How to Survive Pregnancy After Eating Disorder Recovery

When I became pregnant with our first child, I had a solid couple years of eating disorder recovery under my belt.  

After healing from an excruciating battle with anorexia nervosa, I honestly did not think it would be possible to conceive naturally, as many health professionals had indicated I would likely not be able to have children due to my eating disorder.  

So the news of our first pregnancy was an unexpected miracle that we welcomed with open arms. What I wasn’t prepared for were the many unanticipated experiences throughout my pregnancy journey that would trigger eating disorder thoughts and behaviors.  

Navigating Challenges With Prenatal Care

My time in recovery to this point had been characterized by body acceptance and learning how to feed and honor my body with normalized eating.  

I no longer owned a scale or weighed myself and felt comfortable eating a variety of foods according to my body’s needs and wants.  

So when I was met with the scale at my first prenatal appointment, it was a reality check with how my prenatal care would generally unfold.  

But it wasn’t just being weighed at every prenatal appointment that began to reawaken my eating disorder.  

It was all the questioning about my food choices and how much I was exercising and, “Oh, your weight really jumped up this past month, much quicker than we would like it to. You’re not really suppose to eat for two, you know?”.

I saw the scale trend upward toward numbers I had never seen before, all the while being cross-examined about my intake, how I was eating, how to make “healthier” choices for pregnancy and so forth.  

Maintaining Eating Disorder Recovery

While I was in a solid place in my eating disorder recovery, these experiences in pregnancy certainly did impact how I thought about myself and my body, often causing me to second guess if I could really trust my changing body during pregnancy.  

Thankfully, I did not relapse into my past eating disorder behaviors, but I could easily see how this might have occurred, had I not been surrounded by the support system I had at the time.  

The truth is that pregnancy can be a triggering time for countless women - both with and without a history of an eating disorder.  

Sadly, over 90 percent of women with disordered eating are not identified by healthcare professionals during pregnancy, as this is not something that is typically screened for during this delicate and vulnerable time in a woman’s life [1].  

Even more startling, nearly 8 percent of women met diagnostic criteria for an eating disorder at the time of their first prenatal ultrasound, and women with current and past eating disorders had higher eating disorder-related symptoms throughout pregnancy and postpartum; yet, this often goes undetected for the entire pregnancy.

Eating disorders are more common that realized in women of reproductive age. Some studies have identified the prevalence rates of eating disorders during pregnancy as high as 11.5%. For comparison, the Centers for Disease Control and Prevention (CDC) identifies the prevalence rate of gestational diabetes at about 2% - 10% of pregnancies in the United States.

While there is standardized screening for gestational diabetes during pregnancy, there is currently NO standardized screening for eating disorders during the perinatal period (pregnancy and postpartum); even though the prevalence rates of eating disorders are likely HIGHER than that of gestational diabetes during pregnancy.

Women with eating disorders are not likely to voluntarily disclose this information to their health care professionals due to the shame and stigma surrounding these mental illnesses, which increases the need for awareness in antenatal/postnatal care [2].

Pregnancy can complicate an eating disorder as body changes can increase anxiety about weight gain, appetite changes and eating behaviors. The general approach to perinatal care in the United States is incredibly weight-centric and steeped in diet culture, which can further exacerbate triggers during pregnancy and postpartum.

Connection Between Pregnancy and Eating Disorders

Even though I had openly communicated with my OBGYN about my history of having an eating disorder, there was a complete disconnect about how this might impact me during my pregnancy.

The reality is that pregnancy is an intersection of multiple changes, including biological, emotional, and social transformations.  

Not to mention, there is tremendous outside influence and pressure on women specifically during pregnancy, including cultural messages that give the idea that our bodies cannot be trusted; therefore, we MUST take steps to control the many changes that will be occurring.  

Don’t forget the many uninvited comments about how your growing body is changing.  “Wow, you’re enormous!”, or the classic, “Are you sure you’re not having twins?”, while simultaneously rubbing your swollen belly.  

Eating disorders establish a sense of feeling in control of something, such as how you eat, how much you weigh, your clothing size, etc.  

In contrast, pregnancy is about relinquishing control and allowing your body the capacity to grow a baby, which is completely possible without any interference on our part!  

However, if you have had an eating disorder, this aspect of pregnancy can trigger feelings of being “out of control”, which may make certain behaviors even more appealing, like counting calories, exercising a certain amount, etc.

Preparing For Potential Challenges

So yes, pregnancy, is a beautiful, miraculous time; however, with all the unique factors that surround pregnancy, it can be challenging, and for many women, feel like an uphill battle for survival.  

For any woman who has found pregnancy to be challenging and triggering for these reasons, it is important to know that you are not alone.

No matter what your history has been or what you may have experienced up to this point in your pregnancy, you can take proactive steps to truly thrive, protecting yourself and your baby.  

Here are my suggestions for navigating the challenges related to food and body during pregnancy:

Advocate for yourself!

Unfortunately, there is still a lack of education among health care providers when it comes to the connection between pregnancy, postpartum, and eating disorders, such as anorexia nervosa, bulimia nervosa and binge eating disorder.

You MUST be an advocate for yourself!  

This might mean finding a physician, midwife, etc, who has a background in eating disorders or even educating your current provider about your history and things that may be potentially triggering to you.  

Ask for blind weights at your prenatal appointments, and discuss the option of foregoing any discussion about weight and/or food related issues with your medical provider.  

If possible, enlist the support of an eating disorder dietitian as part of your treatment team who can oversee your weight and monitor your nutrition status during your pregnancy.   

If you feel unable to advocate for yourself, enlist the help of your partner or any trusted family member or friend who can support you during your prenatal care and help ask for what you need to keep you safe.

Learn to trust and listen to your body, NOT THE SCALE.  

Diet culture tells us that our weight is what determines our health, our worth, our identity, and our value, but nothing could be further from the truth.  

While the scale may be a tempting way of establishing some sense of control over the many changes your body is experiencing during pregnancy, constantly measuring your weight can sabotage your ability to listen to your body and adequately nourish yourself during pregnancy.  

If you are listening to your body and honoring what you are needing (yes, even respecting food cravings and food aversions), you will gain exactly what you need to support your growing baby!

By the way, the current “guidelines” outlined for weight gain during pregnancy have severe limitations, and it is important to know that appropriate weight gain for a woman during pregnancy is highly individual.

The recommended weight gain ranges are also based on a woman’s pre-pregnancy BMI, which in and of itself is an unreliable indicator of a person’s overall health.  

A woman may gain more than what is recommend for her BMI weight range and go on to have an absolutely normal and healthy pregnancy.  

Again, all the more reason to trust your body as your guide for what you need during pregnancy.  

If you are pregnant and finding yourself struggling with weight gain or confused about what to eat or how to trust your body, please be sure to reach out for support.  

Eat consistently, feed your body adequately.  

Neglecting nutrition intake or resorting to eating disorder behaviors during pregnancy can result in detrimental consequences for both mama and baby.  

Again, certain eating behaviors, such as counting calories, cutting out certain food groups, restricting intake, etc can all give a sense of control, especially when it feels like your body cannot be trusted. However, disordered eating patterns can lead to a host of complications.  

Work with your prenatal dietitian to determine if your nutrition intake is adequate to support you and your growing baby.  

This can also be a good time to get support in learning how to intuitively respond to your body's varying needs and feed yourself accordingly. 

Develop a Support Team.  

You may need more support during pregnancy to help you navigate through some of the challenges you might experience.  

This may include involving an eating disorder dietitian, a therapist/counselor, and/or support groups as part of your prenatal/postpartum care.  

Building a strong community around you and being able to lean on the support of your own village can be incredibly empowering as you prepare to transition into motherhood.  

Hope For Recovery and Healing

No matter what your journey has been, it is entirely possible to have a healthy pregnancy after an eating disorder, and I am definitely living proof of this.  

Currently pregnant with my fifth baby, I am saddened that not much has changed for prenatal health care.  

I still receive the same questions at my prenatal appointments and am faced with the daily decision of how I will care for myself, my body, and my growing baby.  

Pregnancy has taught me the unequivocal capacity my body has to grow a baby and safely carry us both through the many changes of this miraculous process.  

Through weight fluctuations, food cravings, unsolicited comments about my body from complete strangers, and more, I have had the gift of giving life, even from a body that was once broken and utterly destroyed by an eating disorder.

This my friends, is hope for recovery.

If you are currently pregnant and struggling with an eating disorder, please reach out for the appropriate help, care and support you need. Contact the National Eating Disorder Association at 800-931-2237 to connect with resources and support for your recovery journey. 

What challenges did you experience in pregnancy and/or postpartum?

Resources:

[1]: Broussard B. Psychological and behavioral traits associated with eating disorders and pregnancy: a pilot study. J Midwifery Womens Health 2012 Jan-Feb;57(1):61-6

[2]: Easter, A., Solmi, F., Bye, A., Taborelli, E., Corfield, F., Schmidt, U., … Micali, N. (2015). Antenatal and Postnatal Psychopathology Among Women with Current and Past Eating Disorders: Longitudinal Patterns. European Eating Disorders Review, 23(1), 19–27. http://doi.org/10.1002/erv.2328