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A woman’s relationship with her body image in the perinatal period

Body changes in pregnancy and the postpartum period and how we relate to these changes can be complicated. For some women, these changes can become the catalyst to developing an eating disorder, while for others pregnancy and postpartum body shape and weight changes can further complicate an existing eating disorder.  

While it is important to screen and assess for eating disorders, we also need to be exploring a woman’s relationship with her body image and possible dissatisfaction during pregnancy and in the postnatal period.   

During pregnancy

While gaining weight is required for a healthy pregnancy, for women with an eating disorder having to gain weight can be very frightening and triggering. On the other hand, for some women body shape and weight changes in pregnancy can cognitively be attributed to ‘necessary’ changes for baby’s nourishment. Exploring and gaining insight into the cognitive relationship a woman has with her body image during pregnancy can be very helpful in early intervention and identification.   

Following birth

In the postnatal period, cognitions and ways of relating to one’s body can shift and change dramatically. The expectations some women have on their body as they strive to attain their pre-pregnancy size and shape can be unrealistic and consuming. They can also be unhealthy.    

The outcomes of eating disorders and harsh body image perceptions in the perinatal period can be dangerous for both mother and baby.

Women who place emphasis on avoiding weight gain or a changing body shape during pregnancy and/or focus on intensive exercise in the early months following childbirth place themselves and their babies at additional health risks.

 Identified risk factors

  • Antenatal and postnatal depression and anxiety,
  • Impaired foetal development and antenatal complications,
  • Premature births,
  • Lower birth weights and birth defects,
  • Hyperemesis (excessive vomiting),
  • Gestational diabetes,
  • Unplanned caesareans,
  • Increased risk of miscarriages
  • Breast milk supply complications due to nutritional deficiencies in the mother
  • Increased risks of nutritional deficiency for the baby when transitioning from breast or bottle feeding to introducing solids. 

The National Eating Disorder Collaboration (NEDC)

Early intervention of eating disorders in pregnant and postnatal women is dependent on careful screening and assessment and early

It is also important to remember that a female with an eating disorder may be ashamed of her behaviour and may harbour feelings of guilt about how the eating disorder is affecting her baby.

Signs and Symptoms 

In expectant mothers, eating disorder signs and symptoms can manifest as normal symptoms of the pregnancy (e.g. tiredness) or they can be disguised by other expected ailments associated with pregnancy (e.g. signs of vomiting may be mistaken for morning sickness rather than self-induced purging). Health professionals assessing a pregnant or postnatal woman should be aware of signs and symptoms in the context of eating disorders where they could be seen as not in the usual range associated with pregnancy or postnatal periods or are particularly severe.  

In general, common eating disorder presentations can be psychological, physical and behavioural. These signs and symptoms were identified by the NEDC:

Psychological

- Concern, distress or preoccupation with weight gain, even when weight is within the expected range 

- Dissatisfaction with body shape, even despite your discussions with them about expecting normal body shape changes with stages of pregnancy 

- Negative or unusual attitudes towards food and/or eating (see below) 

- Negative attitudes towards the unborn baby

- Depression, anxiety about pregnancy and anxiety about caring for their baby. 

Physical & Medical

- Severe weight loss or low weight in relation to stage of pregnancy 

- Severe weight gain or excessive weight in relation to stage of pregnancy 

- Fainting, dizziness, headaches 

- Shortness of breath, fatigue 

- History of menstrual disturbances 

- Previous infertility or related problems 

- Gastrointestinal problems

- Low bone density 

Behavioural

- Indications of food intake restriction 

- Signs of repeated, self-induced vomiting 

- Restriction of certain foods not advised by a clinician 

- Avoidance of meals or changes in eating behaviour (e.g. refusing to eat with others) 

- Evidence of substance/medication abuse in order to maintain body weight 

- Insomnia or disturbed sleeping patterns 

- Self-harming or suicidal behaviour (in which case emergency treatment will be vital) 

- Excessive or distorted exercise patterns or signs of distress when exercising is not possible

Learn more

What do Therapists need to know? 

 Much of what we have covered for front line health professionals relates in the therapeutic space as well. However, as we are generally providing longer term support and more in-depth assessment and treatment there are further considerations. 

  • Build strong therapeutic rapport It is important to be sensitive to the struggles and concerns of the individual and to be aware of the potential shame and guilt they may be feeling
  • Extra appointments may be necessary with their GP and healthcare team. You may need to support and encourage this so that they can closely track the growth and development of the baby.
  • Support consultation with a nutritionist with expertise in eating disorders as soon as client is willing. It will be helpful to work with the nutritionist throughout the pregnancy to create a plan for healthy eating and weight gain. 
  • Encourage connection to support groups to help build connection and support with other pregnant or new parents who share concerns and fears regarding food, weight gain, and body image.
  • Explore what will be helpful with weight monitoring. As weight monitoring is important information to track the health of the baby it is essential this topic is explored. If it is indicated that weight monitoring for the mother is not helpful you can explore options such as standing on the scale backwards and requesting the numbers are not shared.
  • Encourage and support your client to check with their doctor before attending a prenatal exercise class. 

What should therapists provide?

Everyone is different – and the way that our bodies grow, change and shape themselves to hold and carry our baby during pregnancy can vary greatly from one person to another. We can support our clients with developing positive body images by exploring the following. 

Coping with the challenges of pregnancy

It is important to acknowledge that, while there are a number of positive ‘side-effects’ of pregnancy (like stronger hair and nails and glowing skin), unfortunately there can also be some less-than-pleasant aspects, including weight gain on other areas (besides your tummy), swollen legs and varicose veins – just to name a few.  This is all part and parcel of pregnancy – and is completely normal. 

Managing the pressures

Many mothers, however, struggle with the fact that during pregnancy, the changes to your body size and shape can result in people making comments about your appearance. Whether it’s “Are you sure there’s just one in there?” or “You’re so tiny for six months!” this can increase the focus on your body image and compound your own feelings. 

Looking after yourself

While it is important to eat well to provide nourishment to yourself and your baby, it can be very difficult if you’re not feeling comfortable with your changing body.  Here, it is helpful to keep in mind and appreciate the amazing ability of your body to create a little person. Reflecting on this can certainly help keep things in perspective and focus on the positive. 

Keeping it all in perspective

Pregnancy is a time to be nurturing to both your physical health as well as your emotional health and wellbeing.   

Remind expectant and new parents that they can do this by: 

- Eating well – good quality food will nourish both you and your growing baby 

- Exercising sensibly – even a gentle walk can be great for maintaining mental wellbeing by stimulating those endorphins which have positive impact on your mood, as well as giving you a sense of achievement 

- Being aware of your expectations around body image – are these realistic or are you putting pressure on yourself? 

Find support for body image and eating disorders

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