When a woman has an eating disorder, her life often becomes chaotic, resulting in an interruption of plans for things like school or career. Those plans and life events are mainly about the woman herself, with the impact on others being small or non-existent. When a woman with an eating disorder decides to get pregnant or discovers she is pregnant without intending to be, a second person is now directly impacted by this decision. This section is not meant to shame anyone, but rather to point out the realities and risks of being pregnant and having a baby when a woman is still sick in her disorder, or even in recovery but not for a long time.
Eating for Two
If you are pregnant, nutrition becomes of the utmost important, both to yourself and your developing baby. It is important to eat well-balanced meals, stay hydrated with plenty of fluids, take prenatal vitamins, and have an environment that is as stress-free as possible. Achieving all this can be difficult even for a woman who is at optimum mental and physical health. Factor in a woman who has an active eating disorder, and things get complicated and the risks grow high. There are already many dangers associated with having an eating disorder, including malnutrition, electrolyte imbalances (which can lead to kidney failure, heart attack and death), vitamin deficiencies and dehydration, among them. All of these can be extremely dangerous to a developing fetus, and can lead to miscarriage. Women with eating disorders who become pregnant are at an increased risk of the following complications:
Delayed fetal growth
Low birth-weight babies
Fetal abnormality (such as a cleft palate or cleft lip)
Respiratory distress of the baby immediately after birth
Increased risk of the death of the baby in the last trimester or within one month after birth
Low Apgar scores (a reading of some of the signs of the baby's health taken right after birth)
Low amniotic fluid
Complications during labor (such as a breech birth)
Incompetent cervix and/or spontaneous abortion
Increased risk to the mother of damage to the kidneys and heart
It is also important after the birth of your baby to make sure you eat right and get the proper nutrition. You will have to keep your strength up to handle all the changes in your life that this new found bundle-of-joy will bring, and to handle any postpartum depression that may occur. If you are breastfeeding, eating right becomes even more important because you will pass along any vitamin deficiencies to the baby, or may not produce enough milk to feed your little one. If you do not feel capable of or are not willing to feed and hydrate yourself adequately, you are forcing these same things on your baby.
Making a Decision About Pregnancy
Often a woman with an eating disorder, particularly one who is hearing her biological clock ticking, will argue that she wants a baby and will find the strength and inspiration to take care of herself better if she is pregnant. The good intentions are understandable, but the reality is a baby needs a mother who is already in good mental and physical health in order to have the best start to life. There are some women who manage to abstain from behaviors during a pregnancy (or at least once they find out they are pregnant), but they are the exception rather than the rule. Often these same women return to their behaviors as soon as the baby is born; the behaviors often increasing now that they are dealing with baby weight and a changed body image. In addition, having an eating disorder can increase your chances of never being able to get pregnant, and the longer you have an eating disorder, the higher the risk becomes of having some type of fertility problems.
Questions to ask yourself before you get pregnant:
How comfortable will you feel with the changes in your body during and after the pregnancy, and will this set your recovery back or lead to a relapse?
What effect will nine months of pregnancy have on your ability to recover?
If your body image is bad now, what will adding a substantial amount of weight do to it? It is recommended women gain at least 25 lbs. while pregnant.
Are you in a healthy enough place to know, rather than just hope, that you will take care of your body and the baby during and after pregnancy?
How will you handle the stress of adding a new member to your family?
Are you in a healthy living environment now, and will it be healthy for your baby?
Are you willing to face the idea that if you are still actively sick while your child is growing up, it will negatively impact her/his life? Your child may end up repeating the same patterns and even developing their own eating disorder.
Postpartum depression can be mild to severe. If you have it, how will you handle it?
Even with the joy that a baby can bring, there are many hours and days full of stress and frustration. If you do not have healthy coping skills in place to deal with those types of emotions prior to pregnancy, how will you cope with them when they come with a screaming baby and a lot of new responsibilities?
Are you in a good enough state-of-mind to recognize that you might need help and, if so, will you be willing to reach out for it?
Are you aware that the number of inpatient/residential facilities that take pregnant women is very limited, should you find yourself needing intensive care while pregnant?
Are you really able to take care of someone who will be so completely dependent on you when you have trouble taking care of yourself?
Do you recognize that many infants and children have health issues and learning disabilities that can be tied to their mother’s eating disorder, even if they don’t show up for years?
Are you having a baby to try to feel less lonely, to please someone else, or because you feel time is running out and it’s now or never?
These are all important questions to ask yourself when you have an eating disorder and are making a decision about having a baby. This is not a decision to take lightly, or to make thinking that this will be the motivation you need to recover.
If you are pregnant now, it’s imperative that you are open with your doctor and anyone else treating you (therapist, midwife or others) about your current mental, emotional and physical state. You may need extra appointments with your pre-natal team, and adding in a nutritionist/dietician who is trained to help pregnant women with eating disorders can be helpful, too. A pregnancy can be fuel to take better care of yourself, both in the short-term and long after the baby is born, but it takes a shift in thinking and a commitment to recovery. Search for and take advantage of everything you can in order to stack the odds in your (and your baby’s) favor, so that you can have as healthy a pregnancy as possible.