(Originally written for a friend of mine, who is a doula with a special ministry to pregnant women with eating disorders.)
For a young woman with body image issues, the prospect of carrying a baby and watching her body grow and change (in ways she cannot control) is frightening. In addition to the physical aspect, pregnancy is a bit of an enigma to young women: in high school and college, the unmarried but sexually active fear it. There is shame and stigma attached, which partially accounts for the high abortion rate. Once married, pregnancy is desired and greatly anticipated – the joyful promise of a new baby awaits. Where, exactly, does the woman suffering with an eating disorder fall into this spectrum?
That is a complicated question, as many of us who have been through this experience can attest. The life-dominating obsession of anorexia or bulimia is an intensely lonely experience, and many women with eating disorders truly want to become nurturing mothers to a little one who loves them unconditionally. Having an eating disorder during pregnancy is not a matter of selfishness; of putting one’s vanity or pride before the child’s needs. The pregnant woman struggling with anorexia (or, more commonly, bulimia), needs compassion more than ever in order to reach out for the help she needs.
My eating disorder began 10 years before my first pregnancy in 1996. Although severely underweight in high school, I had managed to maintain a normal-enough weight throughout my early twenties to conceal my bulimia. At 5’5” and 110-120 lbs., I weighed enough to menstruate regularly and had no trouble conceiving and carrying my babies to term. (I had stopped menstruating from age 15-19, as I had insufficient body fat to produce the estrogen needed to ovulate. Many women with eating disorders permanently lose their fertility; it should be noted that I was extremely lucky.)
As a pre-teen, I had casually made the comment once to my mother, “Being a fashion model seems like a fun job to have,” to which she caustically replied: “What would you model – maternity clothes?” This comment stayed with me my entire life…causing me to associate pregnancy with being overweight. As a young married woman, I do not recall, however, being unduly concerned about weight gain or looking “fat” during my pregnancies. However, as I was regularly bingeing and purging (up to four times per day), I did not gain as much weight as the average woman would have. During my first pregnancy, I gained 15 pounds – and delivered a healthy, 8 lb. 4 oz. baby girl. My second pregnancy was similar – the bulimia continued, undetected….and I gave birth to an 8 lb. 1 oz. baby boy.
Towards the end of my third pregnancy in 2003, protein was noted in my urine. Tests were done to check my creatinine clearance – a measure of kidney function. Knowing that long-term bulimia can affect the kidneys, I became worried. Thinking I had been drinking insufficient water, I began fluid-loading…..which skewed the results of the tests and caused my ob-gyn to think my kidneys were failing. Knowing nothing about my bulimia, she assumed I was pre-eclamptic (despite my low blood pressure) and scheduled an induction at 37 weeks gestation. A difficult and painful delivery followed, although my son was healthy and strong at 7 lbs. 6 oz. Several months later, I saw a nephrologist who assured me my kidneys were completely healthy….and that compromised kidney function was often present in late-term pregnancies.
Nevertheless, the experience scared me…..and it was part of the wake-up call God gave me to turn my life around. While Stefan (my third child) was an infant, I began the process of repentance from the eating disorder that could have claimed my life. Intercessory prayer by others, as well as regular time in the Word and personal prayer were tools that I used to overcome the bondage food had become in my life. (See my book, “Redeemed from the Pit: Biblical Repentance and Restoration from the Bondage of Eating Disorders” , (Calvary Press) for helpful information on the process of renewing the mind.)
In 2005, I unexpectedly found myself expecting once again – this time, with a second daughter. In between buying pink outfits and nursery toys, I was by this time talking to women online who found themselves in the same predicament I had years earlier – pregnant; trapped by eating disorders; and scared. I shared with them the same hope that God had given me – and explained that there was freedom available in Christ. I encouraged them to get help, either through their churches or with a local counselor. Eating normally, this time I gained 30 lbs. (although I had slightly more edema) and came home from the hospital 20 lbs. lighter. Without reverting to restriction, purging, or any other unhealthy mechanisms, I was back down to my pre-pregnancy size 3 within a few months. Natalia, who weighed 8 lbs. 6 oz. at birth, was the only one of my children conceived, carried and born post-bulimia.
The physical risks of eating disorders to a pregnant woman (and her unborn child) are sobering. Dehydration can lead to severe cramping, which may be mistaken for miscarriage. Malnutrition causes key nutrients and minerals to be leached from the mother’s bones, in order for the baby to obtain what he/she needs. Worse, in the case of anorexia, miscarriage is common and low-birth weight (along with insufficiently developed brains) is a major risk. Although my children were fortunate not to have been physically affected by my eating disorder while I was carrying them, while practicing bulimia I could not have been the mom that they needed. Constantly being preoccupied with thoughts of food and the takes time, energy and attention away from the little ones who need it most. One of the first things I noticed when I stopped the bulimic behavior was how much more energy I had. I was also able to concentrate and stay focused much more easily.
Overcoming an eating disorder is never easy, and because the mindset and behavior pattern is so difficult to break the motivation to “just do it for the baby” is simply not enough. Moreover, such statements (however well-intentioned) may add to the guilt a pregnant woman with an eating disorder already feels. She needs to feel safe enough to confess the bulimia (or other eating disorder) to her doula or trusted medical professional, in order to get nutritional and spiritual help. Pregnancy can be an added incentive to a woman’s recovery, but transformation is never automatic. If you are pregnant and suffer from an eating disorder, there is hope. Do not be afraid to tell someone you trust, and allow others to help and support you!