Pregnancy and Eating Disorder Recovery
by: Dr. Colleen Reichmann
As I stand on the scale at my OB’s office, I feel uncomfortable. "Why does the weight have to be so important?" I think to myself. I hold my breath and glance down at the number. The nurse jots the number down and leads me into a room. “Undress from the waist down. He’ll be in soon!”
My head spins a little. Undress from the waist down? I haven’t even met this guy. I need a minute to regroup. I start to feel panic. My stomach pushes against my maternity jeans. It feels foreign. My body does not feel like home. It does not feel like it belongs to me anymore. It feels like it belongs to the scale, the nurse, this OB-I take a deep breath. “Focus Colleen. Focus on what matters.” I close my eyes, cup my hands over my growing belly, and whisper, “I am so happy that you are in there. I’ve waited so long.”
Pregnancy after an eating disorder is t-o-u-g-h. I have been recovered for years and found the process to be tricky. And it is much more difficult when you’re in the midst of recovery. It’s difficult for a thousand and one reasons. Let’s start with the body changes. Weight gain, water retention, and shoe size changes- these things can bring up emotions about our bodies.
And the physical stuff-nausea, vomiting, random nerve pain, difficulty finding comfortable positions to sit and sleep in, cramping, acid reflux, hot flashes, appetite changes, and (if you’re really lucky like me!) all over body itching (I am internally screaming just typing that. *shudder*) These physical symptoms can lead to feelings of resentment and mistrust for our bodies. (Additionally, the nausea, vomiting, and appetite changes can seriously mess with you if you have ever struggled with a history of purging and/or restricting)
And don’t even get me started on the commentary from other people- suddenly your body is a hot topic of conversation. How pregnant or not pregnant you look. How much weight you are “supposed” to gain. What you should and shouldn’t eat. How you should and shouldn’t move. It’s enough to make your head spin!
Yep. It is a tough time, and no matter how strongly recovered you feel, it will likely feel overwhelming at certain points. But there are certain steps that you can take to protect your recovery during pregnancy! Here are my top five tips:
1) Ask to be blind weighed, or ask to not be weighed. If you are someone who has decided that the scale is not helpful for your emotional well-being (pssst that should be all of us!), then monitoring the number biweekly likely won’t be helpful. The number will be going up each weigh-in. (As it should!) Ask to be blind weighed. Ask the nurse to put this in bold on your chart: HISTORY OF AN EATING DISORDER: PLEASE BLIND-WEIGHT DO NOT SHARE NUMBER. (Sometimes it is helpful to be super direct with medical professionals, as the default always seems to be that they believe you will want to know your weight.) Another option is to ask that you not be weighed at all, or be weighed much more infrequently. I have heard varying success stories about this ask. Some OB’s will outright refuse, some will listen, some will compromise. A lot of this variation in response has to do with (I believe) body size. Doctors tend to suggest that folks in larger bodies are at a higher risk for medical conditions with pregnancy, so weight monitoring is necessary (thanks fat-phobia!)
2) Throw out the “pregnancy diet” books. If you find yourself perusing all the books that focus on what you should eat that is “best for baby,”-Matey, matey, we’ve got one overboard! Throw the book out. Or click out of that website. If you have a history of an eating disorder, these dietary suggestions can be triggering. Why? Because so much of it seems to focus on eating “clean” foods (I noticed that they kept recommending protein and veggies.) The issue is (other than no food being “unclean” unless you rolled it around in garbage before eating it) that much of the time, when you are pregnant, you don’t have too much control in what you will be able to eat. For example, I only wanted carbs for a solid 22 weeks. Pancakes. Cereal. Mac and cheese. The pregnancy books were suggesting that I eat foods that were making me feel nauseated. Eventually the book suggestions became guilt-inducing. So you know what I had to do with any of those types of books? That’s right- I had to chuck it in the f*ck it bucket. And so should you. Morale of the story? If your bod (and baby) is asking for bagels every day, and bagels are what satiates hunger (and quells nausea)-eat the damn bagels please.
3) Consider staying on your medication. Yes I realize this is controversial. But if medication has saved your life in the past, this is something to think about. I know that everyone’s knee-jerk reaction is to go off medication during pregnancy. But given all of the emotional upheaval that this time period can cause, it may not be the best idea. If the medication that you are on is unsafe for pregnancy, there may be another type that you can shift to. Working with a psychiatrist with a prenatal and postpartum specialty can be a game changer here. Let’s stop with the stigma around this topic. There should be no shame in taking medication during pregnancy, or any other time.
4) Marvel at your growing baby. This was something that was essential for me. Whenever I felt weird about body changes, whenever other people’s voices became too loud, I would turn to marveling. For me, that looked like sitting quietly, cupping my hands around my stomach and talking to my little one. I would wait to feel kicks and hiccups and poke back to say hello. I would remind myself of how many years I tried for this, and about how my baby was a miracle I never thought I would have. My husband Joe would chant a mantra around me often: “Grow. That. Baby!” (He actually got this idea from another eating disorder professional but hasn't been able to recall who! If you are reading this- thank you!) This also helped me to marvel on how cool it was that my body was doing just that- growing a HUMAN! It really helped me to refocus on what was important.
5) Journal. This can be another way to help you refocus on the important stuff- journal letters to your baby. My friend actually gifted me with a pregnancy journal to give to my baby when he’s grown. Journaling can also just be a simple way to get the emotions out. If you have had an eating disorder, you (like me) may have become pretty good at stuffing your emotions down. This stuffing of emotions will likely not be helpful during pregnancy. You might be feeling A LOT of different things. Joy. Sadness. Grieving the loss of your childfree life. Fear about being a “bad” parent. Fears that you won’t attach to your baby. And on and on and on. These emotions are ALL valid and normal to experience- so get ‘em out. Write them down. Sit with them, feel them, notice what they might be trying to help you out with.
Pregnancy is a journey that tends to have tough moments for everyone. But being pregnant while also trying to recover from an eating disorder? It’s a different ball game. Please know that along with these suggestions, I want to urge you to work with a therapist and dietitian throughout the entire process. (And also during the fourth trimester!) You deserve to feel supported throughout this time. Sending you so much love, my recovery mamas! You got this.