Eating Disorders, Pregnancy and Postpartum
This article is going to address eating disorders and pregnancy. I am myself, an ex-PEDS patient with a lived experience of an eating disorder (anorexia nervosa) and today, I am really pleased and thankful that one of the most beautiful things in life is happening to me: I am pregnant!!!
I wanted to write this newsletter because being pregnant can be triggering to your ED and despite being in recovery, I have been finding it very challenging at times. The aim here is to tell you my personal story, my fears and how I am personally managing them.
First trimester:
I can’t tell you how happy I was to see the pregnancy test being positive! I was (wrongly) psychologically pre-conditioned to the fact that suffering from an ED and not having any periods for years would make it much more difficult for me to get pregnant.
The main difficulty throughout my pregnancy journey I found, was that my brain still wanted to be in control of everything. I quickly discovered that safely carrying a growing baby wouldn’t pair well with any kind of rules on food or exercise. During pregnancy, my body was changing and requiring more rest than it used to. My mind was changing too as I didn’t want to take any risk for my baby’s health, therefore being pregnant when you used to suffer from an ED forces you to let go.
My main fear during the first trimester was towards my baby’s wellbeing and health, and I was concerned that my diet and exercise routine might harm him.
Reading about the subjects of diet and exercise on trusted midwifery websites reassured me a lot: if you have a balanced diet (you will find a lot of detail on the NHS website) and avoid certain foods that have a risk of bacterial infection, yourself and your baby will be absolutely fine! Therefore, I was happy that I was able to carry on with the diet that I had put in place during my recovery plan.
Regarding exercise, you can do many types of exercise except the ones where you could fall or hit your bump. The exercise cannot be too strenuous however and you should still be able to have a conversation whilst exercising. The clear rules reassured me that I was doing the right things or to slow down if I was not respecting them: there are clear “rules” that indicate that what I am doing is safe.
I learned that my body had begun to change during the first trimester and that, despite not looking pregnant to the outside world, there were already limits to what I could do. At the end of the first trimester, I had to stop running because I was experiencing pain in my joints and bones. Letting go at that time was really hard for me but thinking about your baby’s health always helps you to make the right decision. Being pregnant doesn’t mean that you have to stop exercising for 9 months, and I found safe alternatives in order to still be active: speed walking, pregnancy-safe indoor workouts, swimming…
The next fear that I would like to talk about is about coping with body changes and body image.
My ED still tries to make things difficult for me in this area: I have experienced negative thoughts and a distortion of my body image making the tiny bump difficult to accept at first. The worst was feeling tight in my trousers and thinking that it wasn’t linked to the pregnancy but due to me putting on weight. Having to buy new trousers, as I couldn’t fit into my usual ones, was psychologically hard and very challenging.
Here again, I would advise to keep reminding yourself the reason you are going through this and all the joy you will get at the end of the 9 months! Try to get comfortable clothes, easy to move in, allowing you to feel active. Find some pregnancy clothes in which you feel beautiful too, it will help you a lot with your body image. I went to do my pregnancy clothes shop with my mum and found it so useful as you can very quickly spiral down in negative thoughts: some pregnancy brands don’t size the same as normal trousers and you can find yourself not fitting in your usual size which is difficult when you suffer from an ED.
As part of the routine pregnancy checks, I was asked to weigh myself at the hospital appointments. I knew that seeing my weight change over time would probably set my ED back and make my life stressful. Also, I didn’t want to be focused on how many kilos I need to get rid off to go back into shape after the birth and so I asked if I could go on the scale… backwards! I explained the situation to the midwives, and they were all happy with me doing this (also when they learned about my history with the ED they sign-posted me to help should I need it). I am proud to say that I genuinely don’t know how much I put on – I just knew that my weight was healthy for the stage of my pregnancy.
The old ED negative and invasive thoughts were triggered in pregnancy, but you will find out that your love for your baby will help you to overcome your fears… really quickly!
Second trimester:
The second trimester was when I began to tell people about my pregnancy. My bump was starting to show, and the 3 first months where the risk of miscarriage is the highest had passed. I found that when you start telling people, they tend to do everything they can to physically help you which on the one hand is really kind but on the other in the head of ex ED patient was a bit frustrating. This is because I didn’t feel, at that time, limited in what I could do.
I think the challenge in the second trimester was people telling me to slow down and to relax, which was at the opposite of what I was doing before I was pregnant. I found myself being split between my wish to carry on with my behaviour as before and obviously not wanting to do too much for fear of risking my growing baby.
Wearing pregnancy clothes became a habit at that time and I stopped thinking about clothes size. As your bump shows more, the change in your figure no longer matters as you realise that it is your baby.
Third trimester:
Nearly there, the final three months!!! What I would like to talk about in this section is about physical changes that impacted on my mobility. Your baby is growing and there are large changes inside Mums body – organs and ribs moving and making room for the baby. The more advanced you are in your pregnancy, the more space your baby takes. This excitement of being near to meeting your little one builds as well.
I will always remember doing my usual walk in the morning and being breathless towards the end of it, my hands on my hips, it felt like I was waddling, my partner dragging me along. At that point, the ED thoughts were hard to manage again, as I was less active and felt quite tired by the end of the day. Who fancies a pregnancy workout after a full day at work at 35 weeks pregnant, anyway?!
The third trimester came a further challenge: being even more hungry! I am always self-conscious about my diet since I had my ED and I still needed a level of control over what I was eating. In the last trimester (and later on when I was breastfeeding) my energy needs increased and for the first time I found myself not able to have that control over quantities of food anymore. I was insatiable, and this is absolutely normal, but for someone with an ED, this is very difficult to accept. My advice on this is to try to give yourself a break, you are growing a little human and about to do one of the most amazing things in life and this will require so much energy and strength from you. This is scientifically supported too: the NHS guidance tells you to increase your daily calories intake during the third trimester. You will have plenty of time to recover and start exercising again later, so try to relax and enjoy the last few months where you can basically do everything you want without any guilt!
Postpartum:
After giving birth, my body was nothing like it was before. On a very positive note, I want to share that pregnancy and especially having my baby is helping me to fight against my ED. In my mind, there is only one winner in the battle between the ED thoughts and the health of my baby. After I gave birth to my little boy, my body image and my diet are no longer the priority. My baby is my world now and I don’t really care about anything else. Sometimes, I surprise myself and think that the maternity has cured me of my ED: it is ok if I don’t have the time to exercise for the day. If we don’t have anything ready in the fridge? Let’s go and grab some takeaway to make our life simpler; I want a piece of cake in desert? Well, I need extra calories because I am breastfeeding; I don’t have toned abs anymore? My little boy is not going to care about that!