By Dr. Danielle Keenan-Miller
As I enter my third trimester, very visibly pregnant, I’ve been thinking a lot about the challenges moms-to-be face in maintaining a body positive attitude. First off, it’s astounding the number of people-- friends, coworkers, family members, and strangers-- who feel emboldened to comment on the size of a pregnant woman’s body. Is her stomach too big? Not big enough? Is she really as pregnant as she says she is? Is she “about to pop”? Whoa! And many people continue lean even harder into the common mistake of thinking that a woman’s weight or shape is an indicator of her health or the health of the baby. The constant weigh-ins at the doctor’s office can also be a trigger for body insecurity for many women. Negative media chatter about pregnant or postpartum celebrities also contributes to negative body image for women, even those who are not yet pregnant (1). Plus, there’s no way around the challenge of adjusting to an entirely new figure confronting you in the mirror (and sometimes seeming to change from day to day!).
As challenging as this new body image landscape can be for any woman, it’s particularly challenging for women that have a history of struggling with eating disorders or body image concerns. Women who have a history of dieting are more likely to engage in unhealthy habits during pregnancy, such as binging and purging, laxative use, dieting, and excessive exercise, and have a harder time adjusting psychologically to the changes in weight and shape that are a natural part of pregnancy (2,3). Not only are these behaviors associated with risks to the baby-- but they can have long-term implications for moms. In fact, poor body image is associated with an increased risk of developing depression during and after pregnancy (4).
So what’s a mom-to-be to do? Here are some helpful hints:
Connect to your deeper values. Remind yourself that these body changes are in service of a bigger purpose, one that will create meaning in your life in a way that your waistline never will. Taking steps to build a bond to your future baby can help orient you towards those values.
Remind yourself that this is how your body should look. As a psychologist, I’m often wary of “should” thoughts, but this is one time where a well placed “should” can do some good. These changes-- the good, the bad, and the weird-- are what is supposed to be happening. They’re a sign that your body is doing what it needs to in order to create and sustain a new life.
Turn down the volume on negative automatic judgments about your body’s shape and size. Those thoughts will pop up from time to time-- most of us have been well programmed by society to value a certain kind of shape that does not match a pregnant body. But it’s possible to catch those old thoughts and decide not to listen to them. Tune it out the way you’d tune out bad advice from your mother-in-law or an out-of-touch colleague.
Speaking of tuning out, have a prepared response to those probably well-intentioned but clueless people who make comments about your body. A quick reply like “Thanks for your concern, but the doctor says we’re both doing great” should suffice in getting your message across.
Make sure your whole team is aware of these challenges. If you’re having significant anxiety, stress, or low mood in response to changes in your weight and shape, it’s worth talking to a therapist who specializes in eating and body image. It’s particularly important to loop in your OB if there are any behaviors (like dieting or purging) that could be impacting the health of your baby. Given that a history of eating disorders is also associated with a variety of negative pregnancy outcomes like low-birthweight babies, it’s important to let your OB know about your eating and dieting history, even if you feel like those problems are in the past. These concerns are often difficult to talk about, but I guarantee you that your OB has heard (and seen!) everything-- and she’s about to see you at your most vulnerable, so you may as well get comfortable now.
1. Hopper, K.M. & Stevens Aubrey, J. (2016). Bodies after babies: the impact of depictions of recently post-partum celebrities on non-pregnant women’s body image. Sex Roles, 74, 24-34.
2. Fairburn, C.G. & Welch, S.L. (1990). The impact of pregnancy on eating habits and attitudes to shape and weight. International Journal of Eating Disorders, 9.
3. Micali, N., Treasure, J., & Simonoff, E. (2007). Eating disorder symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity. Journal of Psychosomatic Research, 63, 297-303.
4. Silveira, M.L., Ertel, K.A., Dole, N., & Chasan-Taber, L. (2015). The role of body image in prenatal and postpartum depression: a critical review of the literature. Archives of Women’s Mental Health, 18, 409-421.