused by reduced calorie intake, excessive exercise, and/or psychological stress. If a woman is not having regular periods, tracking her hormones, cycle, and trying to conceive can be very challenging.
How is Pregnancy affected?
Getting support around eating disorders can be important when one is trying to get pregnant as well as during pregnancy. Improvement in eating disorder symptoms can reduce challenges that may show up in pregnancy- thus leaving you with a healthier and more comfortable pregnancy as well as postpartum.
While complications can vary greatly depending on severity, there has been shown to be an increased risk of premature labor, low birthweight, gestational diabetes, depression, delayed fetal growth, respiratory problems, complications during birth, need for cesarean birth, as well as a difficult time maintaining pregnancy.
Women who are struggling with bulimia will often gain excess weight during pregnancy, which places them at risk for hypertension. Women with eating disorders have higher rates of postpartum depression and are more likely to have problems with breastfeeding. The laxatives, diuretics, and other medications that may be taken may be harmful to the developing baby and take away nutrients and fluids before they are able to feed and nourish the baby.
Common Body Image Concerns during Pregnancy
Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience.
Eating disorders affect about five to eight percent of pregnant women. For those with a history of these illnesses, there is a high risk of relapse during the prenatal and postpartum periods, which can lead to harmful behaviors such as restricting food, overexercising, binging and purging.
All the attention on eating well during pregnancy and gaining the right amount of weight while being weighed and measured at prenatal appointments can be a trigger for women who have challenging relationships with food and their bodies. Instagram pictures of women sporting six-packs while six months pregnant and showing off tight stomachs weeks after birth don’t help matters either.
A lot of the psychological underpinnings of eating disorders relate to control and negative body image. During pregnancy, your body is changing in a way that’s not necessarily in your control. For somebody who already struggles with body image difficulties, even if they’ve achieved a healthy weight, pregnancy can be really complicated psychologically.
Don’t Blame Yourself
For those of you struggling with infertility or pregnancy, please don’t blame yourself. When we shame ourselves for our struggles, it often becomes more challenging to get the help that we need. This is a time to be gentle with yourself, and if you are struggling, this is a great time to get the support that you need for yourself and your growing family.
Ways You Can Support Your Health During This Time
If you are struggling with an eating disorder, getting help to overcome it is the best thing you can do for your reproductive and pregnancy health. Getting medical help either through your primary doctor or a dietician, as well as getting mental health support with a therapist, will help set you up for success during this time.
The majority of women with eating disorders can have healthy babies if they have normal weight gain throughout pregnancy.
Here are some guidelines you can follow if you are trying to conceive or are pregnant:
Prior to Pregnancy:
Achieve and maintain a healthy weight.
Work to reduce eating disorder behaviors, such as restricting or purging.
Consult your health care provider for a pre-conception appointment.
Meet with a nutritionist and start a healthy pregnancy diet, which may include prenatal vitamins.
Seek counseling to address your eating disorder and any underlying concerns; individual or group therapy.
During Pregnancy:
Schedule a prenatal visit early in your pregnancy and inform your health care provider that you have been struggling with an eating disorder.
Strive for healthy weight gain.
Eat well-balanced meals with all the appropriate nutrients.
Work with your support team throughout pregnancy, such as a dietician/nutritionist as well as a mental health therapist, so that you can get the help that you need during prengnacy.
After Pregnancy:
Continue working with a counselor or mental health therapist both to support any postpartum mental health concerns as well as navigate postpartum body changes.
Inform your support network (health care provider, spouse, and friends) of your eating disorder and the increased risk of postpartum depression; ask them to be available after the birth.
Contact a lactation consultant to help with early breastfeeding if you choose to breastfeed.
Work with your nutritionist to help you stay healthy, manage your weight, and invest in your baby.
Working on Body Image satisfaction
Embracing change while trying to conceive.
It’s one thing to know that your body will change during pregnancy, it’s another thing to actually experience it. There are societal pressures to look a certain way during and after pregnancy, and it is common for anyone to struggle with body image during these physical transitions.
Some women embrace the changes that come with pregnancy and giving birth, but for many, the metamorphosis can negatively shift their self-image.
Body dissatisfaction during pregnancy can affect maternal and fetal health, prompting women to severely restrict their eating or trigger a relapse of an eating disorder. And the risk of perinatal depression is four times higher in women who are dissatisfied with their body image.
Changing society’s perceptions of how pregnant and new mothers should look will take time, but there are strategies to help now with the way women view their body image before and after giving birth.
1. Set realistic expectations for appearance and function
Weight gain
One of the most visible changes during pregnancy is weight gain. The majority of baby weight is gained in the second and third trimesters, often at a rate of one pound per week – more if you are carrying twins or triplets.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that women who start out at a healthy weight gain 25 to 35 pounds throughout the course of pregnancy, while those who start overweight gain no more than 15 to 25 pounds, and those who are obese gain no more than 11 to 20 pounds.
Work to remind yourself that weight gain is not only normal during this time, but it is healthy. Your body is working to grow another human as well as support your pregnancy.
Skin changes
Gaining a lot of weight over a short time can cause stretch marks – reddish streaks that run down your breasts, belly, thighs, or other areas that gain weight. Much of how your skin responds to growth is genetic, and is a normal response to this physical transformation. It can be helpful to remind yourself that this is a normal process, and will likely fade significantly postpartum.
2. Prepare your body for childbirth and postpartum recovery
Connecting to physical activity during pregnancy can help you have a healthier and more comfortable pregnancy as well as postpartum. Talk with your prenatal care provider about which activities are safe and which you should avoid. If your eating disorder includes excessive exercise, this will be something to watch for and work with your support team to manage. Focus more on connecting to movement that feels good for your body, rather than movement that changes the appearance of your body.
Practicing these five simple exercises and yoga poses also can help relieve pain and discomfort and prepare your body for childbirth:
Child’s pose (yoga)
Deep squat
Quadruped cat/cow
Perineal bulges
Perineal massage
Once you’ve given birth, specific exercises to strengthen and retrain the abdominal wall, back, and pelvic floor muscles can ease postpartum discomfort. Kayla, a therapist at Minnesota Attachment Collective, actually has some online yoga classes for pregnancy. Check those out here!
3. Join a moms’ group or postpartum support group
Sometimes it helps to share what you’re feeling with people who are going through similar experiences. It can be reassuring to know that you’re not alone and that your feelings are valid.
Look for a moms’ group or postpartum support group in your area. There, you’ll find soon-to-be or new moms with whom you can talk about what’s happening to your body, learn what to expect, and share helpful tips and resources.
4. Limit social media and pregnancy magazine time
We’ve all seen those photos of women who gave birth five minutes ago and look gorgeous in their first Instagram photo with the baby. Or celebrities in magazines who had a baby a few weeks ago and look as if they’d never been pregnant.
Those "postpartum perfect" photos are unrealistic and set false expectations for what to expect after childbirth and in the postpartum period. Labor and delivery can be painful, difficult, and exhausting. We want women to do what makes them feel happy and beautiful after delivery – without facing pressure to achieve an Instagram-worthy look.
Another concern is non-medical organizations and influencers who sell products such as contraction-monitoring devices or gestational beauty concoctions that are not clinically proven and might be harmful to you or the pregnancy. Before you try something promoted on social media, talk it over with your health care provider to see if it is right for you, or if there is something else that may be better.
5. Set clear expectations with loved ones
Sometimes pressure to look a certain way in the perinatal period comes from family and friends. They may have good intentions, asking you to “smile more” or wear makeup to “look more like yourself again.” But don’t feel bad if you have to set someone straight for making unwelcome comments about your appearance.
Remind loved ones that you’re focused on taking care of your pregnancy, your baby, and letting your body recover in a reasonable amount of time.
6. Discuss body image with your prenatal care provider
How you feel about your body affects your health, and your health can affect your pregnancy. If you’re not feeling good about something – physically or emotionally – let them know. They can offer suggestions, point you toward helpful resources, or provide a referral to a psychologist or counselor to talk through your concerns.
Remember that every pregnancy is unique. How you felt physically, mentally, and emotionally in a previous pregnancy may be different this time. And you may have questions you didn’t need to ask the last time around.
Supporting your body image during pregnancy and postpartum isn’t easy, and you are worth it
Among the deadliest of mental illnesses, eating disorders are more common than many doctors even realize. A study of 54 postpartum women published in the Journal of Midwifery & Women’s Health found that nearly 28 percent had psychological and behavioral traits associated with eating disorders, but only one woman’s medical records listed a history of eating disorders. Many women end up suffering on their own.
“Having a baby is one of the most stressful times in a woman’s life, yet we pressure women into believing that it’s the most euphoric,” says Deborah Berlin-Romalis, executive director of Sheena’s Place, an eating disorders support centre in Toronto. “Women are often afraid to say ‘I have anxiety’ or ‘I have depression,’ let alone ‘I have a history with an eating disorder and it has actually come back.’ It’s something that tends to go quietly underground.”
In fact, research shows that most pregnant women with active eating disorders don’t tell their maternity care providers, which may be due to fear of judgment, blame or intervention from child-services agencies. Symptoms can also be difficult to spot because women may appear healthy. As a result, eating disorders often go undetected and untreated during pregnancy.
Many women make it through pregnancy only to relapse after giving birth, when they have little control over their new lives as moms and are subsisting on minimal sleep. Newborns eat, sleep and blow out their diapers on their own schedule. New moms with a history of bulimia or binge-eating disorder are also three times as likely to develop postpartum depression, making their struggles with food that much harder to manage.
You’ll probably need continuing support after your baby is born. You may find the eating disorder gets worse again, even if your symptoms were better during pregnancy. Because you may also be more likely to develop postnatal depression, you and your partner may find it helpful to find out more about postnatal depression so you can recognize the signs and symptoms, just in case.
You can’t plan for everything, especially when it comes to being a new parent. But you may find it helpful to talk to family and friends about your condition and what they can do to help you stay well after the baby is born. This may help you feel more prepared and in control.
Make sure your closest family and friends understand your condition and how it affects you. For example, you could talk to them about:
the symptoms you have experienced in the past
what medication you take (if any)
any warning signs they should look out for
who they can contact if they are worried about you.
Friends and family can also provide practical support, such as:
cooking healthy meals for you
taking the baby for a walk so you can get some sleep
doing any household chores for you, such as cleaning or laundry
spending time entertaining the baby while you take a break – even if it’s just to have a bath or shower.
This may help reduce any extra stress and let you concentrate on staying well.
Having babies often changes the way women think about their bodies. The journey to self-love and acceptance can be challenging for all women, even outside the context of pregnancy and child-birth. At the end of the day your body helped to nurture, grow, and develop a human being. The concept of pregnancy and birth is an amazing and incredible act to behold. Instead of focusing on all the things your body isn't or its perceived shortcomings, bask in the beauty of its ability to give create and give life. That is a concept that not all of us are able to experience.
You deserve support during this time
If you are trying to get pregnant or are currently pregnant or postpartum and also struggle with body image or an eating disorder, now is the time to get support. Work with your primary care provider as well as a nutritionist or dietician to monitor your physical health as needed, and connect with a mental health provider to work to heal what lies under the body image concerns.
Therapy can be a place to work through trauma, expectations around self-worth and body image, attachment challenges, and perfectionism that may be tied in with your eating disorder. With your therapist, you can unpack your experiences, connect to healing, and work to grow a healthy relationship with food, movement, and your body. This is not only a great thing for you, but also a great thing for your family.
If you are in Minnesota, we are here to support you! We have therapists who specialize in fertility, pregnancy, postpartum, and body image. Meet our team here to see who would be the best fit for you!
Meet the Author: Madisen Schillo, MA, CMHC
Maddie is a therapist here at Minnesota Attachment Collective. She is passionate about supporting clients in building the lives that they want to live- including in building self-confidence and a healthy body image, and working to grow their families. You can learn more about Maddie here!
