Eating disorders and the perinatal period

Guest blog by Abigail Reynolds, Projects Coordinator & Perinatal Lead at Wednesday’s Child (MMHA member)

Note: Abigail’s story may be difficult for some to read, so please use discretion and visit our support pages if you are feeling anxious, worried, or upset.

My story: where it all began

In 2019 I found myself pregnant with my second child – delighted, excited, but utterly terrified. The source of my fear? What felt like the impossible task of keeping both myself and my baby safe as I faced the prospect of navigating pregnancy and the postpartum period with a life-consuming eating disorder.

Having developed an eating disorder very suddenly when my older son was one, I didn’t receive a diagnosis or treatment until three years later when, at eight months pregnant, I reached physical and psychiatric crisis point. I had expressed concerns over the degree to which food, exercise and weight were dominating and negatively impacting my life many times to a range of healthcare and perinatal practitioners but was repeatedly told I couldn’t possibly have an eating disorder because I was still a “healthy” BMI.

The mental torment of endless disordered cognitions, compulsions, and the mental and physical energy required to satisfy the ever-increasing demands of a disorder that convinced me that my worth was entirely and inextricably linked to my ability to deprive myself of nourishment and flog myself with excessive exercise rituals, were dismissed by those charged with my care. This wasn’t down to any individual fault or a lack of dedication, but rather too little education and training about eating disorders.

Fertility, conception, and pregnancy with an eating disorder

When I miraculously conceived my second baby despite my undernourished body not having ovulated for two years, I hoped that my body and mind might somehow… reset. Those factory settings would be restored and the fiercely protective, hormone-enhanced love I had experienced in my first pregnancy would be strong enough to snap me out of my disorder. Instead, my life became a constant tug of war between the part of me which wanted more than anything for this beautiful baby to thrive, and this untouchably powerful force that overrode every healthy, intuitive, and protective instinct I had.

What really characterised my experience of perinatal mental illness was a sense of feeling utterly alone and misunderstood. I knew something was horribly, dangerously wrong, and yet those charged with my care were telling me I was fine. My baby was growing, so I “must be managing”. I could find no resources or support which suggested I was experiencing something which, as it transpires, nearly 13% of women[1] will go through to some degree in the perinatal period; an already vulnerable and challenging time.

Eating disorders thrive on secrecy, shame, and low self-esteem. No wonder then that with no help available, my illness escalated and the risks to both me and my baby increased.

Making sure others feel heard and supported

Fast forward three years and, thanks to excellent eating disorder treatment, I am well and fortunate enough to work for Wednesday’s Child, a not-for-profit eating disorder support organisation. In my role as Perinatal Lead, I have begun to address the deafening silence which surrounds the existence and prevalence of eating disorders during the perinatal period.

Resources for professionals

As an organisation, we have developed a well-received free e-learning module for any healthcare professional, or indeed anybody working with new or expectant mothers. It provides extensive lived-experience insight from many women who have struggled with an eating disorder during or after pregnancy, including those who relapsed having previously recovered. In addition, there is a wealth of practical guidance around supporting a new or expectant parent who has an eating disorder (and their family), and information around the potential impacts of these serious mental illnesses on the wellbeing of both mother and baby. Wednesday’s Child also offers lived experience training sessions for organisations or individuals who work with new or expectant parents.

Support for pregnant women and new parents

For new or expectant parents who are themselves suffering from an eating disorder, or concerned about the risk of relapse in the perinatal period, Wednesday’s Child has developed two e-learning modules addressing these issues for:

1. people who are pregnant
   
2. those who have recently become a parent.

These resources aim to reduce the feelings of isolation, guilt, and anxiety that new or expectant mums might experience, and to empower them to prioritise their own health and needs, as well as their baby’s.

Wednesday’s Child also offers a free befriending programme, and we have several volunteers who have themselves experienced – and recovered from – eating disorders during the perinatal period available to offer empathetic, non-judgemental, and practical peer support to anybody struggling.

Understanding eating disorders in the perinatal period

The perinatal period presents numerous potential triggers for anybody who has current or historic experience of an eating disorder, including:

• people commenting openly on a woman’s size and shape
  
• pregnancy ailments such as morning sickness potentially reigniting disordered thoughts or behaviours
• rapid body changes
• decisions and implications around breastfeeding
• pressure to “lose the baby weight”
• huge shifts in routines and relationships.

Navigating the perinatal period as someone who has or had a disordered relationship with food, exercise, weight, or shape can feel like an impossible minefield.

For some women, pregnancy offers increased motivation to recover, and carrying a baby allows them to feel more able to nourish themselves and rest in a way that may previously have felt impossible. The perinatal period can be a real opportunity for meaningful recovery, but supporting women with the appropriate treatment, understanding and knowledge is vital if this recovery is to be sustained into parenthood.

Let’s change the statistics, together

16% of pregnant women will have experienced an eating disorder at some time in their life[2], and of those, 50% will relapse[3] within a year of delivery. These aren’t small numbers, and this relapse rate shouldn’t be inevitable. By improving awareness and increasing knowledge of eating disorders amongst those working with this group of people, we hope that more women who are struggling will get the help they need to keep both themselves and their babies safe and well during this time.

As is the case with so many perinatal mental illnesses, early intervention is vitally important in the treatment of eating disorders. We believe that empowering professionals to feel confident in spotting the signs, asking relevant and nuanced questions, being mindful of potential triggers, understanding both the mental and physical symptoms, and signposting to NHS eating disorder services and relevant third sector organisations is much needed and has the potential to save lives.