Pregnancy can be such an exciting, yet also a scary time for women, both physically and emotionally. Unfortunately, it can also bring a landmine of challenges for women in navigating their relationships with food and their bodies. Society seems obsessed with critiquing the size and shape of your body during and after pregnancy, and never have you been more on display for public comment.

If you have a history of battling an eating disorder, no matter where you are in your recovery journey, these challenges can seem to magnify tenfold.

I’ve so often seen, from my work with others and in my own experience, that holding onto secrecy and shame about how we feel about our pregnant bodies probably keeps you from identifying where you struggle and getting the support you deserve. And the more the shame permeates, the less you might find yourself able to be present physically and emotionally during one the most significant transitions of your life.

When you stay stuck in these feelings of shame, you can unknowingly feel triggered to engage in disordered behaviors. Feeling like you are by yourself in managing this incredibly difficult transition, and without a plan, pregnancy after an eating disorder can be such an incredibly lonely place to be.

If you are like a lot of women entering this transitional time of pregnancy after an eating disorder, maybe you truly thought your issues with food and your body were in the right place, or even well behind you before you got pregnant. However, maybe those first few weigh-ins at the doctor’s office left you feeling scared and confused. Perhaps watching your waistline expand as you navigate your maternity wardrobe has had you panicking.

You might be asking yourself how you could possibly be having a tough time with that number on the scale. After all, maybe you spent a lot of time in therapy or eating disorder treatment in your college years putting all of those disordered ideas in their place.

Continuing to sit with this fear and discomfort about what’s to come, afraid to tell your prenatal providers, afraid to tell your friends or admit what’s really on your mind, can be such an isolating place to be.

All this ends up doing is making you feel more anxious and disjointed.

You might even end up in a place where the shame is so debilitating that you find yourself hiding these thoughts and feelings not only from yourself but your partner. When we aren’t able to be our true selves, further disconnection is just the natural consequence.

What you really need to know is that not only is it entirely normal, but it is incredibly common to struggle with disordered thoughts during pregnancy, especially if you are facing pregnancy after an eating disorder. It’s OK to be struggling and so key to have the self-compassion and self-awareness to notice.

Yes, the unfortunate reality is that pregnancy can bring back many disordered thoughts about food and your body, even if you thought they were long gone. However, if you can learn some simple tools for awareness, support, and self-advocacy, you’ll be better equipped to navigate the challenges that might come up. When you integrate these simple self-care oriented tools, you’ll feel better equipped to navigate food and body challenges in pregnancy and postpartum.

Keep reading for my advice on managing a healthy pregnancy after an eating disorder.

You’ll need to speak up at the doctor

The unfortunate reality is that most providers in our current health care system aren’t the best at connecting the dots between providing adequate medical care along with emotional support. For many women, maybe you do end up checking the box on your intake paperwork that tells your doctor that you have a history of an eating disorder. Unfortunately, often times the conversation ends there.

The key here is to really know what you need from your providers and being able to advocate for that. You might not even be sure what this means for you.  I often help women determine what they do really need from their doctors.

Many women have a tough time with being constantly on the scale, especially if this is something you gave up in eating disorder recovery.

If you are feeling triggered by weigh-ins, ask your doctor or midwife if you can skip this step altogether.

If they insist that it’s necessary, and you want to stick with that provider, you might benefit from blind (backward) weights. Don’t be afraid to remind them at every visit because they may forget.

Many healthcare providers put too much emphasis on weight gain recommendations. Don’t be afraid to ask them to shift the focus to on overall health during pregnancy, aside from weight.  The idea here is to focus simply on trends, and not bring this up with you during appointments unless there is a true medical concern. You can also ask your doctors to limit discussions around food and your eating habits.

The real goal is to figure out what is going to be the most beneficial for your health and to not be afraid to convey that. If you change your mind halfway through your pregnancy, or something else becomes triggering, let them know. You are allowed to change your mind!

You might feel triggered and that’s OK

There are so many physical and emotional changes that take place when you are pregnant that have the capacity to trigger eating disorder thoughts and behaviors to resurface. First, know that you are not alone. Second, please know that feeling triggered does not mean that you are a bad mom, a bad person, selfish, or weak.

It makes so much sense that you would feel triggered during pregnancy after an eating disorder. After all, your body is rapidly changing. Along with this can come nausea, which might alone be confusing or triggering to those with a history of purging.

Hormonal changes accompany and bolster rapidly changing emotions. Do not underestimate the impact of hormones!

Pregnancy can often trigger mood and anxiety disorders, which are usually familiar territory for those who have struggled with an eating disorder.

The best thing you can do when you feel triggered is to simply be able to name it. I try to help clients to be able to identify and explore these triggers, rather than to ignore them. When you do, you are lifting the secrecy that is driving the shame. It’s also important to be aware that simply feeling triggered doesn’t mean you are going to or need to act on those thoughts.

Working to trust your body

Though body changes that happen during pregnancy can feel scary, and even more so if you have an eating disorder past, pregnancy can be a time to really pay attention to your body and its needs. Your body is probably giving you some pretty loud signals and you just need to listen! This is a great time to practice pushing back against ingrained diet culture messages, which say that our bodies can’t be trusted.

One of the best things you can do is eat adequate amounts of food and really listen to you what your body needs to feel nourished. If you are experiencing cravings, try to eat what you want (as opposed to seeking a less-fulfilling substitute). Really try to tune in to your hunger and satiety.

When it comes to weight, try to take the focus completely off of the scale and trust that your body is doing what it needs to do to grow a human. The guidelines that doctors are using are unfortunately outdated, not truly based in current research, and can do a lot more harm than good. Each woman’s body is unique and weight gain needs are entirely different for every woman.

You deserve to have support

Whether you notice that you are struggling or not right off the bat, one of the best things you can do is equip yourself with the support you will need.

Being proactive in setting up support doesn’t mean that you are selfish or a bad mom. Gathering support actually means that you are even more committed to ensuring the health and well-being of your family by acknowledging what you really need to be a healthy and whole mom.

I like to think of the support network here as your own “team”. Ideally, this team should involve a health care provider who is weight neutral or HAES (Health at Every Size) friendly -though that can sometimes be tough and that’s where self-advocacy comes in big time.

Seek out a therapist who really understands the challenges of facing pregnancy with a history of an eating disorder. This therapist can and should also be communicating with your doctor about what’s going on with your care. Enlisting a dietitian who is also adept in both eating disorders and prenatal nutrition might also be an important addition to this equation.

It is entirely possible to survive pregnancy and maintain your physical and mental health during pregnancy and postpartum. Moreover, addressing challenges that come up in this process can help lay the groundwork to feel solid recovery as you enter motherhood. As an eating disorder therapist who also has advanced training and experience treating perinatal mood and anxiety disorders, I’d love to help you on your journey.  I work with clients at my office in Agoura Hills, CA and provide online therapy in California and New York. Give me a call now or click on the button below to schedule your free 15-minute consultation and find out how I can help.