As a mother of two, I like to think I know when I or my young kids are getting sick (too often at the moment). I also like to think that I act as soon as I get so much as a whiff that something isn’t quite right. But it isn’t always that easy…
As someone who had an eating disorder in their late teens and 20’s, I didn’t know what was happening – I was ashamed, and it felt bigger than me. By not acting early myself and not having others encouraging me to get the support I needed, I added years of “experience” to my lived experience.

This week is Body Image and Eating Disorder Awareness Week, and the theme is ‘Know the signs and act early’. When most people think about eating disorders they think of anorexia nervosa in adolescent girls, but of the more than 1 million people living with an eating disorder in Australia, many of them are adult women, and many have binge eating disorder, atypical anorexia, or body image concerns that interfere with their life.

📢 Pregnancy and postpartum are times of significant body, body image, and identity change for women.

Our bodies grow and change just as much as during adolescence, but in a shorter time frame. Sometimes, these changes can bring about body image concerns or eating disorders – usually for those who have experienced this in the past, but sometimes even for people who haven’t.

It isn’t always easy to know the signs so you can act early, so we have pulled together some tips on how to know when you, or someone you know, might need help, and where to get it as you navigate through pregnancy to parenthood.

In Pregnancy

Share Your Truth

If you have experienced body image concerns and disordered eating in the past or are experiencing them when pregnant, it is a good idea to share this with the people around you, and your pregnancy care team. This will set you up with the best chance of avoiding relapse and being well supported throughout your pregnancy. Knowing your history and any current concerns can help your treating team manage any potential risks and regularly check-in with you during this period and provide support and additional monitoring as required.

Your Body Knows Best

Pregnancy can be a challenging time as the body grows and changes in mysterious and magical ways, strangers feel it’s acceptable to comment on your body, the way you like to move may be impacted, you might be turned off certain foods and have cravings for others and you experience fluctuating hormones that have you up and down and everywhere else.  Listening to your body, and trusting your body is really important – right from the beginning. Talking to someone close to you, or journalling about what is happening, and how you feel about it, could be helpful as you navigate the highs and lows of pregnant life.

Weighing In on a Weigh In

As adult women it is usually easy to avoid being weighed, but in some hospitals, and in some states, this is a routine part of care- at intake, and at other time points in your pregnancy. Being weighed can be tough for many people as that number on the scale can hold so much power. Sometimes, weighing is offered, in which case, you can just say ‘No thank you’. If weighing is required, we strongly recommend that all women ask to be ‘blind weighed’ (ie., being weighed without you seeing or knowing the number), particularly when they have a history of body image and eating disorders. You can practice saying: “If it is medically necessary to be weighed, I prefer not to see the number” or, save this picture on the camera roll on your phone, and show it to your care provider. You are allowed to have a say in what happens with your body, and this is important. As we advocate for this practice among health professionals, we urge you to advocate for your own needs until this becomes commonplace in pregnancy care.

In Postpartum

Great Expectations

With all of the focus on labour and birth, there is very little conversation about how your body might look and feel afterwards. It can help to be prepared for the fact that it can take 9-12 months for your body to fully recover and feel like your own again after giving birth. It is completely normal to ‘still look pregnant’ after you have given birth. It takes weeks and months for your internal organs to go back to where they were, for your uterus to contract, and for your abdominal muscles to meet in the middle again. You might find that your body stores fats and fluids in places it didn’t before. Your body’s priority is to produce food for your baby, and to return to regular function. It knows what it is doing.

Look out for:

🚩 If you are feeling upset about your body, talk to your family, friends, or caregivers about this.

🚩 Consider seeking additional support- you can call Eating Disorders Victoria or the Butterfly Foundation helplines.

🚩 It can be helpful to seek the guidance of a women’s health physio in order to ensure that your core and pelvic floor are recovering well.

Focus on Self Care

There is so much pressure on women to “bounce back” after having a child and this can lead women to feel dissatisfied in their bodies. Given the adjustment to your new role and new life, we want to encourage you to focus on you- what’s inside of you- rather than what your body looks like. Self care is critical in this period. Make sure that you are meeting your needs- showering, peeing when you need to, drinking enough water, chatting with a friend, sleeping when you can- this will support your mental health and wellbeing

Look out for:

🚩 Feelings of anger often arise when our needs are not being met. Outsource household tasks that other people can do so that you can take care of yourself and your baby.

🚩 That ‘raisin’ feeling – feeling so drained and like there is nothing of you left of you at the end of the day. Is there something you can do for yourself to get you back to a juicy grape?

Be Mindful of why you’re moving

Exercise has so many benefits, and we want all mums to get moving in gentle, mindful ways, but it is important to check in with yourself and ask why you’re doing it. If you’re exercising to feel strong, get energy, or for your mental health, that is great but if you’re doing it to lose weight or as a punishment then it may be a sign to speak to someone and get some support. Start by mentioning this to your Maternal and Child Health Nurse at your next appointment.

What are the signs to look out for?

🚩 Exercising to lose weight

🚩 Exercising as punishment for eating certain foods

🚩 Exercising for long periods of time (eg., walking for more than an hour per day)

🚩 Compulsive exercise- when you can’t take a rest day for no reason

🚩 Pushing yourself without being medically cleared (e.g., before the 6-week check-up)

If you deprive, how can you expect to thrive?

If you breastfeed, your nutritional requirements are increased. You need to be eating more. In fact, the amount of milk produced during the first 4 months of postpartum represents an amount of energy roughly equivalent to the total energy required in pregnancy. If you’re not adequately nourished it can affect production of breast milk, energy levels, your mood and more!

What are the signs to look out for?

🚩 Saying no to food because you think you “shouldn’t have it”

🚩 Pushing through hunger or skipping meals and snacks

🚩 Exhaustion – it can be hard to differentiate low energy with sleep deprivation but question this if you are getting enough (albeit probably broken) sleep

It can be hard to advocate for yourself but remember that preventing problems is always easier than curing them. Picking up on the signs earlier will mean that it will be a much easier road to becoming healthy again. You are worthy of recovery and support. And for those concerned about others, once you notice something, don’t watch and wait – early intervention can stop an eating disorder in its tracks.

Other resources:

• Listen to Olivia’s Birth Story – https://australianbirthstories.com/podcast/episode-294/
• Access self compassion resources here – https://www.bodyconfidentcollective.org/bcm
• Podcast – we are hoping
• Core & Floor, Restor – https://coreandfloor.com.au/
• Eating Disorders Victoria – PH: 1300 550 236 or https://eatingdisorders.org.au/
• The Butterfly Foundation – PH: 1800 334 673 or https://butterfly.org.au/

References

Paxton, S. J., Hay, P., Touyz, S. W., Forbes, D., Madden, S., Girosi, F., … & Morgan, C. (2012). Paying the price: The economic and social impact of eating disorders in Australia.

Sollid, C., Clausen, L., & Maimburg, R. D. (2021). The first 20 weeks of pregnancy is a high-risk period for eating disorder relapse. International Journal of Eating Disorders, 54(12), 2132-2142.