Pregnancy Birmingham AL
by Dana Dovitch, Ph.D, OBGYN.net Editorial Advisor
Sharon sat in my office, stunned that she was back to see me. She had been a patient seven years before when she was in the midst of a long battle to overcome years of suffering with an eating disorder. Now at 35 years of age we were sitting together again. This time she was looking healthy and was two months into her first pregnancy.
Sharon's life sounded wonderful. She had been married for three years to a man she adored. She had completed her education as an architect and, with her husband, had begun to design plans for their "dream house." Relaxing into the comfort of financial stability and emotional well-being,
they were now beginning a new phase of life: Parenthood.
"I feel so guilty," Sharon confided.
"What's the problem?" I asked.
"I really want this baby but .." she paused.
"But what?" I coaxed, suspecting what the answer would be.
"I can't believe I'm going to say this and I'd only say it to you because I know you'll understand. " She looked out the window and fidgeted.
"Okay," I said, "I'll make it easy for you. You don't want to gain weight and you feel superficial and shallow."
"Yep. That's it. I'm pregnant and grateful for that. And I want to have a healthy baby but I don't want to gain an ounce. Ugh. I'm such a jerk."
From the first time I had met Sharon I was stunned by her looks. She was one of those fortunate young women who came from just the right gene pool to meet the standards for today's image of beauty. Her deep blue eyes were set into a beautifully chiseled face framed by thick blond curls. She had the perfect athletic build that underwear clad Calvin Klein models flaunt. You would never guess that she had been plagued by low self-esteem as a teenager and well into her 20s. But, like so many young women who grew up in trend conscious America, Sharon never felt good enough.
By the time she turned 17 Sharon was hooked by the diet crazed mentality of her peer group. Consumed with fears of being fat, she lived on Bunny Food: lettuce and salad fixings. When her parents could no longer tolerate watching their daughter eat assorted green leafy concoctions, they tried to scream her into submission. In order to "just shut them up I ate whatever Mom cooked. What they didn't know was that, instead of rigid dieting, I discovered bulimia." Sharon would sit at the dinner table eating whatever was fed to her and then would excuse herself to the bathroom where she vomited and sometimes took a few laxatives to finish up the job. Her parents assumed that everything was fine and Sharon assumed that she had discovered the perfect solution.
By the time she came to see me Sharon had stopped throwing up and using laxatives, but she was vigilant about her food choices. I recalled her voicing the words that countless women of all ages had used: "I feel like a crazy person. I just want to be normal. I want to eat like everyone else eats." Over and over again during the next two years of our therapy I reminded Sharon that: "You are not normal in this area of your life. You have an eating disorder. Food and body image may always be more of an issue to you than to other people. Let's find a way for you to accept that and deal with it."
I finally convinced Sharon to see a nutritionist so that she could learn about eating and feel comfortable making good food choices. Meanwhile, in therapy, we focused on her body image and the roots of her injured self-esteem. We discovered that achieving excellence in all her pursuits was of paramount importance. In a world which valued absurdly slim bodies, her's was the one people commented on: "You're so skinny"; "How do stay so slim?"; "I wish I had your body." Those comments only served to reinforce her obsession.
As Sharon began to eat better she learned to trust her body. She could swallow food, digest it and not balloon overnight. She also came to feel that self-acceptance and support from the people in her life whom she valued and loved was more satisfying than superficial acceptance from strangers. With this gradually fought for and achieved health she ventured back into the world feeling stronger and more confident.
The emotional hit which came with pregnancy blind-sided Sharon. She was shocked by what felt like total relapse...in fact, her response was normal.
Women who have experienced the heightened body sensitivity which comes with an eating disorder are forever alert to changes in their physical self. Whether it is a few pounds of menstrual bloat or a few pounds gained on a vacation cruise, they are often called upon to offer themselves words of support when the scale goes up: "It's okay," "Relax," "It's not the end of the world." But pregnancy is a concrete long-term shift in body shape and even the most recovered eating disorder sufferer is presented with an enormous emotional task: to embrace the changes her body undergoes; to contain her panic; to trust that her post-pregnant body will not be disgusting to her.
Sharon and I began to meet throughout her pregnancy and in the months after. The practical techniques we developed to see her through these wonderful and stress-filled days may be helpful to other women who are entering the magnificent and sometimes distressing world of pregnancy and body change.
Some or all of the following suggestions may be helpful for you.
1. See a Nutritionist
Many women are fearful that their food is out of control, that they don't know what "normal eating" is during pregnancy, that they may binge (by mistake!), or are bingeing and don't know it. Nutritional counseling on a weekly basis can provide an emotional safety net.
2. Seek Counseling
Find a counselor who is sensitive to pregnancy and eating disorder issues to support you through the months during and after pregnancy. It is important to have your worries and "crazy" concerns normalized. Remember, even you are journeying through the months of a wanted pregnancy, it is okay to feel scared, angry and lousy when your body changes.
3. Create a Fitness Program
Ask your physician about exercise. Moving your body, staying in shape, and maintaining muscle strength and stamina is not only helpful for a healthy pregnancy and labor, but can give you a feeling of being in control of your out-of-control body. Establishing an exercise program can allow you to feel that you are working WITH your body and not just going along for a wild ride. Establishing an exercise program early on in your pregnancy also paves the way for exercising after your baby has arrived. If you HATE to exercise, contact local gyms as well as the OBGYN department where you will be giving birth to inquire about prenatal exercise classes.
4. Create a Support Network
The company of other women can be a calming influence during pregnancy. Most hospitals offer classes for women (and men) in the final months before labor. These gatherings can provide a powerful reality check for women when they have an opportunity to see that other pregnant women look exactly as they do: bigger! During the early months of a pregnancy it is up to you to talk to the women in your life. Ask for support. Everyone I know loves to talk about their pregnancy...so, don't be shy to open up the discussion and share your fears. They are normal.
5. Read Parenting Magazines and Books
Do NOT buy fashion magazines during your pregnancy. They will only remind you that you are not an anorexic model. Instead, get a good dose of reality and indulge in subscriptions to any and all magazines you desire on parenting. Good reading will lessen your feelings of isolation and welcome you into all the wonderful new aspects of your role as a parent in addition to addressing issues of personal health and fitness. They also offer a zillion resources.
6. Try Massage Therapy
Massage can be a wonderful way to nurture your body at a time when you want to scold it for changing. You can locate a massage practitioner who is skilled in working with pregnant women by contact the American Massage Therapy Association; schools in your area that teach massage; through your doctor's office; or ask friends...many people have a good massage practitioner.
©Dana Dovitch, Ph.D., 1999