Pregnancy During Eating Disorder Recovery
"Wow, thirty weeks along! How are you feeling?" The nurse beams at me as she leads me back to my OB's office. It's my 30 week appointment. I am feeling....all of things.
"Ok! Nervous. SO excited to meet him." How am I feeling? The truth is, there is no way to answer this question in this particular season of my life unless someone has about two hours of time, and is willing to curl up on the coach with me while I laugh, sob, and itch/rub my ankles.
"Hop up on the scale for me, I just need to get your weight before the doctor comes in."
My head spins a little. "Why does weight have to be SO important throughout all of this?" I think to myself. Pregnancy is hard enough without hearing my "grade" every two weeks. 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 doctors, strangers on the street-I take a breath. “Come on Colleen. Deep breath. 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 little guy. I’ve waited so long for you.”
Pregnancy after an eating disorder is t-o-u-g-h.
Pregnancy after an eating disorder is t-o-u-g-h. I had lived experience of anorexia, but had been in strong recovery for years and year by the time I became pregnant. And I STILL found it to be one of the most testing seasons of my life. And this sentiment is one that my close friends, comrades, and clients who have had eating disorders tend to reiterate. The truth is, pregnancy after an eating disorder can be incredibly difficult, no matter what stage of recovery you are in. It is hard when you are recovered, when you have been in recovery for year, or when you are just starting recovery.
There are so many reasons for why this may be. Let’s start with the body changes. Water retention, skin changes, changes in the appearance of our faces and noses, shoe size changes- these things, small as they may be, can all bring up emotions about our bodies. And then of course, there is the inevitable weight gain. Watching our bodies change before our eyes every week can be excruciating. Especially because society tells us that we're supposed to revel in it. (Well, revel in it if we gain weight the "right" way that is.) It can be extra tricky to watch ourselves gain weight in places like our arms, thighs, and faces- when we may have had it in our minds (because again, society demands that we look one way when we are pregnant) that we would only gain weight in our bellies.
There are also a plethora of other symptoms and physical issues that can impact us psychologically during pregnancy- nausea, vomiting, cramping, constant congestion, acid reflux, hot flashes, appetite changes, random nerve pain, shortness of breath, difficulty finding comfortable positions to sit and sleep in, and (if you’re really lucky like me!) all over body itching (I am internally screaming just typing that. I think I fully blocked that out and it just resurfaced while writing this blog*shudder*) These physical symptoms are downright exhausting. And they can lead to feelings of frustration towards our bodies. (Not to mention, nausea, vomiting and appetite changes can seriously mess with you if you have ever struggled with a history of purging or restricting)
Another huge issue during pregnancy that can create complicated psychological experiences for those with a history of an eating disorder? The constant commentary from other people. Anyone who has been pregnant can likely attest to this- your body is a HOT topic of conversation. How you are carrying. If you are showing. How pregnant or not pregnant you look. How you look like you are having twins. How much weight you have gained. How much weight the person commenting gained when THEY were pregnant. What you should and shouldn’t eat. How you should and shouldn’t exercise. Though sometimes well-intentioned, the commentary is completely exhausting, and can be gutting for those of us who have experienced life-long discomfort and lifelong struggles to reside in our bodies peacefully.
I have come to realize that no matter how strongly recovered someone is, pregnancy can be incredibly testing. If you are pregnant while in recovery from an eating disorder, please know that it is ok if it feels overwhelming at certain points. It is ok if you have thoughts of using behaviors, or struggle to appreciate your growing body. Heck it is ok to loathe your pregnant body! AND, there are certain steps that you can take to protect your recovery during pregnancy.
Here are some tips for maintaining recovery during pregnancy
1) Discuss the option of being blind weighed, or ask to not be weighed (or ask your OB about their opinion on what would be the least amount of times you can be weighed while still being monitored safely).
If you are someone who has decided that the scale is not helpful for your psychological well-being (this is likely so many of us!) then monitoring the number twice a month or more likely won’t be helpful. Because here is the thing: the number WILL go up each weigh-in. That's what it does most of the time when we are growing a whole human. So protect your mental health by asking 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 refuse, some will totally listen and respect your reasoning, some will compromise. Sadly, much of this variation in response seems to have to do with body size. Doctors tend to suggest that folks in larger bodies are at a higher risk for medical conditions with pregnancy, so they will insist more that weight monitoring is necessary (so unfair and an entire blog post on it's own for another time.)
2) Throw out the “pregnancy diet” books.
If you find yourself anxiously reading all the books that focus on what you should eat that is “best for baby,”-Matey, matey, we’ve probably gone overboard! Throw the book out. Or click out of that website. Or donate the books. You get it.
If you have a history of an eating disorder, these dietary suggestions can be really tricky to navigate. Why? Because so much of it seems to focus on eating “the right” foods (I noticed that they kept recommending protein and veggies.) Along with this just being triggering in general, the issue here is that, much of the time when you are pregnant, you don’t have too much control over 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? Yep. I had to toss 'em. And so should you. Morale of the story? If your bod (and baby) is asking for waffles every day, and waffles are what satiates hunger (and quells nausea)-eat the damn waffles please.
3) Consider staying on your psychiatric medication.
Yep. 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. I know that lots of OBs and doctors will suggest it. But research suggests that a whopping 68% of people who go off of their psychiatric medication during pregnancy will suffer a relapse of symptoms. Sixty eight percent. I would love it if we, as a society, could begin taking a more standard harm reduction approach on this topic. I would love it OBs would give less lists of all the things we cannot eat and take during pregnancy, and instead have nuanced conversations in which they open with, "let's talk about what level of risk are you comfortable with right now." Because truthfully, given all of the emotional upheaval that this time period can cause, going off of your medication may not be the right move. 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 do away 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 very important for me. And probably my top tip for recovery during pregnancy. Whenever I felt sad or upset about body changes, whenever other people’s opinions 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 would chant a mantra around me often: “Grow. That. Baby!” This also helped me to marvel on how cool it was that my body was doing just that- growing a HUMAN! Yes, it was a form of distraction from the body image thoughts and ED urges. That's ok! We don't have to be challenging every single thought all the time. In fact, when you're in recovery, pregnancy can be a time of pure survival. Distraction and white knuckling it when you have to are ok. Don't let anyone pressure you into feeling like you have to be some kind of fertility recovery goddess at this time. Some of us will simply be in survival mode, and that is ok. More than ok. It's heroic as f*ck actually.
5) Journal.
This can be another way that you can distract yourself and refocus on the important stuff- journal letters to your baby. My friend gifted me with a pregnancy journal to give to my baby when he’s grown, and it was so helpful. Journaling can also just be a simple way to get the emotions out. If you have had an eating disorder, you may have become pretty good at shoving your emotions down. This might become more intense during pregnancy. You will probably be feeling A LOT of different things. Joy. Fear. Sadness. Elation at this miracle. Grieving the loss of your childfree life. Concern 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 them out! Write them down. Sit with them, feel them, notice them, let them ebb and flow.
Pregnancy is a journey that tends to have difficult moments for everyone. But being pregnant while also trying to recover from an eating disorder? It is seriously a whole 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 so much love, so much camaraderie, and a huge hug to my fellow recovery mamas.
By: Colleen Reichmann, clinical psychologist, founder of Wildflower Therapy
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