Pregnancy and Body Image: Holding Compassion Through Change

As my child’s first birthday approached, I couldn’t help but reflect on how pregnancy and postpartum are a vulnerable times for eating disorder recovery. Even though I had done the work to heal my relationship with food, I was still uncomfortable with the changes to my body. This caught me by surprise, and it was a humbling experience. No one is immune to body image stress, especially in a thin-obsessed society. Pregnancy is also a fraught period, especially with reproductive rights under assault and increasing barriers in healthcare. The consequences are even more dire for BIPOC, Queer, and trans people.

Pregnancy is an intense journey. While it can be an exciting time, it can also bring up complicated feelings around your body and sense of self. You might struggle with the way clothes feel as your body changes. At the same time, you might feel pressure to be “happy and grateful” about the journey because that’s how society tells us we should feel. You’re allowed to feel both happy and stressed about your body changes.

Pregnancy, even without complications, may bring changes to your body that are permanent. Yet there is an intense focus on getting back into your pre-pregnancy body, often at the cost of your health and well-being. It fits the overall ideal of being young, thin and hot, which dominates the mainstream. This leaves so many people feeling worthless, ashamed and alone.

Body Image and Control

Each pregnancy experience is unique, even if you’ve had multiple pregnancies. All bodies have their own individual forms and nuanced ecosystem. Pregnancy comes with rapid changes to your body shape, skin, hair texture, teeth and more. These changes can feel out of control and really shake your foundation. Standard prenatal care includes frequent weight checks at doctor’s appointments, which can be especially triggering for people with an eating disorder history.

People who struggle with eating disorders and body image before pregnancy are especially vulnerable. A recent study showed that 15% of pregnant people likely had an eating disorder at one point and that 5% have an eating disorder during pregnancy. Approximately two-thirds of people don’t disclose their eating disorder to their doctor.

Eating disorders also increase the risk of pregnancy complications and postpartum mental health issues, including post-partum depression and post-partum OCD. Research has shown that 40% of people are concerned about their weight during pregnancy. The risk for relapses is 70% for people who went into eating disorder remission during pregnancy.

Lack of control is a major aspect of birth trauma, and this may trigger folks to lean more on their eating disorder to regain a feeling of safety. Body changes from pregnancy can be a  reminder of trauma, which can then cause folks to focus on shrinking their bodies.

Diet Culture Doesn’t Stop at Pregnancy

Body changes in pregnancy are out of our control, yet there is pressure to “bounce back” after pregnancy. The level of scrutiny during pregnancy can be stressful, as well as the unsolicited advice and weight-focused comments from others.

 One thing that was interesting to me was the pressure to have the perfect pregnant body. The expectation was a combination of a smaller figure and just the right amount of baby bump, and any deviation from that had to be justified. This often creates feelings of either “not being pregnant enough” or “being too pregnant.”

The pressure to be thin and the expectations placed on femme bodies don’t go away when you’re growing a human. Commenting on a pregnant person’s body and even touching their belly is socially acceptable behavior. Body comments during pregnancy and postpartum affected me more than I wanted them to. It reminded me of how much my body was under scrutiny.

The guidelines for weight gain during pregnancy are problematic on many levels. Standard guidelines use the BMI to determine how much weight a person should gain, but the BMI has been shown to inaccurately classify women/AFAB people, especially during pregnancy. Imagine being told you have to eat less, even though gaining weight is normal and healthy for you and the baby. These BMI guidelines are still recommended today, even though research has shown they are grossly inaccurate.

Diet culture contributes to disparities in healthcare for black people with a staggering statistic for maternal mortality. Black women are 3 to 4 times more likely to die from pregnancy complications, with most deaths being preventable. Black people are approximately 50% less likely to be diagnosed with an eating disorder, despite having similar presentation to other groups.

Weight stigma ignores social determinants of health and reduces people’s experiences to their weight, rather than actually investigating their issues. BIPOC pregnant people are more likely to be dismissed or ignored when they have medical concerns because of racial bias.

Standard postpartum care in the US only includes two follow-up appointments: Once at 2 weeks and again at 6 weeks. While there is screening for postpartum depression, there are no screenings for eating disorders or other conditions in follow up care. Sleep deprivation combined with the pressure to bounce back makes eating disorder relapse a risk.

Emotional and Identity Shifts

Pregnancy comes with many shifts to your identity and sense of self, which can make it hard to feel grounded and safe. Identity shifts can play out in clothing during pregnancy and postpartum. Whatever your style was before pregnancy, it will have to shift to accommodate your changing your body. That may not necessarily feel good and that’s okay. Maternity clothing is expensive, especially if you want to express your uniqueness in fashion. The changes your body experiences in pregnancy may also be permanent, which is normal but also may feel stressful.

If you are someone that is active, you may struggle with having to make changes to your routine to accommodate your pregnancy. This goes double for any complications that may require bed rest. Eating disorders can often come with labels such as the “active one” or the “thin friend” so there can be a feeling of loss. It’s okay to grieve your former body.

Transgender and non-binary folks might need to navigate gender dysphoria if the changes in their body from pregnancy don’t feel congruent with their gender. Healthcare continues to be cis-normative which leads to feeling alienated and misunderstood. Queer and trans people often need to use fertility treatments to experience pregnancy and often are faced with lack of options for gender affirming care. Infertility supportive spaces are often heteronormative, further leaving queer people feeling left out of the narrative.

How to Cope with Body Image Struggles During Pregnancy

Grounding Practices

Grounding practices can be helpful for soothing any stress and emotions related to your body image. Engaging the senses such as warm beverage, your favorite robe or soft lighting can help create comfort. Gentle walking, especially in nature, can be restorative. Fresh air and peaceful imagery from being outdoors does wonders for our nervous systems.

You can access comfort indoors by finding objects and photos that provide feelings of happiness and/or remind you of positive memories. Seeing these objects visually can help you feel grounded. If you’re someone who likes to meditate, there are a lot of great pregnancy mediations out there. Insight timer is a mediation app that is free.

Setting Boundaries

Boundaries are your friend here, and they can be direct or subtle. If someone comments on your pregnant body, you can respond to it directly or change the subject. Here are some examples:

“My body changes seem normal. I’m growing a person.”

“I’d rather not talk about my body right now.”

Paying close attention to social media messaging around bodies and pregnancy can be helpful. There are so many curated narratives around having the perfect pregnancy that it can negatively impact self-esteem. Implementing a daily limit on social media usage or not using it at all can be helpful.

Reconnect With Your Values

Reconnecting to your values outside of your appearance can be helpful if that’s accessible to you. This can be hobbies and the communities to belong to, especially if your queer, trans and/or BIPOC. Revisiting your values can help remind you that you are more than your body and that your core self is not defined by your weight.

Find Support

Working with a therapist who specializes in body image and eating disorders can be helpful. Attending support groups are also a great option. The National Eating Disorder Association has free virtual support groups.  

You Are Not Alone

Body grief is a normal part of pregnancy and that’s okay. These feelings don’t make you any less of a parent and don’t mean you’re a bad person. Finding compassion for body image stress and grief can help you weather the storm and sit with the discomfort.  Reaching out for support whether it’s through your friends, family, community or therapist can help you feel less alone in your experience.

Conclusion

Body image stress is common but that doesn’t mean your body is the problem. Diet culture and fatphobia make it hard to find peace with your body during such a vulnerable time. Body image struggles are indicative of a larger issue where there is pressure to feel grateful for pregnancy and be “happy all of the time” with being a parent, erasing the complex struggles that come with pregnancy and parenthood. The pressure to bounce back to your former body is another symptom of the lack of post-partum support for families on a federal level, leaving folks to have to return to work before they are physically and emotionally ready. Eating disorders and body image struggles are a political issue which places the blame on our broke system where it belongs.

Struggling with body image during pregnancy? I offer queer-affirming and weight inclusive therapy to help you navigate body changes — whether you're pregnant, postpartum, or navigating identity changes. Reach out at info@ruberticounseling.com to connect.