Eating Disorders
Although this is happy news for most women, for those experiencing eating disorders the confirmation of being pregnant can create an uncomfortable mix of emotions. Pregnancy may have a positive or negative impact on a woman's eating disorder and this may be difficult to predict at first. Your eating disorder may exacerbate the fears that most women have anyway; surrounding weight gain, changes to body shape and disruptions to life routines.
Some women find that they develop better control over their eating disorder symptoms during pregnancy, which is motivated by the desire to have healthy babies and be healthy themselves in order to provide the best care for them. However, some women continue to have difficulties with poor/distorted body image and are unable to distinguish being pregnant from being "overweight". There is also a common fear that the weight gain during pregnancy will be become out of control.
What you need to know
Preparing for Pregnancy
It is important that there is an improvement in the level of management over your eating disorder prior to trying for a baby. This will include nutrition and problem behaviours. This is because being of a low weight and engaging in behaviours to compensate for the food you eat can compromise your fertility
A healthy weight promotes ovulation. Many women with eating disorders may experience a disruption in their hormone production, and periods may not be present. If this is the case they are less likely to ovulate and release a mature egg, which would enable them to become pregnant. Women with Bulimia Nervosa can be of normal weight , but can still have severe nutritional deficiencies that can affect their fertility. Research has shown that once a healthy dietary intake has been resumed, problem behaviours have reduced and weight improved, women with eating disorders can expect to resume their menstrual cycle.
Fulfilling your role as a mother by supporting your growing baby during pregnancy and once your baby has arrived requires great physical and emotional strength, so it is important that you are at your best possible health.
Medication
Many women with active or past eating disorder take medication, such as antidepressants. Medication is an important part of life for a lot of people and it should not be discontinued suddenly as it may lead to a deterioration in your mental health. Ideally, it should be discussed with your GP or Consultant before, or as soon as you find out that you are pregnant to ensure the best outcome for you and your baby. Your Doctor is able to discuss this with the Perinatal Mental Health Liaison Team's Consultant Psychiatrist if needed. It is crucial to protect your emotional health and wellbeing as pregnancy is a major psychological and physical adjustment.
Due to the potential risks of developing postnatal depression which has an association with eating disorders, you should discuss the possibility of taking antidepressant medication within 6 weeks of delivery should you feel your mood has deteriorated. If this is the case, you should consult with your GP to assess what is most suitable for your needs, in view of your medical history. GP's are more than welcome to consult with the Perinatal Mental Health Team Psychiatrist.
There are medications that are safe to take when breastfeeding.
Risks during pregnancy:
The outcome of pregnancy may be compromised in women with disordered eating.
Possible risks to you and your baby include:
- poor nutrition
- dehydration
- cardiac irregularities
- gestational diabetes
- premature birth
- labour complications
- difficulties nursing
- depression
- delayed development
- low birth weight for age
- respiratory distress
- other perinatal complications
- feeding difficulties
The above risks can be minimised by significantly reducing disordered eating patters, including restricting intake or binging and purging, maintaining a healthy weight before conception, and allowing the desirable weight gain during pregnancy.
Tips for changes in the body in summary
- Ensure a better well being both emotionally and physically prior to conceiving.
- Inform your obstetrician of your eating disorder and know what additional help is available.
- Consider working with a dietitian who has specialist experience of eating disorders to ensure your diet and weight in maintained throughout the pregnancy.
- Consider engaging in help available from local mental health and eating disorder services to help you anticipate and manage the challenged of pregnancy and parenting.
- Please make sure that your mental health and physical needs are met.
Once your baby is born
Firstly, congratulations! Now your baby has arrived, just be aware of prolonged mood changes and seek help from your GP or Midwife if this becomes too distressing.
Mums wishing to breastfeed their babies may wish to seek help from their Midwife or Health Visitor who are available to support you in addressing your goals in feeding your baby.
Please don't forget about contraception, this very important!
Become educated - read pregnancy books and articles, talk to others, attend your antenatal classes.
Take some quiet time to reflect on the wonder of your changing body and how these are supporting the needs of your baby. Be kind to yourself and indulge all your senses to make your body feel pampered and relaxed.
Express your wishes regarding your preferred choice of health worker. You can use your appointments with them to express your hopes and fears about your changing body.
Getting the right help - useful services & resources:
During your pregnancy, it is advisable that you seek specialist medical, dietetic and psychological help to enable you to cope with your pregnancy and eating disorder symptoms. Support is available to you via your GP, Midwife, Health Visitor and within Primary Care Services.
Is it also recommended that you inform your Obstetrician about your illness in order that appropriate support and monitoring can be provided.
It is important to eat well-balanced meals and to stay hydrated with plenty of fluids during pregnancy. The 'average' woman gains between 25-35 pounds during a healthy pregnancy. As the foetus develops, it takes nourishment from the mother. If she suffers from an eating disorder this can seriously deplete her own reserves and she may begin to experience exhaustion. Low mood can also accompany being under nourished.
Consult with a specialist eating disorders dietitian before, or as soon you know you are pregnant. With their help, you can create a healthy eating plan to support your own physical and emotional wellbeing during pregnancy, as well as the development of your growing baby. After the arrival of your baby you may wish to continue to see the dietitian for help and advice on returning to a weight you are comfortable with through healthy means.
- To find your local peer support groups click here
- Local Specialist Perinatal Mental Health Team
- Baby Buddy is the multi-award winning free app that guides you through pregnancy, birth, parenting and beyond. You can explore the web version of Baby Buddy or download the full version of the app for free on the App Store and Google Play. There is a lot of information including videos about your physical and mental health.
Websites
- Tommy's
- Understanding how eating disorders affect pregnant women
- Eating disorders and pregnancy
- Beat Eating Disorders
Apps
Downloads
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
Self care and Prevention
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